Ovulation induction in women with polycystic ovarian syndrome (PCOS) can be carried out with drugs, such as clomiphene citrate (CC), which remains the first-line treatment option, and surgery, such as laparoscopic ovarian drilling (LOD), which is usually recommended as one of the second-line treatment options. Laparoscopic ovarian drilling may avoid or reduce the need for gonadotropins and at the same time reduce ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.

We aimed to evaluate the effectiveness of LOD in clomiphene-resistant women and to identify the clinical factors that might predict its success.

Retrospective analysis in a tertiary level infertility unit.

All CC-resistant PCOS women who underwent LOD over a 10-year period were included. Polycystic ovarian syndrome was defined as per the Rotterdam criteria. The follow-up period was up to 3 years post-LOD. Outcomes, such as onset of regular cycles, spontaneous pregnancies, and live births were recorded.

A total of 59 PCOS women who underwent LOD and were available for follow-up were included in the study. Majority of the patients were less than 30 years of age with a body mass index (BMI) > 24 kg/m². Out of those, 12 conceived (20.3%) spontaneously and 14 (23.7%) had regular menstrual cycles after the procedure. The live birth rate was 16.9% (10/59). We did not find any association of clinical factors, such as age, BMI, type of infertility, and history of irregular cycles with LOD success.

Laparoscopic ovarian drilling can be offered as a treatment option in select group of CC-resistant women with reasonable success. Post-LOD, for those who do not have resumption of regular cycles, alternate method of ovulation induction can be initiated.

Thomas S, Vithayathil VP, Chandy A, Aleyamma TK, Kamath MS. Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis. Int J Infertil Fetal Med 2017;8(3):93-96.

Many studies have shown deleterious effects of tobacco abuse in any form on semen quality. We studied the association of tobacco chewing, smoking, and their combination on semen characteristics.

Our study was performed on 216 normal asymptomatic healthy males (49 controls, 54 smokers, 55 tobacco chewers, and 58 consuming both) in the age group of 24 to 35 years. The effect on semen parameters was analyzed.

Consuming both forms of tobacco individually and in combination had statistically significant effect on sperm morphology, progressive motility, and semen concentration. Other parameters show nonstatistically significant decline compared with controls.

As smoking and chewing tobacco negatively affect quality of semen, strategies should be developed to direct attention of the general population toward its effect on fertility status of male.

Vohra RR, Priyadarshi S, Aggarwal N, Vyas N, Yadav SS, Tomar V. Study to evaluate Association of Tobacco Chewing and Smoking with Semen Parameters. Int J Infertil Fetal Med 2017;8(3):97-100.

One of the most challenging problems in in vitro fertilization (IVF) is patient with thin endometrium. The objective of the study was to ascertain whether daily human chorionic gonadotropin (hCG) for 7 days with estrogen in hormone replacement frozen embryo transfer (FET) cycles during follicular phase can increase the endometrial thickness (ET) and reduce the cancellation of cycles.

Twenty-five infertile patients with resistant thin endometrium who had antagonist protocol and planned for frozen embryo replacement were recruited. These patients had prior attempts to thicken their endometrium which had failed. All the patients received estrogen daily from D2/3 of cycle. On day 8 or 9 of estrogen administration, 200 IU of hCG was given daily for 7 days. After 7 days on hCG priming (D14/15), ET was measured and progesterone was started accordingly. Identification of an intrauterine gestational sac with fetal heart beat by transvaginal ultrasonography constituted clinical pregnancy.

Mean ET increased significantly from 5.84 to 7.61 mm (p < 0.01). About 72% of patients had more than 20% improvement in their ET after hCG priming. About 76% achieved an ET more than 7 mm. Overall, 50% became pregnant. The ongoing pregnancy rate was 40%.

A total of 200 IU hCG endometrial priming for 7 days in the proliferative phase of hormone replacement cycles for FET is a highly promising approach to thicken thin endometrium with failed prior attempts.

Nigam S, Shankar K, Varma TR. Role of Low-dose Human Chorionic Gonadotropin in Follicular Phase for Thin Endometrium in Frozen Embryo Replacement Cycles in in vitro Fertilization/Intracytoplasmic Sperm Injection Patients: A Pilot Study. Int J Infertil Fetal Med 2017;8(3):101-105.

The aim of the article is to study infertility—etiology, medication therapy management, and outcomes in a tertiary care hospital.

The purpose of this study was to compare the outcomes of standard aetiology wise treatment protocols of infertility and the various causes which may be a contributing factor to infertility.

A prospective observational study was conducted for 6 months at a tertiary care hospital. Couples diagnosed with infertility, aged 18 to 49 years were enrolled in the study. Details like couple's sociodemographic data, etiology, risk factors associated with infertility, management with current medications, procedures, and outcomes were documented using predesigned infertility proforma.

