Poor responders have suboptimal outcomes following conventional in vitro fertilization/intracytoplasmic sperm injection treatment. There is some evidence that transdermal testosterone and growth hormone may help in improving live birth rates in this group.

To present a case series of women who had sequential transdermal testosterone and growth hormone treatment in view of their being expected poor responders or with a history of previous poor oocyte or embryo quality.

Private assisted reproduction clinic.

A total of 24 women underwent 30 cycles of controlled ovarian stimulation. Ten patients out of 24 had previous poor assisted reproductive technology outcomes, of which 4 were poor responders. Fourteen were expected poor responders. The women used approximately 1.2 gm of transdermal testosterone from day 5 to 25 along with a standard oral contraceptive pill. Growth hormone was given at 8 units/day subcutaneously from day 2 along with the gonadotropins in the antagonist protocol.

The mean age of the women was 34.92 years (±3.6). The average duration of subfertility was 7.54 (±4.005) years. The mean antral follicle count was 9 (±3.28) and the mean anti-Mullerian hormone level was 1.2 ng/mL (±0.56). The mean number of eggs collected was 8 (±5.45). Number of mature (M2) eggs was 6.6 (±4.5) Mean number of eggs fertilized was 5.04 (±4.03); clinical pregnancy rate was 8/24 (33.3%) and ongoing pregnancy rate was 4/24 (16.6%).

This case series shows an encouraging clinical pregnancy rate. The reduced ongoing pregnancy rate probably reflects the suboptimal gamete quality. Further randomized controlled trials (RCTs) are needed to assess the efficacy of sequential transdermal testosterone and growth hormone therapy in poor responders.

The ongoing pregnancy rate in this group with poor prognosis seems encouraging, and further well-designed RCTs would help in assessing the merits of this sequential therapy.

Balasubramanyam S. Sequential Use of Testosterone Gel and Growth Hormone in Expected Poor Responders and those with Previous Poor Assisted Reproductive Technology Outcomes: A Pilot Study. Int J Infertil Fetal Med 2017;8(1):1-4.

To study the role of matrix metalloproteinase (MMP- 1,2,3), inhibitor tissue inhibitors of metalloproteinase (TIMP)-2, and specific gene polymorphisms in unexpected poor ovarian responders (un-PORs).

Group I consisted of 44 un-PORs, group II of 42 subfertile, normal ovarian responders (NORs), and group III of 66 fertile women in a prospective study. Matrix metalloproteinase-1,2,3 and TIMP-2 were assessed in 40 patients from groups I and II. Specific polymorphisms (SP; MMP-1 −519 A/G, MMP-2 −1575 G/A, MMP-3 −1171 5A/6A, and TIMP-2 rs55743137T/G) were investigated in group I, II, and III patients.

Group I required similar amount of gonadotropins compared with group II, with fewer oocytes retrieved, lower fertilization rates, embryos/embryo transfer, clinical pregnancies/cycle, and “take-home babies” (p = 0.900, 0.001, 0.002, 0.001, 0.031, and p = 0.128) respectively, Table 1). Group I had lower MMP-2 with higher TIMP-2 (p = 0.002, 0.037 respectively; Table 2). In the same group, MMP-1 was higher in women with GG genotype of the MMP-1 polymorphism, vs GA genotype (p = 0.047; Table 3). The MMP-2, MMP-3, and TIMP-2 polymorphisms did not affect MMP-2, MMP-3, and TIMP-2 respectively. The same applied for MMP-1,2,3 and TIMP-2 in group II. Comparing frequencies of different genotypes of the MMP-1,2,3 and TIMP-2 polymorphisms, they did not differ between the three different groups: A, B, and C (Table 4).

Impaired MMP-2 activity, associated with significantly higher TIMP-2 detected, could be involved in un-POR pathogenesis. There was no strong association between MMP polymorphisms and un-POR susceptibility. However, women with A/G polymorphism (MMP-1 −519) had lower MMP-1 compared with GG homozygotes.

Identification of patients with poor ovarian response in a pretreatment environment would help improve their ongoing fertility plan and manage their expectations. Also by having the ability to investigate if one belongs to that group, it could provide important family planning information for the patient.

Tzafetas M, Lathouras K, Tantanasis T, Fidani S, Tziomalos K, Kalinderi K, Loufopoulos A, Zournatzi V. Role of Metalloproteinases in the Pathogenesis of Unexpected Poor Ovarian Response with a Possible Genetic Predisposition. Int J Infertil Fetal Med 2017;8(1):5-11.

To determine whether weight loss in obese men improves seminal parameters.

Prospective interventional study.

Infertility clinic and weight loss centers.

All men attending infertility center and weight loss programmes from April 2012 to May 2015 (n = 105).

Diet counseling and exercise.

Collected reproductive parameters included semen analysis (ejaculate volume, sperm concentration, progressive and non-progressive motility) data. Body mass index (BMI) was calculated for all patients with comparisons to reproductive parameters before and after weight loss by using paired-t test and Chi-square tests.

The mean BMI was significantly higher before weight loss (33.2) than after weight loss (30.4) in obese men. The weight loss had significant positive correlation with percentage of progressive sperm motility (p = < 0.001) and static percentage (p = < 0.001). Weight loss had non-significant correlation with semen volume (p = 0.083), concentration (p = 0.418) and non progressive motile sperm (p = 0.361).

