International Journal of Infertility & Fetal Medicine

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2016 | May-August | Volume 7 | Issue 2

EDITORIAL

Editorial

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/ijifm-7-2-iv  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Sandhya Hemraj, Sally M Abraham, US Vinayaka, G Ravichandra, Devdas Acharya

Sonographic Correlation of Gestational Age with Fetal Kidney Length

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:5] [Pages No:37 - 41]

PDF  |  DOI: 10.5005/jp-journals-10016-1125  |  Open Access |  How to cite  | 

Abstract

Background

Gestational age estimation is one of the most important information conveyed by a sonologist when performing an obstetric ultrasound examination. The traditional fetal biometric parameters, such as biparietal diameter (BPD), head circumference (HC), femur length (FL), and abdominal circumference become increasingly unreliable for accurate gestational age estimation with advancing pregnancy, especially in 3rd trimester. This study was conducted to assess the role of fetal kidney length (KL) as an alternate parameter to assess gestational age in 2nd and 3rd trimesters.

Aim

To assess relationship between sonographic gestational age and fetal KL between 18 and 39 weeks of gestation.

Settings and design

Prospective, cross-sectional, single operator study conducted over a period of 1 year in a medical college hospital.

Materials and methods

Three hundred singleton pregnant women between 18 and 39 weeks of gestation were subjected to antenatal ultrasound. In addition to routine fetal biometry, measurements of fetal KL were made by noting distance between upper and lower poles of each kidney on a sagittal section of the fetal abdomen. The right and left KLs were averaged to obtain a single value for the purpose of statistical analysis.

Statistical analysis

Statistical analysis is done using SAS 9.2, SPSS 15.0, Stata 10.1, Med Calc 9.0.1, Systat 12.0, and R environment version 2.11.1. Fetal KL was expressed as mean ± standard deviation. Linear regression analysis was used to establish a relationship between sonographic gestational age in weeks and fetal KL. Level of significance was expressed as p value.

Results

A strong statistical correlation was found between sonographic gestational age and fetal KL. Nomograms and growth curves were constructed to correlate gestational age with fetal KL.

Conclusion

Fetal KL measurements can be used as alternate method of estimating gestational age in women with uncertain last menstrual periods (LMPs) and presenting late in the gestation for safe confinement. In fetal macrocephaly, hydrocephalus, short-limb dysplasias, and when fetal head is engaged, these measurements are valuable alternate parameters to assess gestational age since they are simple, not time-consuming, easy to identify, and measure.

How to cite this article

Hemraj S, Abraham SM, Acharya D, Ravichandra G, Vinayaka US. Sonographic Correlation of Gestational Age with Fetal Kidney Length. Int J Infertil Fetal Med 2016;7(2):37-41.

RESEARCH ARTICLE

Lavanya Rai, Sanghamithra Reddy, Shripad Hebbar

Feasibility of Sonography in estimating Fetal Weight of Low Birth Weight Babies

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:7] [Pages No:42 - 48]

PDF  |  DOI: 10.5005/jp-journals-10016-1126  |  Open Access |  How to cite  | 

Abstract

Background

Currently available ultrasound-based fetal birth weight estimation methods have been designed for a group of neonates with wide birth weight range and hence are faced with increased error of margin. Whenever there is a need for delivering pregnant woman with small fetus, prior knowledge of approximate fetal weight is of utmost importance for neonatal survival, and an error in this process can result in significant morbidity/mortality to the newborn baby. This necessitates need for the establishment of new birth weight formula exclusively for this subset of fetuses.

Objectives

To test the accuracy of established formulae in fetuses ≤ 2000 gm at birth in singleton pregnancies. To develop new formula for this group of small fetuses delivering in our institution with maximal accuracy and reliability and to prospectively validate this formula in subsequent set of pregnant cohort.

Materials and methods

The current study was done in two phases: The first phase was a formula derivation phase wherein the four major parameters [biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL)] were evaluated from a set of 128 postpartum women who delivered a neonate weighing ≤2 kg within 1 week of ultrasound examination. Stepwise regression analysis using birth weight as dependent parameter and fetal biometric parameters as independent parameters was used to develop the best formula for estimating fetal weight at birth. In the second phase (formula validation phase), the newly derived formula was tested for its accuracy in 31 pregnant women who gave birth to neonates weighing ≤2 kg.

Results

The new formula (log10 [BW] = 1.0131 + 0.0216 × HC + 0.0448 × AC + 0.2183 × FL + 0.0001 × BPD × AC – 0.0059 × AC × FL) was superior to established birth weight formulae. In the formula derivation group, the lowest mean ± standard deviation (SD) absolute error was 130 ± 91 gm and the lowest mean absolute percentage error was 9.8 ± 7% SD for the new formula and 61.7% of weight estimates fell within ± 10% of the actual weight at birth and this percentage further increased to 83.6 and 91.4% for error of margin of ±15 and ±20% respectively. When this formula was applied in the validation group, the absolute error in grams was 102 ± 115 and absolute percentage error was 7.4 ± 7; hence 77.4% fell within 10%, 80.6% fell within 15%, 90.3% fell within 20%. Further, in the validation group, mean ± SD of estimated birth weight was 1337 ± 406 gm, which was closest to actual birth weight (1328 ± 433 gm).