Females had an age group of 19 to 38 years with an average age and standard deviation (SD) of 25.64 ± 4.07 years, whereas male patients had an age of 24 to 43 years with a mean age and SD of 30.59 ± 4.17 years. Primary infertility was 59.13% and secondary infertility 40.86%. In women with infertility, ovulatory disorders were the chief cause, followed by unexplained factor, uterine tubal, and more than one cause, whereas in males semen abnormalities were the major cause of both primary and secondary infertility, followed by unexplained, anatomical, more than one cause. Medical therapy involving drugs like clomiphene, gonadotropins, and a combination was administered to females. Males received lycopene, L-carnitine, ubidecarenone, zinc, and astaxanthin. Intrauterine insemination (IUI) was performed in 28 patients. From the available data of 100 couples undergoing management for infertility in the 6 months study period, 19 patients conceived, i.e., 19% showed conception.

The present study shows etiological and pathological causes of infertility. The study highlights positive results with standard treatments.

To identify hidden social, medical, pathological, and other confounding causes leading to infertility.

Khanuja PK, Sunny JA, Pawar SB, Nimbargi V. Study on Infertility—Etiology, Medication Therapy Management, and Outcomes at a Tertiary Care Hospital. Int J Infertil Fetal Med 2017;8(3):106-112.

To present an overview of the current Artificial Reproductive Techniques (ART) guidelines focussing on grey zones

Infertility is a major health and social concern in modern day India. Due to the great diversity in management protocols and absence of standard operating procedures, there is a necessity to develop country-specific guidelines for assisted reproduction. Also, there is need to curb unethical practices. Guidelines in this regard have undergone several changes over the years. It is important that adequate care is taken before the bill becomes a law so that both patients and health workers mutually benefit from ART

The present article gives an insight into the development of guidelines over the years with elaboration of the salient features of the current ART Bill under specific chapter headings, ten chapters in total. Also discussed is the recent Surrogacy Bill. In each context, critical analysis is provided that underscores the grey areas that need to be addressed. At the end of the article, certain recommendations have been put forward to aid the successful implementation of current guidelines

It is imperative that all ART practitioners be well versed with the current ART guidelines as ignorance cannot be cited as an excuse under any circumstance. Also, practitioners can give valuable inputs before the bill finally becomes a law. The law must ensure that physicians are not unnecessarily persecuted in the name of patient rights, as this will lead to fearful practice, which in turn will hamper patient management.

Sharma PJ, Mittal M. Critical Analysis of the Current Assisted Reproductive Technology Guidelines. Int J Infertil Fetal Med 2017;8(3):113-119.

To report the first case of live birth after double trophectoderm biopsy before and after vitrification on the same cohort of blastocyst in our knowledge.

Case report.

A 36-year-old female with a history of 13 years of active married life for treatment of infertility.

Live birth after double trophectoderm biopsy.

Double biopsy pre- and postvitrification and its positive outcome.

Preimplantation genetic screening and diagnosis (PGS/PGD), though an invasive procedure on the embryos, when done meticulously would not dampen the implantation potential of the embryo and second biopsy could be a feasible option to salvage embryos with inconclusive or suspected false-positive PGS/PGD reports.

Bhadarka H, Patel NH, Jadeja YD, Patel KB, Patel NH, Patel MN. First Case of Successful Implantation and Live Birth after Double Trophectoderm Biopsy before and after Vitrification on the Same Cohort of Blastocyst. Int J Infertil Fetal Med 2017;8(3):120-124.

To review and analyze the incidence of heterotypic pregnancies after intracytoplasmic sperm injection (ICSI) and embryo transfer and to report pregnancy outcome after successful management of heterotypic pregnancies.

Nadkarni's 21st Century Hospitals and Test Tube Baby Center, Surat, Gujarat, India.

Retrospective study.

Retrospective data were taken from hospital records from January 2013 to December 2015. A total of 2,771 patients underwent in vitro fertilization IVF/ICSI, out of which 1,455 patients were pregnant (52.5%). Out of the pregnant patients, the incidence of ectopic (EP) and heterotypic pregnancies was calculated. The etiological factors, management of heterotypic pregnancies, and their pregnancy outcome were reported.

Out of the 1,455 pregnant patients, there were 29 EPs (EPs: 1.99%) and 5 were heterotypic (0.34%). Laparoscopic intervention was done for all five of them and successful pregnancy outcome was reported in terms of live birth.

Heterotypic pregnancy is rare and poses a diagnostic dilemma in assisted reproductive technology (ART) cycles. Serial beta-human chorionic gonadotropin (hCG) measurement is not reliable and ultrasonography may not confirm due to the presence of ovarian hyperstimulation syndrome (OHSS) or multiple cysts. Early diagnosis is ideal and good perinatal outcome can be achieved by prompt and excellent laparoscopic management of the heterotypic pregnancies.

Kalra A, Nadkarni AK, Nadkarni PK, Singh P. Successful Live Births after Laparoscopic Management of Heterotypic Pregnancies in Assisted Reproductive Technology Cycles: A Tertiary Fertility Center Experience. Int J Infertil Fetal Med 2017;8(3):125-127.