Vohra A, Rao KA. Luteinizing Hormone in Controlled Ovarian Stimulation. Int J Infertil Fetal Med 2014; 5(3):75-86.

To evaluate the role of placental location in predicting the pregnancy outcome.

It was a prospective observational study conducted between September 2011 and March 2013 at a tertiary care hospital. Placental location, as determined by midtrimester ultrasound in 620 antenatal women, was divided into five groups—anterior, posterior, fundal, lateral and low lying placenta-depending on where > 75% of the placental mass was located. Outcome variables, such as antenatal complications, intrapartum events and neonatal outcome in these women were studied.

Out of 620 women, 274 (44.1%) had anterior, 169 (27.2%) had posterior, 98 (15.8%) had fundal, 61 (9.8%) had lateral placentae and 18 (2.9%) had placenta previa as per the last scan done at 28 weeks. Pre-eclampsia (27.9%) and antepartum hemorrhage (19.7%) were more common in lateral placenta whereas term prelabor rupture of membranes (11.2%) was more common in fundal placenta and these findings were statistically significant. The incidence of intrauterine growth restriction (IUGR) was also found to be higher in patients with lateral (16.4%) and posteriorly (16%) implanted placenta although there was no statistically significant association.

Among the various placental sites of implantation, lateral location of the placenta is associated with adverse antenatal outcomes like pre-eclampsia, antepartum hemorrhage and IUGR.

Faizi S, Pai MV. Role of Midtrimester Localization of the Placenta in predicting Pregnancy Outcome. Int J Infertil Fetal Med 2014;5(3):87-91.

To study the maternal and neonatal outcomes of pregnancies complicated by rheumatic heart disease (RHD).

A retrospective study was carried out in the obstetric and cardiology outpatients department of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India over a period of 1 year (Dec 2011-2012) involving 96 pregnant patients with rheumatic heart disease. Their maternal and fetal outcomes were reviewed.

A total of 96 pregnant mothers with heart disease presented to us during the period of 1 year (Dec 2011-2012). Majority of the pregnant mothers had mitral stenosis n = 46 (47%). Rest of the patients had multivalve disease. Pulmonary arterial hypertension was found to be in 28 patients (29%). Atrial thrombus was seen in the echocardiography of one patient. Mitral valve replacement was done before pregnancy in 16 mothers (16%); these gravid mothers were put on low-molecular weight hepanin (LMWH) and during the midtrimester on the Acitrom. There was one patient admitted with atrial fibrillation. New York Heart Association (NYHA) class I and II heart disease progressed in two patients to class III and IV. There was no maternal or fetal mortality in this study. There were 24 cesarean sections (25%) done out of which 8 were for intrauterine growth restriction (IUGR) (32%), rest were due to maternal reasons. There were 12 preterm deliveries. Four fetuses had intraventricular hemorrhage.

Despite no maternal and neonatal mortality, pregnancy in women with heart disease is associated with significant maternal and neonatal morbidities.

Pandey U. To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease. Int J Infertil Fetal Med 2014;5(3):92-94.

The World Health Organization (WHO) has defined leukocytospermia as > 10⁶ WBC/ml of semen. However, the clinical significance of leukocytospermia is currently a subject of controversy. Evidence from several recent studies indicates that leukocytospermia could significantly contribute to oxidative stress and male infertility. Several clinical trials have investigated the efficacy of antibiotic therapy to treat patients with pyospermia in an attempt to improve fertility. Currently, doxycycline is the most common antibiotic used to treat pyospermia though larger trials are needed to demonstrate its efficacy in treating pyospermia.

Hundred male partners with semen analysis showing the presence of significant leukocytospermia (WBC > 1 × 10⁶/ml), sterile semen culture and satisfying the inclusion and exclusion criteria were enrolled in the study and given doxycycline 100 mg bd for 14 days. Semen analysis for pus cells and oxidative stress (ROS) measurement was done before and after the treatment.

Mean pus cell count before and after treatment with doxycycline was 2.28 ± 1.26 × 10⁶/ml and 1.21 ± 0.58 ×10⁶/mL respectively, the effect being statistically significant (p < 0.05). Resolution of leukocytospermia was seen in 61.4% (54/88) cases after doxycycline treatment. Mean oxidative stress (RLU/ sec/million sperms) before and after doxycycline therapy was 79.72 ± 133.9 and 25.44 ± 47.8, the difference being significant (p < 0.05).

Study results show that treatment with broad spectrum antibiotic like doxycycline leads to significant decrease in the number of pus cells present in semen thereby significantly decreasing the oxidative stress.