Conclusion

Our new formula is likely to estimate birth weight in small fetuses (≤2 kg) with reasonable accuracy and reliability. When compared to available methods of ultrasound birth weight estimation, absolute error and absolute percentage error is least with our formula indicating a good fit.

How to cite this article

Reddy S, Hebbar S, Rai L. Feasibility of Sonography in estimating Fetal Weight of Low Birth Weight Babies. Int J Infertil Fetal Med 2016;7(2):42-48.

RESEARCH ARTICLE

C Chandana, C Shankarappa

Implication of ABO Blood Type on Ovarian Reserve in Indian Women

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:3] [Pages No:49 - 51]

PDF  |  DOI: 10.5005/jp-journals-10016-1127  |  Open Access |  How to cite  | 

Abstract

Background

To explore the association between ABO blood type and ovarian reserve, as reflected by early follicular phase follicle stimulating hormone (FSH) levels.

Materials and methods

In this cross-sectional observational study, early follicular phase (day 3) serum levels of FSH (IU/L) and information on blood types (O, A, B, AB), patient age, and body mass index (BMI) were collected from 300 female patients, who were undergoing fertility evaluation at Vydehi Institute of Medical Sciences and Research Centre (VIMS & RC), Bengaluru. Serum FSH > 10 IU/L was taken as a measure of decreased ovarian reserve (DOR). Data distribution for FSH, age, BMI were analyzed and nonparametric tests were used for comparison across blood groups. Pearson's correlation test was used to determine the relationship between elevated FSH and blood types after adjusting for age and BMI.

Results

Proportions of blood types O, A, B, and AB were 42, 24.3, 28.7, and 5% respectively. Mean age (years) and BMI (kg/m2) among study group were 34.08 ± 3.48 and 24.34 ± 2.56 respectively. Out of 300 women, 240 women had serum FSH < 10 IU/L and 60 women had serum FSH > 10 IU/L. Women with blood type “O” (32 out of 60) were twice as likely to exhibit FSH > 10 IU/L (p = 0.02) compared to “A” and “B” blood type.

Conclusion

Our results have shown that there is an association between ABO blood type and DOR among Indian women. Blood group “O” appears to be associated with DOR that is independent of advancing age and BMI.

How to cite this article

Chandana C, Shankarappa C. Implication of ABO Blood Type on Ovarian Reserve in Indian Women. Int J Infertil Fetal Med 2016;7(2):49-51.

RESEARCH ARTICLE

KK Gopinathan, Avani Pillai, G Parasuram, Fessy L Thalakottoor

Evaluation of the Role of Hysteroscopic Endometrial Injury and Its Timing Prior to in vitro Fertilization Treatment

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:6] [Pages No:52 - 57]

PDF  |  DOI: 10.5005/jp-journals-10016-1128  |  Open Access |  How to cite  | 

Abstract

Aim

To evaluate the role of hysteroscopic endometrial injury and its timing prior to embryo transfer in patients undergoing IVF (in vitro fertilization) treatment.

Materials and methods

A total of 133 patients who underwent hysteroscopy at CIMAR Fertility Centre at Kochi, between January 2013 and December 2014, and had normal hysteroscopic findings were enrolled for the study. These women subsequently underwent IVF treatment and were evaluated in three groups based on the timing of hysteroscopy before embryo transfer: Group I – hysteroscopy performed 50 days or less before embryo transfer (n = 54), group II – hysteroscopy performed between 51 days and 6 months of embryo transfer (n = 45), and group III – hysteroscopy performed more than 6 months before embryo transfer (n = 34).

Results

The implantation rates were 21.8, 22.6, and 21.6% in groups I, II, and III respectively. Overall pregnancy rates were 44.4, 48.9, and 44.1%. Clinical pregnancy rates (CPR) were 40.7, 46.7, and 44.1% and live birth rates (LBR) were 30, 29, and 26% in groups I, II, and III respectively. Thus the implantation rate, overall pregnancy rate, and CPR were not significantly different in the three groups.

Conclusion

Hysteroscopic endometrial injury prior to IVF does not improve the pregnancy rate in patients with normal hysteroscopic findings.

Clinical significance

Due to the lack of definitive evidence regarding the role of hysteroscopic endometrial injury, ideal technique, and its timing prior to embryo transfer, it is necessary to evaluate the role of endometrial injury as a fertility treatment in women undergoing assisted reproductive technology (ART) cycles, as well as to present it in a way that supports clinical practice. At this stage, there is little evidence to support hysteroscopic endometrial injury prior to embryo transfer as a standard of care, and its use should be limited to selected cases after careful deliberation between the medical team and patient.