In one of the largest cohorts of male fertility and obesity, semen parameters demonstrated mild but significant relationships with BMI and semen parameters, possibly contributing to subfertility in this population.

Jaffar M, Ashraf M. Does Weight Loss improve Fertility with respect to Semen Parameters—Results from a Large Cohort Study. Int J Infertil Fetal Med 2017;8(1): 12-17.

The aim of this study was to evaluate the relevance of routinely done laboratory parameters in women with hypertensive disorders in pregnancy.

Hypertensive pregnant women were divided into two groups based on perinatal outcome as those with and without poor perinatal outcome. They were analyzed with various laboratory tests done at the time of diagnosis: Hematological parameters, such as hemoglobin, hematocrit, platelet count, total leukocyte count, and differential count; renal parameters, such as serum urea, creatinine, and uric acid; liver function tests; and serum lactate dehydrogenase (LDH). Coagulation parameters, such as prothrombin time, activated partial thromboplastin time, and international normalized ratio were compared between the two groups. Data were presented as mean ± standard deviation; á level of p < 0.05 was set as statistically significant.

Among the various hematological parameters, platelet count showed statistically significant differences between hypertensives with and without perinatal mortality or morbidity (p = 0.029, p = 0.029 respectively). All renal parameters showed statistically significant differences (p ≤ 0.005). Serum aspartate aminotransferase (p = 0.034) among the liver parameters and serum LDH (p = 0.024) showed statistically significant differences between the two groups. Coagulation parameters were abnormal among patients with thrombocytopenia.

Blood pressure alone is not sufficient in monitoring women with hypertensive disorders in pregnancy. Laboratory parameters that are cost-effective and routinely done in most laboratories are significant in assessing the severity of maternal disease and the perinatal outcome. It can hence, be used to monitor hypertensive women in pregnancy.

Preethi DS, Rai L, Nambiar MJ, Kumar P, Pai MV, Amin SV. Role of Laboratory Investigations to Assess Maternal and Perinatal Outcome in Hypertensive Mothers. Int J Infertil Fetal Med 2017;8(1):18-23.

Priya K, Divyashree PS. Restoring Fertility in Cancer Survivors: Ovarian Tissue Cryopreservation or Assisted Reproduction Technique. Int J Infertil Fetal Med 2017;8(1):24-31.

Laisure BN. Infertility Counseling. Int J Infertil Fetal Med 2017;8(1):32-35.

Spontaneous abortion has been reported in 15 to 20% of all diagnosed pregnancies. The most common cause of spontaneous abortion is chromosomal abnormalities of the embryo. Robertsonian translocation (RT) is one of the major chromosomal rearrangements with a prevalence rate of 0.1% of the general population and 1% of the infertile population. Robertsonian translocation carriers, especially 21-14, are the most common balanced rearrangement among the carrier couples with a history of spontaneous abortion.

Cytogenetic analysis was carried out based on phytohemagglutinin-stimulated peripheral blood lymphocyte cultures and without phytohemagglutinin-stimulated amniocyte culture. Lymphocyte and amniocyte culturing and GTG banding were performed following standard protocols as described by the Association of genetic technologists (AGT) Cytogenetics Laboratory Manual.

Cytogenetic evaluation of both the partners and the child revealed that the child had translocated Down's syndrome and the mother was a carrier of balanced RT of 14q;21q. Amniocentesis of the next pregnancy and detection of chromosomal abnormality in the fetus was done by fluorescence in situ hybridization (FISH) analysis of the amniotic cells with 13,18,21,X,Y probe mix found normal chromosomal constituent in the fetus.

The present study shows that genetic counseling, cytogenetic evaluation, prenatal diagnosis by amniocentesis, and FISH together help couples with nonhomologous RT and history with syndromic child and repeated abortions to get normal offspring.

De P, Chakravarty S, Chakravarty A. Pre- and Postnatal Genetic Evaluation reduce the Reproductive Risk of nonhomologous Robertsonian Translocation Carrier Couple. Int J Infertil Fetal Med 2017;8(1):36-40.

To enlighten the readers regarding rare and distinct presentation of fetal encephalocele in parietal location and its significance.

Cranium bifidum is a defect in the cranium through which there can be herniation of intracranial contents. If the content of herniation is meninges, it is called meningocele and if it contains brain tissue in addition to meninges, it is called meningoencephalocele or encephalocele. The incidence of encephalocele is 1 in 4,000 live births. The most common location is the occipital region (75%) followed by frontoethmoidal (15%), which is common in Asian population, and rarest is the basal followed by parietal locations. The exact incidence of parietal encephalocele is not available due to its rarity.

We present a case of a 24-year-old primigravida female in second trimester who came for antenatal scan to rule out anomalies. On examination by ultrasonography, we found a large cerebriform soft tissue herniating through a defect in skull vault from the vertex region with secondary microcephaly

Here we give an overview of rarest form of encephalocele in parietal region, which grossly differs from the already reported parietal encephaloceles of atretic type presenting as small skin-covered subscalp lesions that contain Meninges and neural and glial rests. In our case, the encephalocele was distinct, being larger in size with normal brain parenchyma as the major content of the herniating sac.

Only few cases of parietal encephalocele is reported in the literature, that too of atretic type. Apart from being the rarest form, this variant is found to be associated with poor prognosis.

Rathinam S, Rudrappa R, Talluri B. Parietal Cranium Bifidum: A Rare Presentation. Int J Infertil Fetal Med 2017;8(1):41-44.