Aggarwal R. the Effect of Doxycycline on Pus Cells and Oxidative Stress in Male Patients with Leukocytospermia. Int J Infertil Fetal Med 2014;5(3):95-99.

In spite of significant advances in the field of reproductive medicine, repeated implantation failure (RIF) is a challenging and extremely disappointing problem. The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depends mainly on uterine receptivity and embryo quality. Successful evaluation of endometrial receptivity conducive to embryo implantation continues to be a challenge in assisted reproductive technology (ART). Several researcher groups have reported the successful use of granulocyte-colony stimulating factor (G-CSF) during IVF cycles in terms of achieving higher clinical pregnancy rates on account of increased endometrial thickness. Women who fail to achieve adequate endometrial thickness despite conventional treatment with high dose estrogen or those with a history of repeated implantation failures in spite of normal endometrial thickness often do not achieve pregnancy and resort to gestational surrogacy. A new therapeutic approach to achieve successful pregnancy in such patients would be very desirable.

To assess the efficacy of a single dose of intrauterine G-CSF on endometrial thickness, implantation and clinical pregnancy rates in women who either had a thin endometrium after estrogen priming (< 8 mm) or a history of repeated implantation failures at IVF, undergoing embryo transfer after 10 days of priming with oral estradiol and vaginal slidenafil.

Two hundred and thirty-one women (between 24 and 46 years of age) undergoing IVF-ET were recruited for the study. All cases were prospectively studied at the Mumbai Fertility Clinic and IVF Center (a subdivision of Kamala Polyclinic and Nursing Home) over a period of 6 months from January to June 2014, after their written informed consent. Subgroup I consisted of 117 patients who had a persistently thin endometrium (< 8 mm) in spite of high dose oral estradiol valerate and vaginal sildenafil priming. Subgroup II consisted of 114 patients who had a history of repeated (two or more) implantation failures (RIF) at IVF-ET cycles despite adequate endometrium (≥8 mm). All were infused with a single dose of G-CSF (300 mcg) in the uterine cavity after 10 days of priming with oral estradiol valerate and vaginal sildenafil citrate. Endometrial thickness was reassessed 4 days after G-CSF instillation. This was followed by administration of intramuscular progesterone in oil (100 mg) daily with embryo transfer on day 5 of progesterone for all patients. All embryo transfers for patients undergoing oocyte donation or embryo donation were done at the 4-cell stage on day 2. All Frozen embryo transfers (FET) of vitrified embryos were at 8 cell stage. Estimation of serum beta hCG was at 14 days post-embryo transfer for all patients. Successful implantation and net clinical pregnancy rate was confirmed based on appearance of gestational sac on sonogram after 10 days and observation of fetal cardiac activity after 20 days of positive β-hCG results.

Out of total 231 patients recruited in the study, 95% patients from subgroup I (n = 111) and 94% patients from subgroup II (n = 107) showed mean increase in endometrial thickness by at least 2.5 mm within 4 days of G-CSF single dose instillation. A total of 218 patients from both subgroups underwent S. β-hCG estimation 14 days post IVF-ET. Out of 103 β-hCG positive patients, 83 showed net clinical pregnancy (fetal cardiac activity present) giving a net pregnancy rate of 38.07% for the whole study group with 37% in the subgroup with thin endometrium (< 8 mm) and 39.25% in the subgroup with adequate (≥8 mm) endometrium with history of two or more failed implantation at previous IVF-ET cycles. There were no adverse events for the whole study population.

There can be a strong possibility with a single dose of 300 mcg intrauterine infusion of G-CSF to achieve significant increase in the endometrial thickness with higher successful pregnancy rate among infertile women under- going IVF-ET cycles with a history of a persistently thin endometrium or repeated implantation failures (rather difficult to treat patients). G-CSF could be a valuable tool to consider before advising the option of surrogacy. In the absence of a control group, our conclusions warrant conduct of further studies.

Shah J, Gangadharan A, Shah V. Effect of Intrauterine Instillation of Granulocyte Colony-stimulating Factor on Endometrial Thickness and Clinical Pregnancy Rate in Women undergoing in vitro Fertilization Cycles: An Observational Cohort Study. Int J Infertil Fetal Med 2014;5(3):100-106.

Achar S, Ramarajan A. Term Pregnancy following Myomectomy for Leiomyomatosis. Int J Infertil Fetal Med 2014;5(3):107-109.

Muralidhar L, Venkatesh S, Pandey P. Partial Vaginal Agenesis with Transverse Vaginal Septum. Int J Infertil Fetal Med 2014;5(3):110-112.