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   Table of Contents - Current issue
January-June 2018
Volume 5 | Issue 1
Page Nos. 1-36

Online since Thursday, January 17, 2019

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Editor’s view point p. 1
Kuldeep Jain
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Freeze all for all − Proceed with caution p. 2
Abha Maheshwari
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Adjuvant therapy in poor ovarian response – Where do we stand? p. 4
Rupali Goyal
In the current era, there is an ever increasing incidence of poor ovarian response. Many strategies have been studied and hypothesized for the management. Androgens have been widely used and studies in the management of Poor ovarian response. The two prime androgens used in poor ovarian response are Dehydroepiandrosterone [DHEA], Androstenadione and testosterone. Use of Growth hormone, recombinant luteinizing Hormone and vasoactive substances have been analyzed based on the current evidence.
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Oocyte quality and ICSI outcome in patients with tuberculosis p. 9
Kiran Chaudhary, Bharti Jain, Kuldeep Jain
Objective: To evaluate the effects of tuberculosis on oocyte characteristics and ICSI outcome. Study design: Prospective comparative observational study. Setting: Tertiary level infertility care centre. Materials and methods: Study group: Women undergoing ICSI with h/o tuberculosis (1 clinical + I laboratory criteria). Control group: Women undergoing ICSI without h/o tuberculosis or tubal factor infertility. Sample size: 28 patients in study and 30 patients in control group. Exclusion criteria: Age >35 yrs. Intervention: ICSI(intracytoplasmic sperm insemination). Statistical analysis method: Statistical analysis was performed by the SPSS program for Windows, version 17.0. Continuous variables are presented as mean ± SD, and categorical variables are presented as absolute numbers and percentage. Data were checked for normality before statistical analysis. Normally distributed continuous variables were compared using the unpaired t test, whereas the Mann-Whitney U test was used for those variables that were not normally distributed. Categorical variables were analysed using either the chi square test or Fisher’s exact test. For all statistical tests, a p value less than 0.05 was taken to indicate a significant difference. Primary outcome measures: no. of mature oocytes (oocyte retrieval rate); no. of other variants of oocytes (M1, dysmorphic, GV, small, large, or polar body). Secondary outcome measures: FSH, LH, AMH, and AFC values; no. of days of stimulation; fertilization rates; embryo morphology; implantation rates; ongoing pregnancy rates. Results: There was no statistically significant difference with regards to age, FSH and LH levels, AFC between the two groups. The mean AMH values in cases and controls were 1.51 ± 0.96and 2.6 ± 1.46 respectively ,the difference being statistically significant. (p value -0.021) mean days of stimulation in cases were 10 while in controls were 10.4, the difference being statisticallt insignificant. Retrieval rates of M2 oocytes in cases and controls were 33.3% and 93.3% respectively , the difference being statistically significant(p value- <0.001) Comparison of other variants of oocytes and the fertilization rates (cases-72.0 ± 29.0,controls-83.7 ± 17.0) didn’t reveal any statistically significant difference between the two groups. There was statistically significant difference (p value -0.0001) between the cases and controls when compared for number of grade A embryos (cases:85.7%, controls: 93.1%). The clinical pregnancy rates in the cases and controls were 14.3 % and 36.7% respectively, the difference being statistically insignificant. However when cases and controls were compared for ongoing pregnancy rates (cases: 3.6% ,controls : 30.0%) the difference was statistically significant (p value-0.013). There was only 1 case of ectopic gestation which was in controls and incidence was statistically insignificant. Conclusion: ICSI cycles in patient with positive history of genital tuberculosis were associated with low AMH values, lesser M2 retrieval rates, lesser grade A embryo formation rates and lesser ongoing pregnancy rates. However the study results are limited because of the small sample size. More studies with greater sample size are needed to evaluate the oocyte quality in these patients undergoing ICSI cycles.
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Impact of BMI on IVF outcome p. 14
Surveen Ghumman, Pinkee Saxena, Sandesh Patel, Shipra Gupta, Mohita Gupta
Introduction: Nowadays increasing number of obese women are seen attending infertility clinics. The objective of this study was to find out relationship of body mass index (BMI) on IVF cycles and to note of increased BMI. Materials and Methods: This was a retrospective study. All the patients undergoing IVF during the study period were divided in to three groups based on BMI − Group 1: <25 kg/m2; Group 2: 25 to 29.9 kg/m2; Group 3: ≥30 kg/m2. Records were analysed such as patient’s age, BMI, duration and cause of infertility, antral follicle count and hormonal profile. The total gonadotropins dose used, duration of stimulation, number of retrieved oocytes and pregnancy rate were noted. Results: A total of 151 women with non-donor IVF cycles were analysed. There were 58 patients in Group 1, 68 patients in Group 2 and 25 patients in Group 3. Laboratory parameters such as serum FSH, serum LH, serum AMH and serum E2 were compared. Serum AMH were found to be slightly higher in the obese group but was not statistically significant. Other hormones levels were comparable in the three groups. The total gonadotropin dose required for stimulation of follicles was found to be significantly higher in Group 3. The number of oocytes retrieved was similar in the three groups and so was the pregnancy rate. Conclusion: The present study suggests that BMI does not have significant impact on IVF cycles.
