International Journal of Infertility & Fetal Medicine

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2023 | January-April | Volume 14 | Issue 1

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Kamini A Rao


[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ijifm-14-1-iv  |  Open Access | 



Rr Ayu Fitri Hapsari, Endah Wulandari

Histological Properties of Male Rats Testicular Organs after Given Jatropha curcas Seed Extract

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:7] [Pages No:1 - 7]

Keywords: Jatropha, Leydig cells, Primary spermatocytes, Seminiferous tubules

   DOI: 10.5005/jp-journals-10016-1307  |  Open Access |  How to cite  | 


Aims and objectives: Jatropha is a medicinal plant that has anti-inflammatory properties. This plant is being developed as a male contraceptive drug, especially for densely populated areas. Jatropha seeds contain a toxic compound in the form of currant. This compound is thought to be able to affect the male reproductive organs by inhibiting sperm production and reproductive hormones. So, this study aims to determine the histological structure of male rat testes after being given Jatropha seed extract. Materials and methods: This research is an experimental design. There were five doses of Jatropha seed extract treatment, which were given every day for 28 days. Each treatment group contained five male rats. Observations were made on the testes with hematoxylin and eosin (HE) staining. Parameters were measured by measuring the length of the diameter of seminiferous tubules, counting Leydig cells and primary spermatocytes. Results: Histological data of testicular organs after being given Jatropha seed extract (doses 0, 5, 25, 50, and 250 mg/kg BW) were obtained—seminiferous tubule diameter 1040, 847, 869, 1005, and 842 μm; the number of Leydig cells is 36, 121, 85, 40, and 63; and primary spermatocyte counts showed 152, 205, 122, 143, and 138 [analysis of variance (ANOVA); p < 0.05]. The seminiferous tubule and Leydig cell counts both positively correlated with primary spermatocytes. Conclusion: Jatropha seed extract has potential in the development of male contraception, as evidenced by the seminiferous tubules as sperm producers having a smaller diameter and a reduced number of primary spermatocytes. The increase in Leydig cells indicates the testosterone hormone is formed, the process of spermatogenesis continues, and continues to influence the male secondary sex characteristics. Research highlights: This study found that there was a narrowing of the seminiferous tubule diameters in the administration of Jatropha seed extract compared to the control group, indicating a change in the structure of the organ. This study found Leydig cells increased compared to the control; this shows testosterone production is not disturbed. Primary spermatocyte cell count decreased compared to control, indicating decreased spermatozoa production. The three research parameters are seminiferous tubule diameter, number of Leydig cells, and primary spermatocytes after being given Jatropha seed extract. This information is expected to be used as a basis for the development of male contraceptive drugs.



Lubna Mukhtar, M Lakshmidevi, B Gowthami

Estimation of Fetal Weight at Term by Clinical Method Using Symphysio Fundal Height and Abdominal Girth and Ultrasound Using Hadlock Formula and Its Correlation with Actual Birth Weight

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:8 - 11]

Keywords: Abdominal girth, Actual birth weight, Fetal weight estimation, Hadlock formula, Symphysio fundal height

   DOI: 10.5005/jp-journals-10016-1305  |  Open Access |  How to cite  | 


In prenatal care, labor management and preparation, particularly when deciding on the mode of delivery, the accuracy of fetal weight predictions is crucial. At both extremes of birth weight, perinatal complications are higher, so it is also necessary to develop conceptual strategies to reduce the rate of unwanted pregnancy outcomes. The purpose of this study was to estimate the fetal weight during term pregnancy using clinical and ultrasonic methods, as well as to correlate the actual birth weight with the estimated weight. Materials and methods: A prospective observational study of all term pregnant women who came for antenatal checkup and patients admitted to the obstetric ward fulfilling the inclusion criteria. The patients were subjected to clinical evaluation and investigations, and data was collected in a predesigned pro forma. All the measurements were routinely documented in the antenatal visit of pregnancy, and the estimated weight was calculated by using the formula abdominal girth (AG) × symphysio fundal height (SFH) and Hadlock method and both were compared with the weight of the fetus after delivery. Results: A total of 500 pregnant women with singleton pregnancies were studied. The average actual birth weight was 2758.19 ± 341.25. The mean weight estimated by AG × SFH was 2862.67 ± 327.37, and that by the Hadlock method was 2902.11 ± 336.35. The p-value of the estimated fetal weight (EFW) by AG × SFH was 0.699, whereas for the Hadlock method, it was 0.669. The average error was 104.50 gm with AG × SFH and 143.9 gm with the Hadlock method. The mean percentage error was 3.8% in AG × SFH and 5.1% by the Hadlock method. The standard deviation (SD) was found to be the smallest with AG × SFH (197.85), followed by ultrasound (USG) (219.61). Correlation analysis showed a significant positive relationship between the weight of the fetus at birth and the estimated birth weight for both methods. Conclusion: From the present study, we conclude that the estimation of fetal weight at term by a clinical method is as accurate as the USG estimation of fetal weight. It can be routinely used at term gestation. It is of more practical use at peripheries where USG machines or trained personnel for doing USG are not available.



