Accumulating evidence suggests that oxidative stress plays an important role in the development of male infertility and recently antioxidants have been tried to treat men with idiopathic infertility.

To assess the effect of treatment with vitamin C, vitamin E, zinc, selenium, and coenzyme Q10 on seminal fluid parameters in infertile men with idiopathic oligoasthenozoospermia.

A prospective randomized trial was conducted on 32 infertile men with idiopathic oligoasthenozoospmia who received a daily supplement of one caplet containing vitamin C (90 mg/day), vitamin E (15 mg/day), coenzyme Q10 (4 mg/day), selenium (30 µg/day), and zinc (5 mg/day) for 3 months. Semen analysis was performed at baseline and 3 months after treatment using World Health Organization (WHO) 2010 guidelines.

Significant improvement in sperm concentration was observed after combination therapy (9.13 ± 4.29 vs 11.3 ± 6.05 × 10⁶/mL, p < 0.05). Sperm progressive motility (18.1 ± 8.68 vs 24.6 ± 10.2%, p < 0.01) and total motility (28.4 ± 8.71 vs 34.4 ± 11.7%, p < 0.01) also increased significantly following treatment. No change, however, was observed in semen volume or the proportion of sperms with normal morphology.

The combination of vitamin C, vitamin E, zinc, selenium, and coenzyme Q10 can significantly improve sperm concentration and motility in infertile men with idiopathic oligo­asthenozoospermia, which could be attributed to their synergistic antioxidant action.

Alahmar AT. Effect of Vitamin C, Vitamin E, Zinc, Selenium, and Coenzyme Q10 in Infertile Men with Idiopathic Oligoasthenozoospermia. Int J Infertil Fetal Med 2017;8(2):45-49.

In assisted reproduction technique cycles, controlled ovarian stimulation (COS) leads to supraphysiological levels of steroid hormone secretion and the subsequent need for luteal phase support (LPS). Therefore, existing data on the steroid secretion profile in the luteal phase of spontaneous conception cycles and its predictive value for pregnancy outcome need to be discussed against the background of preceding COS. The clinical significance of luteal phase hormones, such as estrogen (E2) and progesterone (P4), in predicting pregnancy after controlled ovarian hyperstimulation protocols for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is still poorly understood. The aim of the present study was to investigate the role of midluteal serum E2 and P4 level in predicting successful pregnancy in patients undergoing IVF/ICSI.

One hundred fifteen women were recruited for the study. They were given gonadotropin-releasing hormone antagonist protocol and human chorionic gonadotropin (hCG) was administered if at least three follicles were more than 18 mm in size. Transvaginal ultrasound-guided oocyte retrieval followed by ICSI and embryo transfer (ET) was done. Post-ET, all women had same LPS. The E2 and P4 measurements were done at day of ET (day 0) and 9 days post-ET (day 9). Levels of E2 and P4 were compared between those who subsequently became pregnant and those who could not achieve pregnancy. Statistical analysis was performed using Statistical Package for the Social Sciences.

Forty-six (40%) achieved pregnancy. The E2 and P4 levels on day 9 were significantly higher in those who achieved pregnancy (p < 0.01). Out of 46 pregnancies, 38 were ongoing viable pregnancies.

Luteal phase E2 and P4 can be used as prognostic marker to predict pregnancy in IVF/ICSI cycles.

Nigam S, Joy I, Shankar K, Varma TR. Midluteal Serum Estrogen and Progesterone Levels predict Pregnancy Rate in in vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Prospective Study. Int J Infertil Fetal Med 2017;8(2):50-53.

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that arises due to assisted reproductive technologies (ARTs) during infertility treatment. Recently, the use of selective dopamine receptor agonists on D2 receptors (e.g., cabergoline) has been suggested in the prevention of OHSS. The aim of this study was to evaluate the effect of cabergoline in the prevention of OHSS in high-risk patients undergoing ART.

This was a randomized, double-blind, parallel group (cabergoline group and placebo) study. A total of 110 women undergoing in vitro fertilization (IVF)–intracytoplasmic sperm injection procedure using a long agonist protocol with high risk for OHSS were recruited for the study on the day of final trigger. All the patients were followed up every 48 hours for 10 days from the day of the final trigger and clinically assessed with ultrasound and blood tests. The size of ovaries and fluid collection in the pouch of Douglas (POD) was measured with ultrasound. A sample size of 92 subjects was calculated for the study to be powered at 80%. Assuming a drop-out rate of 10%, 110 subjects were enrolled for the study.

