Suresh KP, Gajendragad MR, Rahman H. Design and Analysis of Observational Studies. Int J Infertil Fetal Med 2014;5(2):33-39.

A case control study evaluating pregnancy outcomes post embryo reduction. Study takes into account all patients with successful day three embryo transfers resulting in multifetal pregnancy. First trimester embryo reduction was carried out by intracardiac injection of KCl.

A total of 26 multifetal pregnancies were reduced to twins at early gestational age (7-9 weeks). Two cases (7.6%) of miscarriage, no cases of chorioamnionitis and five cases (19.2%) of transient spotting were recorded as postoperative complications. There was no vanishing of embryos in those reduced to twins. A total of 24 patients (92.3%) with twin pregnancies took home at least one baby, while 18 (69.23%) of these took both babies home. This was analyzed and compared with a control group of women with nonreduced twins pregnancies.

The preterm delivery rate (defined as fetuses delivered before 37 weeks) in twin pregnancies was 53.8% (n = 14), with a severe preterm rate (defined as fetuses delivered before 32 weeks) of 23.07% (n = 6). One case (1.92%) of stillbirth occurred. The perinatal mortality rate was 13.46% (n = 6 newborns, and a 33-week stillbirth), mainly due to severe preterm labor. The latter group included no registered cases of newborns with congenital malformations. A total of 24 patients (92.3%) with twin pregnancies took home at least one baby, while 18 (69.23%) of these took both babies home.

In two of the 26 multifetal pregnancies reduced to twins there was miscarriage of both fetuses before 24 weeks of gestation the median interval between reduction and multifetal loss was 5 weeks.

In pregnancy reduced to twins as compared to nonreduced twins the percentage of miscarriage was slightly higher, but not statistically significant (7.6% compared to 6.9%, 0.07 × 2, P 0.8). The median gestation at delivery was lower (33.3 ± 9.2 compared to 35.67 ± 5.84 weeks, 2.26 > 2.0 t, 0.05 P) and the median weight deficit was greater (1.58 ± 0.96 compared to 1.92 ± 0.89 (4.04 > 3.37 t, 0.001 P).

Shewale AR, Shewale B. Preterm Delivery and Growth Restriction in Multifetal Pregnancies reduced to Twins: Case-Control Series. Int J Infertil Fetal Med 2014;5(2):40-43.

About 15% of all couples are infertile and require fertility treatment. With constantly improving clinical and laboratory procedures, pregnancy rates of about 30% per transfer are routinely reported. In non-donor-oocyte cycles, the percentage of in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI) cycles that result in pregnancy ranges from 18 to 45%, depending on several factors (Society for Assisted Reproductive Technology 2009). But a patients concern is about the success rate—‘What is my chance of getting pregnant’? For the success in IVF/ICSI—embryo transfer cycle there are many variables thought to be directly related to the implantation and successful outcome.

To identify independent predictors ICSI outcome.

The research was approved by the institutional review board. A retrospective ongoing study was performed, over a period of 3 years at a well established infertility institution. A sample size of 1020 patients was considered from two hospitals of the same institution. The patients were stimulated by different protocols specific to each patients age, AFC, etc [Polycystic ovarian syndrome (PCOS) patients showing hyperresponse in follicular study-antagonist protocol]; though a majority underwent long agonist protocol. They were evaluated and the outcome was assessed through logistic regression analysis. Several variables were taken into consideration—to name a few; age, previous pregnancy outcome, previous ART treatment if any, E2/LH/P4 [baseline values and on the day of human chorionic gonadotropin (hCG)], etc. A preferential scoring was derived to obtain a predictive scoring for pregnancy outcome.

A pregnancy predicting scoring was arrived at. On considering several variables, the cut off score represented a 50% success rate of IVF/ICSI cycle.

Bearing in mind that fertility is independent of hospital protocols and primarily dependent on the individual woman, the derived predictive scoring can be applied to individual cohort of patients under infertility treatment and has excellent discrimination ability for assessing the likelihood of pregnancy outcome. Application of this scoring will allow individualized treatment decision-making for patients under infertility treatment.

Gracias RH, Thalakottoor LF, Gopinath P, Karunakaran GK. Fertility Scoring Index: Cimar's Novel System to Predict Assisted Reproductive Technology Success. Int J Infertil Fetal Med 2014;5(2):44-57.

Various prognostic factors in assisted reproduction procedures have been described and analyzed which includes woman's age, cause of infertility, ovarian response and uterine receptivity, the semen quality, and the body mass index (BMI). Optimal BMI is required for an optimal response. There is controversy among various reports, which is partly caused by the varying focus of investigators and differences in study designs, which led us to examine the relationship between BMI, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcome in our unit.