Amr El-Helaly, Khaled Moussa, Hassan Morsi, Dalia Abu-Sharia, Jack Hamer, Amr Farag

Ionomycin Oocyte Activation with Teratozoospermic Male Partners in Couples Undergoing Intracytoplasmic Sperm Injection: A Comparative Prospective Study

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:6] [Pages No:12 - 17]

Keywords: Infertility, Intracytoplasmic, Oocyte, Original research, Sperm, Teratozoospermia

   DOI: 10.5005/jp-journals-10016-1304  |  Open Access |  How to cite  | 


Background: Fertilization failure can be defined as the improper transition of the metaphase G1 phases within metaphase II (MII) oocytes. This can be partially attributed to the sperms’ inability to appropriately activate the oocyte. To overcome failed oocyte activation after intracytoplasmic sperm injection (ICSI), many different measures have been previously trialed. Aim: To evaluate the efficacy of artificial oocyte activation (AOA) using ionomycin in improving fertilization and pregnancy rates in ICSI for couples with teratozoospermic male partners. Materials and methods: A total of 114 infertile couples having ICSI, with 100% teratozoospermic male partners, were divided after ovum pick up. Group I included 61 cases that underwent ICSI using surgically retrieved sperms with ionomycin AOA immediately after sperm injection. Group II included 53 cases which underwent ICSI using fresh semen samples, with some oocytes activated from each sample using ionomycin (case group), and the rest were not activated (control group). Embryos were assessed for cleavage and quality 48–72 hours after ICSI and two high-quality embryos were transferred on day 3 or 5 of fertilization. Results: Within all activated and nonactivated samples, the median number of cultured oocytes of each sample was 7 (5–11) vs 4 (3–6), respectively, while the median number of fertilized oocytes was 4 (3–8) vs 3 (2–4), respectively. The median fertilization rate was 72.1 vs 66.7% (p = 0.156). The median number of grade A embryos was 2 (1–3) vs 1 (1–2), respectively. Among group II, grade A embryo production rate was greater within the activated group (40%) as compared to the nonactivated group (33.3%); however, statistical significance was not achieved (p = 0.051). The overall pregnancy rate was 58/114 (50.9%). Conclusion and clinical significance: Ionomycin oocyte activation may help increase fertilization and pregnancy rates; however, in this study, the effect was not clinically significant. Albeit, there may be a favorable effect on early cleavage and grade A embryo production pending further research.



Manisha Gupta, Neelima Agarwal

Evaluation of Pattern of Hysterosalpingography in Infertility Patients

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:18 - 21]

Keywords: Hysterosalpingogram, Infertility, Tubal blockade, Tubal factors, Tubal patency

   DOI: 10.5005/jp-journals-10016-1302  |  Open Access |  How to cite  | 


Aim: Infertility is a major burden for couples in developing nations, accounting for majority of gynecological outpatient consultation. The fallopian tubes are delicate structures, vulnerable to infections and their sequelae. The tubal factors are one of the leading causes of infertility. Fallopian tube patency and morphology of the uterus and cervix are best assessed by hysterosalpingogram (HSG). With this background, we aim to study different patterns of HSG in infertility. Materials and methods: The present study was an observational study conducted over a period of one and a half years. A sample size of 172 patients seeking treatment for infertility and who fulfilled the inclusion criteria were recruited in the study. A routine hysterosalpingography was done to look for patency of the fallopian tubes and to identify uterine and intraluminal tubal abnormalities. Results: The prevalence of infertility reported in the current study was 5.1%. In the present study, abnormal HSG findings were found in 37.2% (n = 64) of subjects. Majority of the patients had unilateral tubal blockade (24.4%) followed by peritubal adhesions (19.7%). Conclusion: This study showed that HSG is an important and cost-effective tool in diagnosing genital tract abnormalities and tubal patency in infertility patients.



