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   Table of Contents - Current issue
Coverpage
July-December 2016
Volume 3 | Issue 2
Page Nos. 51-101

Online since Thursday, November 16, 2017

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EDITORIALS  

Editor’s view point p. 51
Kuldeep Jain
DOI:10.4103/fsr.fsr_14_17  
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Unexplained infertility – debate continues p. 52
Kuldeep Jain
DOI:10.4103/fsr.fsr_12_17  
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REVIEW ARTICLES Top

Anti-Mullerian hormone – Promises and pitfalls p. 58
Sumita Agarwal, Neena Malhotra
DOI:10.4103/fsr.fsr_3_17  
Anti-Mullerian hormone (AMH) measurement is a routine practice that precedes every assisted reproductive techniques (ART) cycle in the current day. However, there is much more to AMH than just prediction of the cycle response. Many more applications have emerged in keeping with its role in understanding ovarian physiology and pathology. Many more contentious aspects need exploration on its measurements adding dimensions for future research.
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Overview of reconstructive and sperm retrieval surgeries in male subfertility p. 63
Siddharth Jain, Shipra Gupta, Surveen Ghumman
DOI:10.4103/fsr.fsr_13_17  
Male subfertility is an important clinical entity. It entails direct medical, financial, and psychological impact on the couple. A standardization of protocol in its management is yet to be achieved. Detailed workup of the males presenting with subfertility is necessary to elucidate the etiology and prognosticate the disease. Microsurgical reconstruction holds an important place in the management of obstructive disease of male genital tract. With the advent of microsurgical sperm retrieval techniques, couples have a chance to become the biological parents in the cases of nonobstructive azoospermia. All available treatment options should be given to patients to help them achieve a long-term possibility of spontaneous conceptions.
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An outline on the aetiopathological association of genetic polymorphisms in women with female genital tuberculosis p. 66
Venkanna Bhanothu
DOI:10.4103/fsr.fsr_4_17  
The aetiopathological association of genetic polymorphisms in women with female genital tuberculosis (FGTB) is not understood completely. This review summarises the role of gene polymorphisms in Mycobacterium tuberculosis infection leading to infertility and switching on of the toll-like receptor 2 (TLR2) as well as the interferon-gamma (IFN-γ) signalling mechanisms and attempts to give information on amplification refractory mutation system (ARMS)–multi-gene (MG)/multi-primer (MP) polymerase chain reaction (PCR). The study was conducted in the Department of Zoology, Osmania University, Hyderabad, India. Desired articles for systematic reviews and meta-analysis strategies were used for the critically review. Keywords and internet searches were conducted in all electronic databases from the beginning of September 03, 2006 to July 07, 2017. Full-text, English language reviews and research articles based on FGTB, gene polymorphism and infertility were included. This review provides a comprehensive overview on the role of genetic polymorphism and mycobacterium infection in causing infertility, related symptoms and highlights the role of ARMS–MG/MP PCR for the detection of gene polymorphisms among infertile patients with FGTB. A total of 163 studies were recognised; only a minimum number of reviews (n = 4/163, 2.45%) scored well. A review on the association of genetic polymorphism in a well-characterised set of infertile patients with FGTB and healthy control women without tuberculosis was chosen as main outcome. This study noted that more research is needed to correlate mutations in TLR2 and IFN-γ along with the functional consequences of other factors and recommends considering the ARMS–MG/MP PCR for a rapid analysis of any known mutation in genomic deoxyribonucleic acid.
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ORIGINAL ARTICLES Top