To study impact of BMI on IVF outcome prospectively

It is a prospective study over a period of 1 year in the age group 25 to 35 years attending the IVF clinic was conducted at a tertiary infertility center in Bangalore, India between November 2010 and October 2011.

There is a close association of increased BMl in particular when BMl is > 30 kg/m² and the reduced outcomes of IVF/ ICSI treatment in the form of decreased clinical pregnancy and higher early pregnancy loss. Furthermore, increased BMl is related to higher dosage and duration of gonadotropins requirement increased risk of cancellation and fewer collected oocytes.

Obesity is associated with an increased risk of early pregnancy loss. Also need of high dose of gonadotropin, less number of collected oocytes is observed. Implantation rate, pregnancy rate and miscarriage rate was comparable but live births are high in normal weight and overweight as compared to extremes of BMI. So will be appropriate to recommend life style modifications including weight loss to achieve an appropriate BMI prior to IVF.

Sharma R. Prospective Study of Effect of Body Weight on in vitro Fertilization Outcome in Reproductive Age Group. Int J Infertil Fetal Med 2014;5(2):58-63.

Rathod AT. Torsion of Gravid Uterus due to Uterine Asymmetry associated with Placental Abruption, Intrauterine Fetal Demise and Maternal Shock. Int J Infertil Fetal Med 2014;5(2):64-65.

Dhobale S, Rajan RS, Rao KA. Hemoperitoneum in Third Trimester of Pregnancy: Unusual Cause-Spontaneous Rupture of Uterine Varices. Int J Infertil Fetal Med 2014;5(2):66-68.

Terminal deletions in the short arm of chromosome one are generally associated with characteristic phenotype with dysmorphic features, including congenital anomalies and mental retardation with various degrees. Different outcomes depend on the sizes and locations of the deleted areas characterized by moderate to severe intellectual disability, delayed growth, hypotonia, seizures, limited speech ability, malformations, hearing and vision impairment and distinct facial features. The symptoms may vary, depending on the exact location of the chromosomal deletion but not a single reported case showed any ‘feature of anemia’.

We report here one male and one female individual with partial deletions on chromosome no. one, both at 1p36 region. Cytogenetic analysis of blood lymphocytes was studied with high resolution GTG-banding analysis, using cyto-vision software on their chromosomes. Results revealed 46, XY, del(1)(p36.21) in the male who was also diagnosed as a ‘beta thalassemia trait’ and the other case was 46, XX, del(1)(p36.3) in the female who was diagnosed as a case of ‘HbE-beta thalassemia’.

This report provides additional cases to the growing literature.

Deletion 1p36 is the most common terminal deletion syndrome with an estimated occurrence of 1:5000 live births. We report two patients with 1p36 deletions among which one shows ‘atypical’ proximal interstitial deletion at 1p36.21 using HR-GTG banding analysis. Interestingly, both the patients manifest one extra clinical characteristic that is different from those seen in ‘classical’ monosomy 1p36 syndrome, is ‘microcytic anemia’.

Based on the analysis of the clinical and molecular data from our patients and those reported in the literature, we suggest that deletion 1p36.21 chromosomal abnormality may constitute yet another deletion syndrome distinct from the classical distal 1p36 deletion syndrome.

Our aim was to find out further information regarding anemia since there are previously reported cases of anemias associated with this 1p36 region—one is presence of a ‘putative tumor suppressor gene’ important in the evolution of chronic myelocytic leukemia and the other is one inherited erythroblastopenia, commonly known as ‘Diamond-Blackfan anemia’ (DBA), caused by mutation in the gene encoding ribosomal protein L11 (RPL11) to answer families’ questions in the clinical setting.

Standard cytogenetic analysis was used with high resolution GTG-banding analysis, using cytovision software for karyotyping and high performance liquid chromatography (HPLC) and amplification refractory mutation mutation system (ARMS-PCR) to detect the five common Indian b-thalassemia mutations: [IVS-I-5 (G >C), Cod 15 (G-A), Cod 8/9 (+G), Fr 41/42 (–TTCT) and Cod 26 (G-A)].

Results showed 46, XY, del(1)(p36.21) in the male, additionally diagnosed as a ‘beta thalassemia trait’ and in another case 46, XX, del(1)(p36.3) in female who was diagnosed as a case of ‘HbE-beta thalassemia’.

These two patients with deletion 1p36 represent association with other genetic disorder which is characterized by hematological abnormalities.

De P, Chakravarty S, Chakravarty A. 1p36 Deletions in Two Cases with Thalassemia. Int J Infertil Fetal Med 2014;5(2):69-74.