International Journal of Infertility & Fetal Medicine

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2011 | May-August | Volume 2 | Issue 2

EDITORIAL

Editorial

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:1] [Pages No:0 - 0]

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

REVIEW ARTICLE

Joe Leigh Simpson, Michael Christopher Hann, Anisha Kshetrapal, Maria I New

Novel Therapies for Treating Short Stature with Congenital Adrenal Hyperplasia

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:6] [Pages No:45 - 50]

PDF  |  DOI: 10.5005/jp-journals-10016-1017  |  Open Access |  How to cite  | 

Abstract

Abbreviations

Congenital adrenal hyperplasia (CAH); Salt wasting (SW-CAH); Non-salt wasting (NSW-CAH); Growth hormone (GH); Gonadotropin releasing hormone analogs (GnRHa); Luteinizing hormone releasing hormone analog (LHRHa); 21-hydroxylase gene (CYP21); 21-hydroxylase pseudogene (CYP21p); Hypothalamic-pituitary-adrenal (HPA); Corticotropin-releasing hormone (CRH); Adrenocorticotropic hormone (ACTH); Bone mineral density (BMD); Standard score (SDS).

REVIEW ARTICLE

Pankaj Talwar

Semen Banking and Cryobiology

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:10] [Pages No:51 - 60]

PDF  |  DOI: 10.5005/jp-journals-10016-1018  |  Open Access |  How to cite  | 

Abstract

Cryo banking of spermatozoa is an essential aspect of fertility preservation. With the advancements in cryobiology and better understanding of cryoprotectants and assisted reproduction, indications for semen banking are expanding. The exponential developments that have occurred over the years in the field of cryopreservation have proved that frozen sperm is as good as fresh sperm in fertilizing oocytes. Semen banking has major role in fertility preservation in cancer patients.

RESEARCH ARTICLE

Bharti Bansal, Rutvij Jay Dalal, P Palshetkar Nandita, D Pai Hrishikesh, Takhtani Manisha, Saxena Nidhi

Metformin throughout Pregnancy in Women with Polycystic Ovary Syndrome: Safety and Advantages

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:4] [Pages No:61 - 64]

PDF  |  DOI: 10.5005/jp-journals-10016-1019  |  Open Access |  How to cite  | 

Abstract

Objective

To study the incidence of spontaneous abortions, congenital malformations, neonatal and maternal hypoglycemia after metformin therapy in pregnancy.

Design

Prospective study.

Setting

Outpatient.

Patient(s)

56 women previously oligomenorrheic, nondiabetic women with polycystic ovarian syndrome, who conceived while on metformin.

Intervention(s)

Metformin 1 to 1.5 gm/day throughout pregnancy.

Main outcome

Incidence of 1st trimester abortions, gestational diabetes, teratogenicity and maternal complications, like gastritis and hypoglycemia.

Results

On metformin, the incidence of 1st trimester abortion was 11% and the incidence of gestational diabetes was 7%, which is much lower than the incidence otherwise cited for PCOS women. No major congenital abnormalities were observed.

Conclusion

Metformin therapy in pregnancy reduces the otherwise high incidence of 1st trimester abortions, and gestational diabetes in PCOS women is tolerated well and is not found to be teratogenic.

RESEARCH ARTICLE

Suseela Vavilala, K Geeta

The 11-13+6 Weeks Scan: Where do We Stand? A 5-year Review at Fernandez Hospital

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:5] [Pages No:65 - 69]

PDF  |  DOI: 10.5005/jp-journals-10016-1020  |  Open Access |  How to cite  | 

Abstract

Objective

To examine the clinical utility of 11-13+6 weeks scan for screening for chromosomal abnormalities and to assess the potential value of the same ultrasound examination in the early diagnosis of fetal structural anomalies.

Design

A prospective interventional study at Fetal Medicine Unit, Fernandez Hospital Pvt Ltd, a tertiary care perinatal center, Hyderabad, India, between September 2005 and March 2010.

Methods

All pregnant women < 13+6 weeks at booking are offered a routine obstetric scan between 11 and 13+6 weeks. All scans are done by obstetricians who are accredited by Fetal Medicine Foundation. All expectant mothers undergoing 11-13+6 weeks scan were included; all expectant mothers with antenatal booking after 14 weeks were excluded from the study.

Results

Between September 2005 and March 2010, a total of 11,012 scans were done between 11 and 13+6 weeks. Complete follow-up was available for 7,916 cases; 1,460 are ongoing pregnancies and 1,636 expectant mothers were lost to follow-up. The median maternal age in our population is 27 years and 340 (4.30%) mothers had advanced (> 35 years) maternal age. The median NT in our population is 1.58 mm. Increased nuchal translucency (NT > 95th percentile) was found in 362 (4.59%) scans. Miscarriages/abortions and termination of pregnancy were significantly higher in women whose fetus had an increased nuchal translucency thickness. Nuchal translucency thickness was significantly higher in women with advanced maternal age (ANOVA F = 0.002, Fishers exact test p-value for equality of medians = 0.04). Absent fetal nasal bones were present in 20 (5.57%) of women with increased NT compared to five (0.07%) women with normal NT. Among 7,916 women, 367 (4.64%) women were screen positive for chromosomal abnormalities. After counseling, only 40 screen-positive women accepted prenatal diagnostic procedures. Skull/brain abnormalities were found in 25 fetal images, abdominal abnormalities in 17, spinal abnormalities in eight, bladder abnormalities in five and cardiac abnormalities in five fetal images.

