International Journal of Infertility & Fetal Medicine

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2011 | January-April | Volume 2 | Issue 1

EDITORIAL

Editorial

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/ijifm-2-1-v  |  Open Access |  How to cite  | 

REVIEW ARTICLE

Yoel Shufaro, Joseph G Schenker

Implantation Failure, Etiology, Diagnosis and Treatment

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:7] [Pages No:1 - 7]

PDF  |  DOI: 10.5005/jp-journals-10016-1009  |  Open Access |  How to cite  | 

Abstract

Embryonic implantation is a complex interaction between the embryo and the endometrium. Despite great investigative effort this process is still obscure. Contrary to the great advancement in patient care, follicular recruitment, oocyte quality and aspiration, embryo quality, culture and cryopreservation, our understanding of the implantation process did not enhance as much, and the tools to intervene within this process are limited. The implantation of the transferred embryos still remains the major limiting factor in IVF. Here we will review the current literature on the maternal (uterine, hematologic, immunologic and others) and embryonic factors that are associated with repeated implantation failure (RIF) and describe the various therapeutic approaches to cope with them. In addition, we will present our conclusive recommendations on how to investigate and manage RIF based on the literature and our own experience.

REVIEW ARTICLE

Usha Ahluwalia, Mala Arora

Posthumous Reproduction and Its Legal Perspective

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:6] [Pages No:9 - 14]

PDF  |  DOI: 10.5005/jp-journals-10016-1010  |  Open Access |  How to cite  | 

Abstract

Assisted reproductive techniques allow us to use donated and cryopreserved gametes posthumously. This can pose legal issues, such as legitimacy of the child born, inheritance rights of the child, and life long psychosocial implications. The law in different countries takes a varied stand on it. Posthumous use of gametes must abide by the law of the land. A valid consent of the deceased is required. Mourning period of at least one year should be allowed prior to embarking on ART procedures on the surviving partner. The law regarding legitimacy of the child born after death or divorce of a spouse needs amendment. The psychological development of these children needs to be studied by long-term studies.

REVIEW ARTICLE

Igal Wolman, Arnon Agmon, J Ariel

Diagnosis and Management of Short Cervix in Singleton Pregnancies

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:15 - 18]

PDF  |  DOI: 10.5005/jp-journals-10016-1011  |  Open Access |  How to cite  | 

Abstract

Prevention of preterm labor will reduce perinatal mortality. Screening of cervical length by ultrasound should begin at 16 weeks by transvaginal ultrasound. If the cervical length is more than 35 mm, the exam should be repeated every 2 to 3 weeks till 32 weeks. If the cervical length is between 25 and 35 mm the ultrasound screening should be done weekly or biweekly. Fetal fibronectin estimation should provide supplemental information. If the cervical length is less than 25 mm cervical cerclage should be performed if gestational age is less than 22 weeks. Progesterone therapy is preferred if the gestational age is more than 22 completed weeks.

RESEARCH ARTICLE

Rutvij Jay Dalal, Nandita P Palshetkar

Role of Hysteroscopy Prior to Assisted Reproductive Techniques in Patients with Previous IVF Failure

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:19 - 22]

PDF  |  DOI: 10.5005/jp-journals-10016-1012  |  Open Access |  How to cite  | 

Abstract

Background

There have been numerous advances in the area of assisted reproduction. Among the various reasons of implantation failure, intrauterine lesions play an important role.

Objective

The aim of the present study is to evaluate the role of hysteroscopy prior to any assisted reproductive technique in patients who had previous one or more failed IVF cycle(s).

Materials and methods

It is a retrospective study of 248 women who attended our infertility clinic over a period of 18 months, who had a variable number of failed IVF cycles previously.

Results

Out of the 248 women studied, in 62 (25%) patients, intrauterine pathology was detected, which when rectified by hysteroscopy gave a considerable increase in pregnancy rate.

Conclusion

According to this study it can be concluded that evaluating the uterine cavity is an important step before any assisted reproductive procedure.

RESEARCH ARTICLE

Madhuri Patil, Rashmi P Hagargi

Endometrioma and ART: Does the Needle Work?

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:9] [Pages No:23 - 31]

PDF  |  DOI: 10.5005/jp-journals-10016-1013  |  Open Access |  How to cite  | 

Abstract

Aim and Objectives

The aim of this study was to see if the fertility outcome improved when IVF/ICSI was done after administration of GnRH analogs and cyst aspiration in comparison with patients in whom either only cyst aspiration or only GnRh analogs were administered.

Materials and methods

This was a prospective study done in a tertiary level ART center which included 30 patients over a span of 5 years from 2004 to 2009. All of them had endometriomas and underwent assisted reproductive techniques (ART) either after cyst aspiration with or without GnRH analog pretreatment or only GnRH analog pretreatment.

