Background: Cigarette smoking is the leading source of oxidative species of free radicals, which causes an imbalance in the sperm's homeostatic state during spermatogenesis. Telomere length is influenced by a variety of factors, including oxidative stress, obesity, infection, telomere uncapping, and autoimmune disorders. Materials and methods: The study participants were divided into two groups—fertile nonsmokers (n = 85), who served as the control group, and infertile smokers (n = 85). The subjects chosen ranged in age from 26 to 39 years. After 48–72 hours of sexual abstinence by masturbation, semen samples were collected from each subject and allowed to stand at room temperature for 30 minutes for liquefaction. Following liquefaction, the samples were subjected to automated computer-assisted sperm analysis (CASA) to assess the quality of the sperm in accordance with World Health Organization (WHO) guidelines from 2010. The morphological characteristics and velocity parameters were evaluated using CASA, just like the major semen characteristics. Results: The relative and absolute telomere length of sperm telomere loss was significantly affected by smoke toxicants in infertile subjects. Meanwhile, elevated 8-hydroxy-2’-deoxyguanosine (8-OhdG)/dG and reactive oxygen species (ROS) levels in infertile smokers were negatively correlated with absolute telomere length, and sperm morphology was directly related to damaged or telomere-shortened sperm. Furthermore, halo sperm acrosome status with reduced live sperm cells was discovered in infertile smokers. Conclusion: Finally, our findings show that smoke toxicants directly or indirectly affect sperm cells by increasing oxidative species (ROS) and that sperm maturation, spermatogenesis, and sperm telomere shortening are all significant issues when sperm cells are subjected to oxidative stress, which causes deoxyribonucleic acid (DNA) integrity to be compromised. Clinical significance: Male infertility, increased ROS, abortion, chromosomal abnormalities, defective sperm, and as a smoke toxicant apart from cancer, it also causes infertility in males.

Aim: Robotic myomectomy (RM) is a newer modality of minimally invasive surgery. As compared to laparoscopic myomectomy (LM), there is greater ease, accessibility, and precision for surgeons and fewer intra and postoperative (post-op) complications. This study aims at evaluating and comparing the short-term surgical outcomes of RM and LM. Materials and methods: A retrospective observational study was conducted from September 2016 to August 2019. A total of 35 study participants, 14 cases who underwent LM and 21 cases who underwent RM, were included. Variables like size and number of myomas, intraoperative blood loss, operating time, short-term surgical outcomes such as duration of hospital stay, need for blood transfusion, and complications were noted and analyzed. The mean of the two groups was compared using a two-sample unpaired t-test, and a p-value of <0.05 was considered statistically significant. Result: The mean age of study participants who underwent LM was 33.7 ± 5.5 years, and for RM was 32.3 ± 5.6 years. The mean surgical or operating time was 184.6 ± 9.2 and 300 ± 14.1 minutes in LM and RM, respectively. The estimated blood loss was 395.7 ± 78 mL and 255 ± 123.5 mL in LM and RM, respectively, which was statistically significant. The number of days of hospital stay postsurgery were 3.9 ± 1.1 and 2.2 ± 1.4 days in LM and RM, respectively, which was statistically significant. The average size of myoma in LM was 6.3 ± 1.2 cm, whereas in RM was 9.2 ± 1.3 cm. Conclusion: Removal of bigger, multiple fibroids, and myomas at difficult locations was made easier with less blood loss by RM when compared to LM. Short-term surgical outcomes were better in RM as compared to LM. Clinical significance: Robotic myomectomy (RM) has been shown to reduce immediate post-op complications and helps in faster recovery and discharge from the hospital as compared to LM.

