To assess the reduction in fetal loss following transabdominal cervicoisthmic cerclage done for repeated failed vaginal cerclages and/or inaccessible cervices.

An observational study of 113 pregnancies in 90 women after transabdominal cervicoisthmic cerclage from January 1999 to December 2010 at Fernandez Hospital, Hyderabad, Andhra Pradesh, India.

Mean gestational age at the time of elective transabdominal cervicoisthmic cerclage was 11.6 weeks. Patients were delivered by lower segment cesarean section (LSCS) with a mean gestational age of 36 weeks. Live birth rate was 90.5%. Incidence of mid-trimester miscarriages was 8.6% after cerclage compared with 62.9% before cerclage. Before cerclage, only 13.1% pregnancies continued beyond 28 weeks whereas after cerclage, 88.6% crossed the period of viability. Prior to cerclage, preterm delivery rate was 7.0% (as majority of the pregnancies were lost prior to period of clinical viability) and only 13.6% of these preterm babies survived. Although the incidence of preterm deliveries was 23.8% after cerclage, 80% of these preterm babies survived. Excluding first-trimester miscarriages, fetal loss was 93.3% prior to cerclage and 13.7% postcerclage. In effect, the take home baby rate among pregnancies was only 5.8% before cerclage compared with 86.7% after cerclage. Mean birth weight after cerclage was 2.5 kg.

Transabdominal cerclage reduces fetal loss and improves pregnancy outcome in women who had failed vaginal cerclages and in those with inaccessible cervices.

Marakani LR, Dasari S, Gundabattula SR, Joseph E. Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices? Int J Infertility Fetal Med 2013;4(1):1-5.

To assess the effectiveness and safety of fixed dose combination (FDC) of antioxidants in treatment of idiopathic oligoasthenozoospermia.

Placebo-controlled, Double-blind, randomized, Parallel three arm, Multicentric trial.

Fertility clinics of five centers across India.

One hundred and thirty-eight male subjects, aged between 21 and 50 years and subfertile for 1 year or more with the following baseline sperm selection criteria: Concentration <15 million/ml and total sperm motility <40%.

Eligible subjects were randomized to either of the three arms in a double-blind manner, i.e. arm 1 was given 2 tablets twice daily of FDC of antioxidants (coenzyme-Q10: 50 mg, L-carnitine: 500 mg, lycopene: 2.5 mg and zinc: 12.5 mg); arm 2 was given 1 tablet of FDC of antioxidants and one tablet of placebo twice daily and arm 3 was two tablets twice daily of matching placebo all for 180 days.

The primary outcome measures were improvement in sperm count and sperm motility, whereas pregnancy rate was the secondary efficacy outcome.

Compared to placebo, a statistically significant improvement was seen in sperm count (14.8-26.35 in arm 1 and 14.37-24.8 million/ml in arm 2, p < 0.0001), and sperm total motility (39.2-51.6% in arm 1 and 38.4-50.1% in arm 2, p < 0.0001), at 90 days, and treatment further improved these parameters at day 180. No intergroup difference was seen between arm 1 and arm 2. Mild adverse event of upper gastrointestinal discomfort by 8 subjects (three in arm 1; one in arm 2 and four subjects in arm 3) were reported. No serious adverse event was seen in the study.

Exogenous administration of fixed dose combination of antioxidants is a safe and effective therapy in improving the male subfertility.

Gopinath PM, Kalra B, Saxena A, Malik S, Kochhar K, Kalra S, Zaveri H. Fixed Dose Combination Therapy of Antioxidants in Treatment of Idiopathic Oligoasthenozoospermia: Results of a Randomized, Doubleblind, Placebo-controlled Clinical Trial. Int J Infertility Fetal Med 2013;4(1):6-13.

To compare risk factors for extratubal gestations with tubal gestations.

Case control design with retrospective examination of an electronic database to identify ectopic gestations. Ectopic gestations were confirmed through ultrasound examination or serum beta hCG levels. We defined an ectopic gestation as implantation of pregnancy outside uterine cavity; tubal ectopic including implantation in the tube, isthmic, ampullary, or fimbrial and extratubal ectopic including implantation in the ovaries, cervix, abdomen, interstitia or cesarean scar.

Ninety-one (1.1%, 95% CI: 0.9-1.3, 1 in 90 pregnancies) of 8,203 pregnancies during the study period were ectopic gestations including 69 (0.8%, 95% CI: 0.7-1.1, 1 in 120 pregnancies) tubal gestations and 22 (0.3%, 95% CI: 0.2-0.4, 1 in 372 pregnancies) gestations in extratubal locations. Extratubal ectopic gestations were more common in women with advanced maternal age (odds ratio: 7.4, 95% CI: 1.3, 43.9, p = 0.03) compared to women with tubal ectopic gestations.

Risk factors for extratubal gestation did not differ from risk factors for tubal gestations except for advanced maternal age. Pregnant women with advanced maternal age have to be additionally counseled on the increased risk for extratubal gestations.

Pochiraju M, Surampudi K, Marakani LR, Dasari S, Gundabattula SR. A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations. Int J Infertility Fetal Med 2013;4(1):14-17.

Anovulation is a common cause of infertility with poly cystic ovarian disease being the commonest.

To estimate the prevalence of various causes of anovulation in patients younger than 35 years of age attending infertility clinics and to ascertain the nature and extent of metabolic abnormalities and efficacy of therapy.

Sixty cases of anovulatory infertility diagnosed by standard method were recruited for the study. Transvaginal sonography and hormonal profile like LH, FSH, Prolactin and Thyroid profile evaluated to establish the cause of anovulation. Menstrual history, Body Mass Index, Waist Hip ratio and presence of hirsutism, acanthosis nigricans were recorded. Metabolic parameters like lipid profile, OGTT and Glucose insulin ratio were also assessed. All parameters were reevaluated at 3 and 6 months of treatment and were statistically analyzed. Response to treatment in terms ovulation and pregnancy achieved was also analyzed.

Women with anovulatory infertility has shown good improvement to appropriate treatment.

Bhandoria G, Rudra S. Anovulatory Infertility: A Prospective Study. Int J Infertility Fetal Med 2013; 4(1):18-23.

Desai P. Predicting Obstetric Vasculopathies through Study of Diastolic Notch and other Indices of Resistance to Blood Flow in Uterine Artery. Int J Infertility Fetal Med 2013;4(1):24-30.

Kamath MS, Acharya M, Kamath V, Aleyamma TK. Disseminated Intravascular Coagulation after Myomectomy: A Case Report and Review of Literature. Int J Infertility Fetal Med 2013;4(1):31-33.

Govindaraj SK, Muralidhar L, Venkatesh S, Saxena RK. Disorder of Sexual Development with Sex Chromosome Mosaicism 46 XY and 47 XXY. Int J Infertility Fetal Med 2013;4(1):34-37.