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Comparison of antral follicle count measurement between 2D and 3D SonoAVC modality − An observational study p. 18
Noopur Chhasatia, Bharati Dhorepatil
Introduction: Several studies have reported a correlation between antral follicle count (AFC) by 2D modality and anti-Mullerian hormone. However, few studies have reported a comparison between 2D modality and 3D SonoAVC AFC measurements. Objective: To compare the total AFC using 3D SonoAVC with 2D modality. Materials and Methods: We included 50 infertile women presenting to a private fertility clinic between January and May 2018. AFC was measured on day 2 or 3 of menses. The scanning was performed by transvaginal ultrasound using 2D and 3D technology. Results: Statistical analysis demonstrated that both modalities were equivalent. Although AFC was higher using 3D SonoAVC as compared to 2D modality (mean difference of three follicles), the difference was not found to be statistically significant (P = 0.184). Conclusion: SonoAVC is a promising tool for AFC measurement in infertile women and is comparable to 2D AFC measurement. Modification of technology and post-processing can further improve the accuracy.
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Facts of life and global issues affecting semen parameters causing male infertility in and around our institute − A prospective study p. 23
Veer Karuna, Kriti Grover, Nidhi Verma, Preeti Singh, Priya Gupta, Monika Rathi
Context: Nowadays, the inability to conceive is a common problem. Reason can be either from female or male side. Male lifestyle factors such as alcohol consumption, tobacco smoking and chewing are some of the most common causes of male infertility. Aims: The aim was to describe the semen quality (sperm count and motility) of those consuming alcohol and smoking and chewing tobacco. Settings and Design: This prospective study was conducted in and around of our institute, during the period of July 2017 to June 2018. Materials and Methods: A total of 203 cases, aged 18 to 50 years, were included for semen analysis by using manual method according to World Health Organization 2010 criteria and also asked to answer a validated questionnaire about life habits and health status. Data analysis was performed by Statistical Package for the Social Sciences version 19. Results: Of 203 samples, 125 (61.58%) cases were between the ages of 18 and 30 years. Percentage of normozoospermia, oligozoospermia and azoospermia were 73.40%, 23.15% and 03.44%, respectively. Out of 47 (23.15%) sample of oligozoospermia, 38 (80.86%) were alcoholic, 32 (68.09%) men tobacco smokers and 12 (25.54%) men tobacco chewers. A total of 72 (35.47%) out of 203 samples showed reduced sperm motility, of which 50 (69.44%) patients were addicted to alcohol consumption. Conclusion: This study indicates that male fertility is damaged by negative influences of lifestyle factors. Therefore, before the attempt to conceive, it is advisable to modifying lifestyle factors discussed in the present study that helps controlling their own fertility potential.
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Tracking the implantation window: Synchronizing endometrial preparedness for implantation with stage of blastocyst to be transferred in antagonist IVF cycles involving single blastocyst transfers p. 27
Bindu N Chimote, Natchandra M Chimote
Introduction The day of menstrual period is usually not taken into account during embryo transfer in IVF cycles. Aim We sought to track the relevance of ‘implantation window’ by contemplating a correlation between stage of blastocyst transferred and endometrial preparedness for implantation with respect to day of menstrual period in antagonist in vitro fertilization (IVF) cycles. Design, Materials and Methods This study involved retrospective analysis of 443 cycles in women undergoing antagonist treatment protocol followed by oocyte-retrieval approximately between days 12 and 16 (rarely on days 17 and 18 in case of long follicular phase) of their menstrual period. All cycles involved day 5/6 single blastocyst-transfer (sBT) of top (AA) or good (AB/BA) quality blastocysts of various stages. Slightly modified Gardner’s system for blastocyst-stage grading was followed. Inner cell mass, trophectoderm, were graded as A, B, C as per Gardner’s system. Clinical pregnancy rate (CPR) and live birth rate (LBR) were main outcome measures. Results Overall CPR = 26.64% (118/443), whereas LBR was 21.67% (96/443). CPR was influenced by transfer of various stages (1–6) of the blastocysts on different days of menstrual period (days 17–24, covering the implantation window). Our results indicate that as day of menstrual period advances during the window period, higher stage blastocyst-transfer enhances the odds of a live birth. Conclusion Synchrony between stage of blastocyst transferred and the endometrial preparedness for implantation with respect to day of menstrual cycle has a definitive influence on LBR in IVF cycles. Asynchrony and out of phase BT may lead to missing out the implantation window and unnecessarily hamper CPR/LBR.
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Live birth from TESA-ICSI in a modified natural cycle − A case report p. 33
Swati Kumari, Gunjan Kacker
Low ovarian reserve affects 10% of all women seeking fertility treatment. Management of patients with diminished reserve is challenging to fertility experts as they respond poorly to ovarian stimulation, and often such patients resort to oocyte donation. The number of births from natural cycle oocytes with surgically extracted sperm is low, but the case presented here describes a successful case in which a live pregnancy was achieved. In the treatment of a 36-year-old female with bilateral antral follicular count of one to two, two M II oocytes were obtained after modified natural cycle. The husband’s semen analysis showed severe infection with occasional dead sperms. The patient did not respond to antibiotics and due to unavailability of sperm on the day of oocyte extraction, the oocytes were vitrified. Sperms were subsequently extracted by TESA. The vitrified oocytes were warmed, and ICSI was performed on the same day. One eight-cell grade I embryo was formed on D3 which was transferred in a programmed hormone replacement cycle. Pregnancy was obtained and a healthy infant was delivered. Hence, in women with low ovarian reserve, the use of modified natural cycle may provide a good alternative to achieving pregnancy prior to considering oocyte donation.
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