There was no significant difference observed in the size of right and left ovary, POD fluid volume, total leukocyte count (TLC), and serum estradiol level (E2 level) between both the groups from day 0 to day 8, except packed cell volume. No significant difference was observed in the incidence rate of moderate OHSS between both groups (p = 0.728). The differences in clinical pregnancy rate, implantation rate, and live birth rate were also insignificant.

Cabergoline does not reduce the incidence of moderate OHSS when compared with placebo. Large, well-designed studies are needed to evaluate the effectiveness of cabergoline when used for the prevention of OHSS.

Singh S, Singh S, Raman AK, Ramakrishnan S, Ashraf CM. Efficacy of Cabergoline in the Prevention of Ovarian Hyperstimulation Syndrome: A Randomized, Double-blind and Placebo-controlled Trial. Int J Infertil Fetal Med 2017;8(2):54-60

In recent past, many studies had come up with the combination of time-lapse (TL) imaging of embryo morphokinetics as a noninvasive means for improving embryo selection and in vitro fertilization (IVF) success. The primary objective of the study was to find out if there is significant variation in morphokinetics of embryos with different implantation potential and also to study the effect of sperm freezing on time points of embryogenesis events in embryos with implantation potential.

Kinetic data and cycle outcomes were analyzed retrospectively in 142 patients who had undergone IVF/intracytoplasmic sperm injection (ICSI) cycles using semen with normal parameters and embryo transfer (ET) on day 3. For the surety of specificity of morphokinetics, only cases with single ET cycles were included in the study. Timing of specific events, from the point of ICSI, was determined using TL imaging. Kinetic markers like time to syngamy (t-pnf), t2, time to two cells (c), 3c (t3), 4c (t4), 5c (t5), 8c (t8), tMor, CC2, CC3, t5–t2, t5–t4, s1, s2, and s3 were calculated. The cleavage synchronicity from the 2–8 cell stage (CS2–8), from 4 to 8 cell stage (CS4–8), and from 2 to 4 cell stage (CS2–4) were calculated as defined elsewhere. Deoxyribonucleic acid replication time ratio (DR) was also included in the comparison. Analysis of variance test was used for comparison of the mean timing of cell division and cell cycle intervals.

Morphokinetics t-pnf, t2, t8, CC2, S2, S3, CS2–8, CS4–8, and CS2–4 differed significantly between embryos with and without implantation potential, when embryos were developed using fresh semen, while t3, t4, t5, CC2, S2, t5–t2, CS2–4, and DR differed significantly between the embryos with and without implantation potential when frozen semen was used. No significant difference was found in mean value of any of the above-stated parameters when comparison was done between implanted embryos fertilized by either fresh or cryopreserved sperm.

Many morphokinetics parameters of embryogene­sis vary significantly between embryos with different ability to implant; therefore, the criteria developed in our IVF lab can be useful for selection of suitable embryo even at day 3 of development with more chances of implantation.

Study indicates necessity of development of individualized selection model based on morphokinetics for every IVF lab and also confirms freezing as an important tool for fertility preservation of males as it does not affect events of embryogenesis.

Bhadarka HK, Patel NH, Patel KB, Sodagar NR, Jadeja YD, Patel NH, Patel MN, Patel AV, Patel DH, Patel JS. Study of Morphokinetics in Day 3 Embryo with Implantation Potential and Effect of Sperm Cryopreservation on Embryogenesis. Int J Infertil Fetal Med 2017;8(2):61-67.

To compare reproductive outcomes of day 2 and day 3 embryo transfer (ET).

In this retrospective records study, all couples who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and ET cycles at Lilavati Hospital & Research Centre over a period of 1 year were studied. Data were collected and analyzed by chi-square test and unpaired t-test by Statistical Package for the Social Sciences, version 16.

There was no statistically significant difference between the clinical and demographic parameters of group day 3 and day 2 ET. In our study, clinical pregnancy rate was 45% in day 3 ET and 36.5% in day 2 ET group [odds ratio (OR) 1.43, p-value 0.49]. The ongoing pregnancy rate was 39.2% in day 3 ET and 26.9% in day 2 ET group (OR 1.75, p-value 0.26). We observed that the miscarriage rate was 5.9% in day 3 ET and was 5.8% in day 2 ET group (p-value 0.69, OR 1.02). We observed one case each of multiple pregnancy, ectopic pregnancy, and fetal anomaly (anencephaly) in day 2 ET group, while in day 3 ET group, no such case was detected.