Effect of Body Mass Index on Semen Parameters in Subfertile Men

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Body mass index, Semen, Subfertility

   DOI: 10.5005/jp-journals-10016-1299  |  Open Access |  How to cite  | 


Aim: To determine the effect of body mass index (BMI) on semen parameters in men with subfertility. Methodology: The present study was a cross-sectional study conducted from 1st January 2021 to 30th June 2021. All subfertile couples having male factor subfertility attending the subfertility clinic were asked to participate. The weight and height of all men were recorded, and they were asked to submit a semen sample to the reference lab. The results of the semen analysis conducted as part of an initial assessment were compared with the following World Health Organization (WHO) reference values. Results: We included 347 males in the analysis. The mean age of the participant was 31.06 ± 4.89 years, and the mean duration of subfertility was 3.58 ± 1.62 years. Of these, 60.5% had primary subfertility. There were 44.4% of men with normal BMI and 9.8% were underweight. In our study population, 41.5% of men were overweight, and 4.3% were obese. When stratified according to BMI, only motility was significantly affected by BMI (p = 0.044). Conclusion: A high BMI is associated with reduced motility of sperm in semen samples. Obese men are more likely to have abnormal total motile sperm count than men with normal BMI. Larger studies are needed to assess the relationship between semen quality and BMI.



Hoang Minh Lam, Tuyet Thi Vi Le, Ha Le Bao Tran

Intrauterine Infusion of Leukocyte Platelet-rich Plasma Enhances Fertility Outcomes in the Murine Model of Asherman's Syndrome

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Asherman's syndrome, Damaged endometrium, Leukocyte platelet-rich plasma, Mouse model, Tissue regeneration

   DOI: 10.5005/jp-journals-10016-1292  |  Open Access |  How to cite  | 


Background: Platelet-rich plasma (PRP) contains many platelets and growth factors (GFs) that have been proven to promote wound healing, cell proliferation, and migration. The impact of leukocyte platelet-rich plasma (L-PRP) consequence in the murine model of Asherman's syndrome (AS) is considerable. Aim: To evaluate the effect of one dose of L-PRP in the murine model of AS. Materials and methods: Asherman mouse models were conducted by inserting the 25 gauge needle into the uterine horn through the lumen and stabilized for three estrous cycles. L-PRP (20 µL/horn) was injected into the uterine horn through the vagina of mice at the diestrus of the third estrous cycle. The function of the uterine was recorded at the eighth estrous cycle. Statistical analysis: Data were expressed as mean ± standard deviation (SD). Student's t-test and one-way analysis of variance (ANOVA) were performed by GraphPad 8.0. Results: L-PRP solution increases the number of uterine glands, increases the thickness of the endometrium, and expands the area of uterine lumen in the PRP group after one cycle of estrus. Besides that, using the L-PRP solution increased the rate of pregnancy in the mouse. Conclusion: One dose of L-PRP has a positive impact on improving uterine function in the murine model of AS. Clinical significance: This study provides a scientific basis for the potential application of the one dose-L-PRP in the clinical treatment of endometrial damage.



Rubina Izhar, Muhammad Ahmad Tahir, Tahir Ghani, Zubaida Masood

Comparison of Pregnancy Outcomes between Ongoing Pregnancies after Accidental Misoprostol Use and Normal Pregnancies: A Case-control Study

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:7] [Pages No:31 - 37]

Keywords: Abortifacient, Congenital abnormalities, Misoprostol, Unwanted pregnancies

   DOI: 10.5005/jp-journals-10016-1310  |  Open Access |  How to cite  | 


Aim: Literature reports are conflicting regarding the association of anomalies with misoprostol use. We conducted this study to assess the association of misoprostol with congenital abnormalities. Materials and methods: In this prospective case–control study, women with early pregnancy were recruited from the antenatal clinic and divided into cases and controls on the basis of exposure to misoprostol. They attended antenatal visits, delivered at the hospital, and their babies were examined for abnormalities before discharge. Results: There were 22 (9.2%) babies with abnormalities in the misoprostol group and 16 (6.2%) abnormalities in controls (p = 0.208). When stratified according to the type of exposure to misoprostol, abnormalities were significantly higher in those with intended exposure than in accidental exposure (12.3 vs 3.5%, p = 0.023). Misoprostol exposure was not significantly associated with abnormalities. Controls were less likely to have abnormalities than those with misoprostol exposure, but this did not remain significant after all cofounders were added to the model. Conclusion: Exposure to misoprostol leads to more congenital abnormalities. However, chances of having a baby with an abnormality are not significantly increased with misoprostol exposure when all other risk factors are controlled for. These findings may aid clinicians in reassuring low-risk women with accidental exposure in early pregnancy. Clinical significance: Women with accidental exposure to misoprostol are less likely to have congenital abnormalities than those with voluntary exposure because they were found to ingest a lesser amount of the drug.