How to cite this article

Pillai A, Parasuram G, Thalakottoor FL, Gopinathan KK. Evaluation of the Role of Hysteroscopic Endometrial Injury and Its Timing Prior to in vitro Fertilization Treatment. Int J Infertil Fetal Med 2016;7(2):52-57.

RESEARCH ARTICLE

Kishore Nadkarni

Successful Conception and Delivery in an Unusual Case of 46,XY Pure Gonadal Dysgenesis with Spontaneous Breast Development, Menses, and Bilateral Hydrosalpinx

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:3] [Pages No:58 - 60]

PDF  |  DOI: 10.5005/jp-journals-10016-1129  |  Open Access |  How to cite  | 

Abstract

Aim

To study unusual presentations of 46XY pure gonadal dysgenesis (Swyer syndrome), implications of delayed diagnosis, importance of karyotype and early gonadectomy and pregnancy outcome with ART.

Background

To report a case of Swyer syndrome with spontaneous breast development, menses and bilateral hydrosalpinx with Successful pregnancy outcome.

Case description

30 years old lady presented with primary infertility, secondary amenorrhea and normal secondary sexual characters. Sonography revealed small uterus with atrophic ovaries and B/L hydrosalpinx. Hormonal profile showed hypergonadotrophic hypogonadism and Karyotype was 46XY. Laparoscopic salpingectomy and gonadectomy was done. Histopathology revealed streak gonads with no evidence of malignancy and diagnosis of 46XY disorder of sexual development (DSD)/ Swyer syndrome was made. After endometrial preparation with ethinyl estradiol, patient conceived with allogenic oocytes and delivered preterm twins vaginally at 31 weeks.

Conclusion

Patients with Swyer Syndrome usually present at adolescence with delayed puberty and/or primary amenorrhea. However they can present late with secondary amenorrhea or just irregular, infrequent menses or primary infertility. Karyotype is mandatory in such cases and early gonadectomy improves long term survival as incidence of malignancy in the dysgenetic gonad is high. Incipient malignancy is usually the source of estrogen in patients with normal secondary sexual characters. Hypoplastic uterus is responsive to estrogen therapy in terms of enlargement and endometrial preparation and also this uterus may have the ability to respond to the process of labor and these patients can deliver vaginally.

Clinical significance

Early diagnosis and timely management of patients with dysgenetic gonads is important. Pregnancy is possible with allogenic oocytes. Genetic counseling and long term follow-up is required.

How to cite this article

Singh P, Kalra A, Nadkarni PK, Nadkarni K. Successful Conception and Delivery in an Unusual Case of 46,XY Pure Gonadal Dysgenesis with Spontaneous Breast Development, Menses, and Bilateral Hydrosalpinx. Int J Infertil Fetal Med 2016;7(2):58-60.

RESEARCH ARTICLE

P Dahm-Kähler, Mats Brännström

Uterus Transplantation: An Update and Preparations for Introduction in India

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:7] [Pages No:61 - 67]

PDF  |  DOI: 10.5005/jp-journals-10016-1130  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Rao KA, Dahm-Kähler P, Brännström M. Uterus Transplantation: An Update and Preparations for Introduction in India. Int J Infertil Fetal Med 2016;7(2):61-67.

CASE REPORT

K Muthukumar, TK Aleyamma, Sumi Thomas

Severe Early-onset Ovarian Hyperstimulation Syndrome following Use of GnRH Agonist Trigger along with Low-dose hCG

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:5] [Pages No:68 - 72]

PDF  |  DOI: 10.5005/jp-journals-10016-1131  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Thomas S, Kamath MS, Muthukumar K, Aleyamma TK. Severe Early-onset Ovarian Hyperstimulation Syndrome following Use of GnRH Agonist Trigger along with Low-dose hCG. Int J Infertil Fetal Med 2016;7(2):68-72.

CASE REPORT

Nupur Garg, Revathi Govind, Smitha Avula

An Unusual Presentation of Partial Hemolysis, Elevated Liver Enzyme Levels, and Low Platelet Levels Syndrome in a Case of in vitro Fertilization-DEM Pregnancy

[Year:2016] [Month:May-August] [Volume:7] [Number:2] [Pages:3] [Pages No:73 - 75]

PDF  |  DOI: 10.5005/jp-journals-10016-1132  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Garg N, Govind R, Avula S, Rao KA. An Unusual Presentation of Partial Hemolysis, Elevated Liver Enzyme Levels, and Low Platelet Levels Syndrome in a Case of in vitro Fertilization-DEM Pregnancy. Int J Infertil Fetal Med 2016;7(2):73-75.

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