Conclusion

The 11-13+6 weeks ultrasound scan is an important diagnostic tool that should be offered to all pregnant women as a routine standard of antenatal care in the first trimester of pregnancy in India. However, as a screening tool, it mandates addition of cost-effective biochemical tests. To make the combined screening cost-effective, this study calls for making a national policy for Down's syndrome screening for India.

RESEARCH ARTICLE

Krishna Kavita Ramavath, Srinivasa Murthy Pasumarthy

Postmyomectomy Reproductive Outcome in Women above 35 years

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:5] [Pages No:71 - 75]

PDF  |  DOI: 10.5005/jp-journals-10016-1021  |  Open Access |  How to cite  | 

Abstract

The aim of this retrospective study was to assess the conception rate, reproductive outcome and complications after myomectomy in women aged above 35 years. Myomectomy was performed using abdominal and laparoscopic technique.

Myomectomy was performed in 50 women in this study. By abdominal method in 35 cases (75%) and laparoscopic-assisted method in 15 cases (30%). Overall conception rate is 20% which occurred after one to one and half year postmyomectomy. Multiple regression analysis showed that age was the only factor which influenced the conception rate: < 35 years, 70% (21/30); > 35 years, 20% (10/50; p < 0.005). Risks for spontaneous abortions (8%), pre-eclampsia (10%), preterm labor (4%) and gestational diabetes (10%) are increased.

All cases were delivered by cesarean section. No case of uterine rupture is seen. The retrospective study suggests that myomectomy after 35 years has only a slight increase in the reproductive performance in women presenting with infertility and has a higher risk for preeclampsia, gestational diabetes, preterm labor and NICU admission of the newborns.

RESEARCH ARTICLE

Manasi Venkatraman, Sameer Dikshit, Ketan Gundavda

Analysis of 42 Cases of First Trimester Screening in a Private Set-up

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:4] [Pages No:77 - 80]

PDF  |  DOI: 10.5005/jp-journals-10016-1022  |  Open Access |  How to cite  | 

Abstract

Combined NT and first trimester biochemistry for aneuploidy has become a standard practice. This study was conducted in a busy private clinic. The results of this study showed that this study can be successfully performed in a busy private clinic. The results of the combined screening match those of the conventional screening tests. Proper counseling help the women to take a decision towards invasive testing in screen positive cases.

CASE REPORT

SR Raghuwanshi, ST Shashikala, KA Rao

Repeat Transabdominal Laparoscopic Encerclage

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:4] [Pages No:81 - 84]

PDF  |  DOI: 10.5005/jp-journals-10016-1023  |  Open Access |  How to cite  | 

Abstract

We report here the first case of placement of a repeat laparoscopic abdominal cervicoisthmic cerclage by using a suture passer. The report is on a 34-year-old G5P1L1A3 with a history of repeated second trimester pregnancy loss with one successful laparoscopic cerclage term LSCS delivery, again underwent repeat laparoscopic abdominal encerclage in present pregnancy at 12 weeks using suture passer suprapubically. Patient underwent procedure safely with blood loss less than 40 ml and discharged after 24 hours of observation without any postoperative complication. Repeat laparoscopic abdominal encerclage can be done safely in previous LSCS patient who had term pregnancy following laparoscopic abdominal cerclage using a simple instrument suture passer without any postoperative complication or discomfort to the patient.

CASE REPORT

Rakesh Sinha, Seema Gupta, Pratima Kadam, Meenakshi Sundaram, Nupur Sood, Sharda Adlakha

Laparoscopic Myomectomy for Multiple Submucous Myomas

[Year:2011] [Month:May-August] [Volume:2] [Number:2] [Pages:3] [Pages No:85 - 87]

PDF  |  DOI: 10.5005/jp-journals-10016-1024  |  Open Access |  How to cite  | 

Abstract

We report an interesting case of multiple submucous fibroids which was removed by laparoscopic myomectomy. The patient presented with severe menorrhagia and a large uterus of clinically 24 weeks size. She was 29 years and nulliparous. The ultrasonography showed multiple echoes in the endometrial cavity. We did a diagnostic hysteroscopy and found the uterine cavity studded with multiple fibroids of varying sizes. We did a laparoscopy and removed 64 submucous fibroids laparoscopically. We report this interesting case where we removed the submucous fibroids laparoscopically in a single sitting. This reduces the complications of hysteroscopic myomectomy for such large and multiple submucous fibroids. Medline search did not reveal any report of laparoscopic removal of submucous fibroids.

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