Padmalatha Dakshnamurthy, Elavarasi Samidurai, Prasanna Karthik, Kannan Rajendran

An Observational Study of COVID-19 Infection in Pregnant Women at a Tertiary Care Center

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Coronavirus disease 2019, First wave, Morbidity, Mortality, Pregnancy complications, Second wave

   DOI: 10.5005/jp-journals-10016-1306  |  Open Access |  How to cite  | 


Background: COVID-19 infection is a disease caused by severe acute respiratory syndrome coronavirus 2. The manifestations, effects, and severity of the infection are varied in different waves, especially during pregnancy. Materials and methods: The study was conducted in two equal time periods during the first and second waves. During the first wave, the period of study was between June and August 2020 corresponding to the peak of the first wave, and in the second wave, the study period was between May and July 2021 corresponding to the peak of the second wave. Results: A total of 3,791 pregnant women was screened for COVID-19 infection during the first wave and second wave, the pregnant mothers with COVID-19 positive were 4.2 (n = 163) and 5.1% (n = 191), respectively. Around 60% were antenatal mothers and 37% were postnatal mothers who were COVID-19-positive. The predominant age group affected was between 20 and 25 years of age. Gestational diabetes mellitus (GDM), gestational hypertension, anemia, previous lower segment cesarean section (LSCS), postdated pregnancy, and past history of infertility were the high-risk factors observed during the study. Hypoxia was observed in 15% of patients in the second wave. About 49.7% (n = 95) of the COVID-19-positive mothers in the second wave required steroids, anticoagulants, and antiviral drugs. Conclusion: The incidence of COVID-19 infection was mild and asymptomatic during the first wave and symptomatic as well as with complications during the second wave. The disease severity, intensive care unit (ICU) admissions, duration of stay, LSCS delivery, and need for antivirals, anticoagulants, and steroids were more during the second wave of COVID-19.



Ashish Bijaykrishna Banerjee, Prerna Jain, Kavita Choudhary, Anita Banerjee

Primary Infertility: A Rural-based Study of Associated Risk Factors in North-west Part of India

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:42 - 46]

Keywords: Primary infertility, Prevalence, Rural, Sociodemographic

   DOI: 10.5005/jp-journals-10016-1298  |  Open Access |  How to cite  | 


Background: The inability to conceive is experienced as a stressful situation and has an impact on multiple dimensions of health for both individual and society. Despite the significant concerns of infertility, estimation of its prevalence is limited. Infertility is seen as a stressful situation and affects many aspects of life for the individual and the community. Despite the remarkable trepidations of not having children, estimation of its prevalence is limited. Objectives: To estimate the prevalence and establish a relationship with sociodemographic factors of primary infertility. Materials and methods: The study was a community-based cross-sectional descriptive study conducted from April to May 2021 in a rural health training center (RHTC) area among 1860 eligible couples aged 18–49 years. A complete enumeration of all the houses was done to list all the eligible couples residing in the area. Data were collected by a face-to-face interview on a house-to-house visit by interns posted in RHTC using a predesignated, pretested semi-structured data collection tool. The data collected were compiled and entered in an MS Excel sheet and analyzed using Statistical Package for the Social Sciences (SPSS) program version 23 (SPSS Inc., New York, USA). Categorical variables were expressed in actual numbers and percentages. Categorical variables were compared using Pearson's Chi-square. Result: The overall prevalence of primary infertility in our study was found to be 7.25%. The percentage of women with primary infertility increased with higher age-groups. Sociodemographic factors which had a statistically significant association with primary infertility were age at marriage (p < 0.01), religion (p < 0.01), literacy (p < 0.03), occupation (p < 0.01), socioeconomic status (p < 0.001), family history of infertility (p < 0.02), and addiction (p < 0.03). Physiological factors that had a statistically significant association with infertility were body mass index (BMI) (p < 0.001), age of menarche (p < 0.03), and menstrual pattern (p < 0.01). Conclusion: The findings of this study can benefit healthcare providers and policymakers in providing enhanced reproductive services to the rural population.