Objective: To study the effect of double cryopreservation on the potentiality of the blastocyst in terms of implantation, pregnancy, and perinatal outcomes. Methods: This study was designed with retrospective data from September 2016 to August 2021 where 39 patients (60 embryos) attempting recryopreserved blastocyst transfer. Endometrial preparation was done solely by hormone replacement therapy (HRT), and any other forms of endometrial preparations were excluded. Results: Our study found that the implantation rate was 88% and the pregnancy rate was 43.5%, overall wherein 64% were singleton pregnancy rate and 23% were twin pregnancy rate. Perinatal outcomes revealed gestational age, birth weight, and number of ventilation days of the neonates. Conclusion: Our study concluded that it is advisable to do recryopreservation and embryo transfer (ET) in optimal conditions rather than to waste the embryos by transferring them under trivial conditions.

Background: Chronic endometritis (CE) is a continuous and subtle inflammation of the endometrium caused by bacterial pathogens. It is associated with infertility and poor reproductive outcomes and presents with nonspecific symptoms, making the diagnosis difficult. The gold standard diagnostic criterion is histopathological examination (HPE) and cluster of differentiation (CD) 138 immunohistochemistry (IHC) of endometrial tissue, which is a marker of plasma cells. The effect of antibiotic treatment on reproductive outcomes in Indian infertile women with CE undergoing assisted reproductive technology (ART) has not been extensively studied. Aim: To investigate the influence of oral antibiotic treatment on reproductive outcomes in women with CE undergoing ART. Settings and design: Prospective cohort study at a tertiary care teaching hospital. Materials and methods: A total of 234 infertile women planned for ART underwent endometrial biopsy in the proliferative phase. They were divided into CE-negative (group I) and CE-positive group (group II) based on endometrial biopsy HPE and CD138 IHC. Women in group II received oral antibiotic therapy, and a repeat biopsy was done to assess the cure rate. If CE persisted, they received a second course of antibiotic therapy. They had undergone intracytoplasmic sperm injection (ICSI), and embryo transfer was done where at least one good-grade embryo was transferred. The baseline characteristics and ART outcomes were compared among the two groups. Statistical analysis: Statistical Package for the Social Sciences (SPSS) 29.0 version, Chi-squared test, one-way analysis of variance (ANOVA), and independent sample t-test. Results: The baseline characteristics, controlled ovarian stimulation cycle characteristics, and cycle outcomes were comparable among the two groups. No significant difference in cumulative pregnancy rate (p = 0.95), cumulative miscarriage rate (p = 0.21), ongoing pregnancy rate (p = 0.52), and cumulative live birth rate (p = 0.69) was noted between the two groups. Conclusion: Evaluation and treatment of infertile women undergoing ART for CE is an effective option to improve reproductive outcomes. Clinical significance: To improve reproductive outcomes in ART, routine screening and timely oral antibiotic treatment for CE is a feasible choice.

Background: The cervix and the changes it undergoes in pregnancy play an important role in the initiation and progress of labor. Materials and methods: The period of study was from January to December 2022 for a period of one year. A total of 370 low-risk primigravid antenatal mothers were included in the study. Cervical length was measured transvaginally at 37 weeks. Results and analysis: The average length of the cervix ranged from 1 to 5 cm. The cervical length was <3 cm in 48.3% of patients and >3 cm in 51.7% of patients. Among the 370 primigravid mothers, 248 were delivered by labor natural (67%), 97 by lower segment cesarean section (LSCS) (26.2%), and 25 by instrumental delivery (3.8%). Patients with a cervical length of <3 cm had a shorter duration of labor when compared to patients with a cervical length of >3 cm. The need for induction and the induction delivery interval was less in patients with shorter cervical length. Conclusion: Ultrasonography (USG) is one of the key investigations in antenatal care. Transvaginal cervical length measurement is a useful tool to predict favorable outcomes in labor induction and the progress of labor. Hence routine measurement of transvaginal cervical length in all the antenatal mothers will help the treating obstetrician in planning the management of delivery.