There are chances that day 3 ET has better clinical and ongoing pregnancy rates than day 2 ET, but the difference is not statistically significant. Study showed similar miscarriage rates in both groups and very low incidence of complications like multiple pregnancy, ectopic pregnancy, and fetal anomaly. So, it is safe to schedule and transfer embryos either on day 2 or on day 3 for planning and programming cycles in coordination with patient and IVF team and for adjusting weekends (nonworking days).

Many steps of IVF procedure became standardized. However, the optimum timing of ET is still debatable. Several studies comparing ET on day 2 vs day 3 after oocyte retrieval have been performed, but the conclusions are conflicting. Despite development in culture media allowing blastocyst transfer, many centers still practice day 2/3 ET.

Shintre HS, Pai HD, Talreja D, Shah KR. Comparison between Day 2 and Day 3 Embryo Transfer following in vitro Fertilization/Intracytoplasmic Sperm Injection. Int J Infertil Fetal Med 2017;8(2):68-74.

Prior to the era of in vitro fertilization, no options for conception were available to women with primary ovarian insufficiency, decreased ovarian reserve, or genetically transmittable diseases. Oocyte donation (OD) has been used in such women for almost 30 years. It also offers an opportunity to study the participation of the uterus in the process of human embryo implantation.

To identify recipient variables that may have a significant impact on the pregnancy outcome of an OD program.

The present study was conducted at Madras Medical Mission Hospital, Chennai, India. We retrospectively evaluated 192 patients and 283 embryo transfer cycles as a result of OD over a period of 5 years. Rates of implantation, clinical pregnancy, ongoing pregnancy, miscarriage, and live birth were calculated for different age groups, endometrial thickness (ET), indications of OD, fresh and frozen embryo transfers (FET), type of subfertility, past history of endometriosis, and body mass index (BMI) of the recipients. Data evaluation was mainly done by Chi-square analysis, and receiver operating characteristic (ROC) curves were made for age and ET.

The results of this study showed a clinical pregnancy rate (CPR) of 37.1%, implantation rate (IR) of 19.3%, miscarriage rate of 20.4%, ongoing pregnancy rate (OPR) of 32.2%, and live birth rate (LBR) of 26.6%. Significant association was seen between age of recipient and OPR (p = 0.014), and also between fresh embryo transfers, CPR, OPR, and LBR (p < 0.05). The ROC curves showed a significant association of LBR with age of recipient.

Although no single or combined recipient variable(s) could be identified as predictor(s) of pregnancy, significant association was found between OPR, LBR, and recipient's age and also between fresh embryo transfers with CPR, OPR, and LBR.

Punhani R, Balasubramanyam S, Shankar K, Varma TR. A Retrospective Study of Recipient-related Predictors of Success in an Oocyte Donation Program. Int J Infertil Fetal Med 2017;8(2):75-82.

To evaluate clinically suspected cases of intrauterine growth restriction (IUGR) for Doppler study of uterine artery, umbilical artery, and fetal middle cerebral artery. To compare the various indices of the three vessels in predicting perinatal outcome. To evaluate the positive predictive value among these parameters. To compare the Doppler findings with fetal outcome.

One hundred and two singleton pregnancies complicated by IUGR and severe preeclampsia or both were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery, and umbilical vein which were compared with 104 uncomplicated pregnancies that formed the control group.

One hundred and two singleton pregnancies included in the study population had at least one major or minor adverse outcome. Major adverse outcome criteria included perinatal deaths — including intrauterine and early neonatal deaths, etc. Minor outcomes included cesarean delivery for fetal distress, APGAR score below 7 at 5 minutes, and admission to neonatal intensive care unit for treatment.

Low diastolic and high indices characterize the pregnancies with abnormal outcomes. The uterine artery had a better sensitivity and specificity as compared with the umbilical arteries and diastolic notch had the highest sensitivity and specificity. Doppler also provides a noninvasive method of assessing the fetal and maternal circulation during pregnancy.

Kumar V, Sharma G, Khan S, Singhania A, Singhania S. Study of the Significance of Fetal Doppler Flow Velocimetry in the Perinatal Outcome of Growth-restricted Fetuses. Int J Infertil Fetal Med 2017;8(2):83-88.

Bhat SK, Nambiar R, Nayak D, Shah KH. Prenatal Diagnosis and Postnatal Management of Congenital Pulmonary Airway Malformation. Int J Infertil Fetal Med 2017;8(2):89-92.