Toyaja Mohan Jadhav, Sushil Garud

Incidentally Detected Allantoic Duct Cyst of Umbilical Cord: A Case Report

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:47 - 50]

Keywords: Allantoic duct cyst, Allantoic duct remnant, Favorable fetal outcome, Umbilical cord accidents

   DOI: 10.5005/jp-journals-10016-1301  |  Open Access |  How to cite  | 


Aim: To present an uncommon case of allantoic duct cyst of the umbilical cord (UC), detected incidentally during the histopathological evaluation of the placenta sent for evaluation of suspected chorioamnionitis in a case of antenatal care (ANC) with post datism and leaking P/V with meconium-stained liquor, who underwent emergency lower segment cesarean section (LSCS) and had an uneventful fetal outcome. Background: Allantoic duct cysts of the UC are the embryological remnants of either the allantois or the omphalomesenteric duct and represent true cysts of the UC. They are uncommon and have a reported incidence of less than 1%. Most often, they are associated with additional fetal abnormalities and unfavorable fetal outcome. Isolated UC cysts resulting in an uneventful fetal outcome are rare. We present one such case of an incidentally detected UC cyst with no associated fetal abnormalities resulting in a favorable outcome. Case description: Allantoic duct cyst of UC detected incidentally during the histopathological evaluation of the placenta sent for evaluation of suspected chorioamnionitis in a 24-year-old case of ANC with post datism and leaking P/V with meconium-stained liquor, who underwent emergency LSCS and had an uneventful fetal outcome. Conclusion: Embryonic remnants of the UC, when persistent, may present as UC cysts, which can be diagnosed during pregnancy with careful routine ultrasonography examination. Most UC cysts are associated with fetal anomalies, and it is uncommon to have an isolated UC cyst with a normal fetal outcome. Clinical significance: UC cysts, when noted, always necessitate a complete postnatal clinical and histopathological examination of the neonate as well as the placenta along with karyotyping to rule out the presence of structural and/or chromosomal abnormalities associated with these cysts. This case has been reported to increase the awareness as well as the number of cases of true UC cysts in literature, and to promote research regarding the association of such cysts with placental abnormalities, including chronic placental insufficiency.



Maria Jana Kingsley-Godwin, Angel G Tenev, Tanya T Kitova, Ekaterina H Uchikova, Maria C Koleva, Penka P Stefanova

A Rare Massive Congenital Cervical Lymphangioma: Case Report with Systematic Review of the Literature

[Year:2023] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:51 - 54]

Keywords: Cystic hygromas, Lymphangioma, Massive, MRI, Prenatal ultrasonography, Surgery

   DOI: 10.5005/jp-journals-10016-1303  |  Open Access |  How to cite  | 


Aim and background: Lymphangiomas are congenital anomalies of the lymphatic system consisting of benign cystic masses of enlarged lymphatic vessels sequestered from the lymphatic circulation and may appear at any site and age. Diagnosis predominantly occurs at birth with 95% located in the cervical, axillary, and head regions. Occasionally, lymphangiomas produce symptoms in neonates by exerting pressure on surrounding tissues, as seen in large masses in the mediastinum and neck regions, as well as infective or hemorrhagic complications. The purpose of this article is to evaluate the clinical presentation and advances in the management of lymphangiomas and to present a case of massive cervical lymphangioma discovered antenatally on the 30th gestational week. Case description: We present a case of a 27-year-old pregnant woman gravida 2, para 1, taking folic acid up to the 9th gestational week. Her brother was born with Down syndrome and died 9 months after birth. On prenatal sonographic examination on the 22nd gestational week, no fetal abnormalities were found. On prenatal ultrasonography at the 30th gestational week, a tumor formation originating from the fetal neck and polyhydramnios were discovered. Following various investigations including prenatal MRI, the diagnosis of massive cervical lymphangioma (cystic hygroma) was made. A male neonate was delivered by cesarean section by the 41st gestational week and is continuously surgically managed by pediatric surgeons and other specialists. Conclusion: Massive lymphangiomas are complicated tumors, which pose management difficulties. They can be effectively managed by staged surgical intervention and multi-professional healthcare teams including surgeons, pediatricians, primary healthcare clinicians, dermatologists. Clinical significance: The case is rare and interesting due to the tumor's massive size and resulting compressive symptoms. Continuous surgical treatment and multidisciplinary management approach were applied, improving the prognosis for the child. This will serve as an education/encouragement for healthcare teams.


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