Background, aims, and objectives: Clomiphene citrate (CC) resistance remains one of the unsolved problems facing gynecologists during the stimulation of ovulation in polycystic ovarian syndrome (PCOS). This study was conducted to study the effect of coenzyme Q1O (Co-Q10) in reverting CC resistance in PCOS patients in improving ovulation and pregnancy rates. Materials and methods: This cohort study involved 50 CC-resistant PCOS infertile patients. This study was conducted at Tanta and Benha Universities in the period from 1^st May 2019 to 30^th April 2021. All PCOS resistant to CC received initial pretreatment with CO-Q10 capsules in a dose of 100 mg twice daily after meals for 3 months. Induction of ovulation started after the initial pretreatment using CC in a dose of 150 mg twice daily for 5 days starting at day 3 in each cycle. At the same time, Co-Q10 supplementations were used as an adjuvant with CC for 5 days. Results: The mean age of our patients was 27.46 ± 2.91 years, the mean BMI was 26.40 ± 2.67, and infertility duration was 3.92 ± 1.16 years. About 64% were overweight and obese and 36% were normal weight with BMI. Most cases (64%) had positive family history of infertility due to PCOS. After Co-Q10 supplementation, the serum estradiol was 171.66 ± 56.79 pg/mL, midluteal progesterone was 9.09 ± 1.79 pg/mL. Ovulation was present in 56%, representing significant improvement after use of Co-Q10. In addition, the rate of pregnancy was 28% and ongoing pregnancy rate was 16%. Conclusion: Coenzyme Q10 (Co-Q10) pretreatment before induction of ovulation in CC-resistant PCOS improved ovulation and pregnancy rates. Ongoing pregnancy rates were improved after Co-Q10 supplementation in CC-resistant women. Clinical significance: Co-Q10 could decrease CC resistance in most cases with improved ovulation and pregnancy rates. CO-Q10 could be an option for patient before shifting to second-line therapy.

Aim: This case report shows the rare occurrence of ovarian torsion prior to oocyte pick. Clinical acumen and timely diagnosis could save the ovary for future fertility and health. Background: Ovarian torsion is an acute surgical emergency and is commonly encountered in ovarian cysts larger than 5 cm and in polycystic ovaries and also hyperstimulated ovaries postoocyte pick up and in ovarian hyperstimulation syndrome (OHSS). Case description: A 34 years woman stimulated for in vitro fertilization (IVF) under the standard flexible gonadotropin-releasing hormone (GnRH) antagonist protocol presented on the 8th day of stimulation with slow insidious onset gradually increasing squeezing pain in the right iliac fossa and lumbar area. Clinical examination and investigations by Doppler ultrasound (USG) revealed a diagnosis of right ovarian torsion. She successfully underwent a laparoscopic detorsion and fixation of the ovary following which she underwent a subsequent oocyte retrieval 36 hours after trigger. All oocytes were obtained from the normal left ovary. None of the follicles from the torted right ovary revealed any oocytes. Conclusion: She underwent frozen blastocyst embryo transfer which led to a successful pregnancy. Clinical significance: Ovarian torsion is an acute surgical emergency that if not tackled could be life-threatening. The stimulation cycle could proceed further after detorsion of the ovary and the cycle could be continued with mature good quality oocytes although obtained from the contralateral ovary. The cycle was salvaged which resulted in organ salvage, significant time gain, and prevention of cycle cancellation costs. In an era of minimalistic surgery, laparoscopic de torsion and cycle and organ salvage could be an answer to ovarian torsion cases with preserved blood supply.