Depending on the pretreatment received, they were classified into three groups:

• Group B: Both GnRH analog and cyst aspiration

• Group C: Only cyst aspiration

• Group G: Only GnRH analog.

The patients were not randomized.

The number of days required for stimulation, total dose of stimulation required, number of oocytes obtained, quality of embryos, and the pregnancy rates for each group were tabulated for comparison.

Statistical analysis

The significance of the difference in ART outcome after the different modalities of pretreatment, which was estimated in terms of pregnancy rates was evaluated by calculating the p-value.

Observations and results

Significant difference was observed between the pregnancy rates in the three groups, with the maximum pregnancy rate in group B, followed by the group G and then the group C. The p-value showed a trend, though not statistically significant, indicating the need for larger prospective studies with greater number of subjects.

Conclusion

Pretreating endometriomas by aspirating the cysts and administering three doses of GnRH analog depot preparation prior to IVF/ICSI seems to be better than administering GnRH analog depot preparation alone or aspirating the cysts alone in terms of the number of days required for stimulation, the number of oocytes obtained, and the clinical pregnancy rates.

RESEARCH ARTICLE

Zakia Firdous, Nuzhat Aziz

Internal IIiac Artery Occlusion Balloon Catheters to Minimize Blood Loss in Adherent Placenta: A Retrospective Cohort Study

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:33 - 36]

PDF  |  DOI: 10.5005/jp-journals-10016-1014  |  Open Access |  How to cite  | 

Abstract

Methods

Adherent placenta cases were identified using hospital database over a 9 years period from 2001 to 2009 at Fernandez hospital, a tertiary perinatal center with 5000 deliveries annually. Mothers who had preoperative internal iliac artery balloon placements were compared with those who did not have. Maternal morbidity was assessed in the form of intraoperative blood loss, total units of blood products transfused, mean operative time, length of postoperative hospital stay, use of adjuvant procedures (for control of hemorrhage), adjacent organ damage, cardiac arrest, and maternal mortality.

Results

Forty-one subjects with a diagnosis of adherent placenta were identified out of 32,354 deliveries (incidence of 1:789) and 27 of these had peripartum hysterectomy. Six had preoperative internal iliac artery balloons placement before hysterectomy (study group) and 21 had hysterectomy alone (control group). Significant difference was found in mean amount of blood loss (p = 0.002) and in mean number of blood products given (p = 0.04). No statistically significant difference was found in mean operative time and length of postoperative hospital stay. There were four subjects who had adjacent organ damage, two had cardiac arrest, two required recombinant factor VIIa in the control group when compared with none in the study group.

Conclusion

Preoperative placement of internal iliac artery occlusion balloon catheters reduced morbidity by minimizing blood loss and adjacent organ damage.

CASE REPORT

Meenakshi Bharath, Nivedita Shetty, T Shashikala, Harpreet Kaur

Ovarian Ectopic Pregnancy Following Assisted Reproductive Techniques: A Rare Entity

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:37 - 39]

PDF  |  DOI: 10.5005/jp-journals-10016-1015  |  Open Access |  How to cite  | 

Abstract

Ovarian ectopic pregnancy should be kept in mind as a rare possibility following assisted reproductive techniques. Although early use of quantitative serum â-hCG and pelvic ultrasonography has increased our diagnostic capability for ectopic pregnancy, ovarian pregnancy still represents a diagnostic problem. Laparoscopy is the gold standard for diagnosis and treatment for ovarian ectopic pregnancy.

CASE REPORT

Yeshita V Pujar, Bhavana Y Sherigar, Shobhana Patted, BR Desai, Jayashree Ruge

Unsuspected Acquired Hemophilia in a Patient with Severe Postpartum Hemorrhage

[Year:2011] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:41 - 43]

PDF  |  DOI: 10.5005/jp-journals-10016-1016  |  Open Access |  How to cite  | 

Abstract

A 24-year-old healthy multigravid patient developed postpartum hemorrhage 3 days post normal delivery. She underwent curettage × 3 followed by laparotomy and hysterectomy. Postoperatively she developed a subrectus hematoma that required laparotomy and drainage. Persistent bleeding per vaginum prompted a third laparotomy for internal iliac ligation, which could not be carried out due to massive retroperitoneal hematoma. She received multiple transfusions of blood and blood products. Her APTT was prolonged but DIC screen was negative. Prolonged APTT was not corrected by addition of normal plasma. This pointed to autoantibodies to factor VIII. She responded to immunosuppression with prednisolone and cyclophosphamide.

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