Aim: To describe the adverse fetal outcome at term due to discontinuation of clopidogrel before delivery in woman with coronary artery disease who was on dual antiplatelet therapy (DAPT) for 5 years. Background: Acute myocardial infarction (MI) during pregnancy is reported more often than pregnancy outcomes in woman with coronary artery disease (CAD). The recommendation regarding the mode of delivery in women with preexisting CAD is not uniform, and the role of continuing DAPT before delivery is a matter of debate in the literature. Case description: A 38-year-old primigravida with a history of CAD for 5 years was hospitalized at 37 weeks for safe confinement. She was a tailor by occupation and was diagnosed with CAD 5 years ago, for which she underwent primary percutaneous transluminal angioplasty with an everolimus-eluting stent of the left anterior descending (LAD) artery. She has been taking tablet (Tab) aspirin, Tab clopidogrel, β-blockers, and statins since then. She was married for 20 years and was investigated for primary infertility. Her cycles were irregular, and she was diagnosed with polycystic ovary syndrome (PCOS), treated with oral ovulogens without success, and stopped further fertility treatment when diagnosed with CAD. She recognized herself as pregnant only at 32 weeks. She was scheduled to be delivered by elective cesarean section (CS) at 38 weeks. The cardiologist and the anesthesiologist advised her to stop clopidogrel 1 week before CS. She suffered from sudden intrauterine fetal demise (IUFD) the day before the scheduled CS and went into labor. She was delivered by emergency cesarean, and the stillborn baby weighed 3.4 kg. Conclusion: Discontinuing DAPT in pregnant women with CAD may lead to IUFD. Clinical significance: Continuing DAPT from pregnancy till delivery or substituting with heparin to prevent thrombosis is essential, possibly preventing sudden intrauterine death. The benefits should be weighed against the risk of bleeding when such therapy is stopped.

Aim: Diprosopus is the rarest form of conjoined twinning, and hence this case is evaluated in detail with multimodality imaging both antenatally and postnatally. Background: Diprosopus is a Greek word meaning “two faces.” It is also known as craniofacial duplication. These patients will have two faces with a single thorax and abdominopelvic cavity. The number of limbs may vary from 4 to 7. They are frequently associated with other congenital anomalies of the central nervous, gastrointestinal, cardiovascular, and respiratory systems. Case description: We are presenting a case of 26-year-old primi conceived by intracytoplasmic sperm injection (ICSI). Targeted imaging for fetal anomalies (TIFFA) scan showed complete duplication of facial structures, cerebral hemispheres, the thalami and midbrain, and a large posterior fossa. Other associated anomalies included a hypoplastic left heart with a double outlet right ventricle, a congenital diaphragmatic hernia on the left side, and a duplicated gall bladder. The fetus had a single trunk and abdomen with two upper limbs and two lower limbs. Prenatal fetal magnetic resonance imaging (MRI) confirmed the findings. The poor prognosis was explained to the parents and they decided on medical termination of pregnancy. Postnatal fetal examination and multimodality imaging [X-ray, ultrasonography (USG), and computed tomography (CT)] were performed which correlated with the antenatal diagnosis and helped to understand and delineate the anatomy better. Conclusion: Detailed prenatal USG imaging helps in identifying most of the anomalies which can be confirmed by fetal MRI. Postnatal CT with the three-dimensional (3D) reconstruction aids in definite diagnosis in selected patients. Clinical significance: A high index of suspicion is required to diagnose diprosopus in an anomaly scan. Since it is associated with multiple anomalies of other systems, the radiologist/sonologist should thoroughly search for the same. The supplementary use of fetal MRI helps to confirm the diagnosis. Postnatal CT with 3D reconstruction aids in better comprehension of the anomalies.

Aim and background: The global incidence of cancer is on the rise and with the advancement of cancer care, the survival of cancer patients has also improved. Addressing the fertility needs of survivors is also of paramount importance to improving their quality of life. Case description: We present a case of a young lady with osteosarcoma who was referred to our center for fertility preservation and controlled ovarian stimulation (COS) was done using the antagonist protocol, followed by in vitro fertilization and embryo cryopreservation for future use. Conclusion: Embryo cryopreservation in cancer patients is a well-established method of fertility preservation. In regards to oncofertility, evidence supports a multidisciplinary approach, early referral to a fertility specialist, and individualized discussion on options for fertility preservation without compromising the cancer treatment. Clinical significance: This case highlights the need to include discussions on fertility preservation in oncology patients by the primary care providers and the options available for the patients.