The impact of endometrial scratching on the outcome of in vitro fertilization cycles: A prospective study p. 80
Rita Bakshi, Bhavya Jha, Ram Prakash
DOI:10.4103/fsr.fsr_11_17  
Objective: Local endometrial trauma (endometrial scratch) is a treatment strategy to improve implantation rates. The objective is to study the relation of endometrial scratching in case of in vitro fertilization. Design: A randomized retrospective study was conducted to know the effects of endometrial scratching on the results of IVF procedure. Materials and Methods: Source of data: This study is undertaken at the International Fertility Centre, New Delhi, with patients with infertility undergoing IVF cycles. Method of collection of data (including sampling procedure if any): All diagnosed cases of primary and secondary infertility requiring IVF are enrolled in the study. A detailed history and clinical evaluation is done. Information is collected in a pretested proforma. Inclusion criteria: All diagnosed cases of primary and secondary infertility requiring self-egg IVF, who came to the OPD of International Fertility Centre, New Delhi. The group in which endometrial scratching preceded the IVF cycle was selected randomly irrespective of socioeconomic status, BMI, or any other factors . The cases and controls were of the same age group. Exclusion criteria: All cases of natural conception or IUI case. Statistical analysis: Following statistical methods are employed in the present study – contingency table analysis and Chi-square test. Results: (1) Endometrial scratching is statistically significant on 1st cycle of IVF outcomes. (2) Success of endometrial scratching in cases of recurrent implantation failure is statistically not significant. (3) Success rate of endometrial scratching in primary infertility cases is statistically not significant. (4) Success rate of endometrial scratching in cases of secondary infertility is statistically not significant. Conclusion: Endometrial scratching is statistically significant on 1st cycle of IVF outcomes. It is postulated that local endometrial injury in stimulated cycles delays endometrial development due to the wound repair process and thereby corrects the asynchrony between the endometrial and embryo stages.
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Role of FNAC mapping to guide directed sperm retrieval in infertile males for in-vitro fertilisation (IVF) p. 87
Dharmender Aggarwal, Chandra B Singh, Anil K Sarda
DOI:10.4103/fsr.fsr_7_17  
Background: Focal areas of spermatogenesis may exist in men even with small atrophic testis, raised follicle stimulating hormone (FSH) and in men previously considered to be having absence of spermatogenesis such as sertoli cell only syndrome. The study conducted by us has evaluated the regional differences in spermatogenesis by fine needle aspiration cytology (FNAC) mapping according to a standard template. This study aims at finding a possibility of directed sperm retrieval from region with better spermatogenesis for use in assisted reproduction techniques and intra-cytoplasmic sperm injection. Aimsand Objectives: The study was conducted with an aim to compare histological grading of spermatogenesis in testicular tissue by FNAC and biopsy in infertile males and to map the pattern of spermatogenesis in the testis of infertile males. Materials and Methods: Forty azoospermic men were taken into study and everyone underwent FNAC from eight different segments of one testis. They further underwent open biopsy from the segment, which showed better spermatogenesis. Results of FNAC and biopsy were compared. Results: Frequency of normal spermatogenesis was equivalent in all segments of testis by FNAC mapping (P value = 0.986). Sperm detection rate was 90% by eight-segment FNAC mapping in azoospermic participants. Correlation between results of FNAC and biopsy showed 85% concordance and 15% discordance. The eight-segment FNAC mapping showed sensitivity of 100%, specificity of 44.5%, and accuracy rate of 87.5% in detecting normal spermatogenesis. Conclusion: It is recommended to do FNAC mapping for every nonobstructive azoospermic subject, before undergoing retrieval procedure for better localization of spermatogenesis.
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A prospective, randomized trial comparing the effects of letrozole versus clomiphene citrate for induction of ovulation and pregnancy rate in women with polycystic ovary syndrome p. 93
Ratnabali Chakravorty, Amitoj Athwal, Dipanshu Sur, Rupam Saha
DOI:10.4103/fsr.fsr_10_17  
Objective: To compare the effects of letrozole and clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS). Design: Prospective, randomized, not blinded, controlled trial. Materials and Methods: This prospective, randomized clinical trial included 127 patients of infertile women with PCOS. The first group comprised 66 patients who received letrozole (2.5–5 mg) daily and the second group 61 patients who received (50–100 mg) CC daily for 5 days starting on day 3 of menses. Both the groups were followed by ultrasound until the dominant follicle reached a diameter ≥18 mm, human chorionic gonadotropin (hCG) 10,000 IU was given, and timed intercourse was advised. The treatment continued for three cycles in both the groups. Main Outcome Measures: Occurrence of ovulation, endometrial thickness, and pregnancy rate. Results: The mean age, duration of infertility, body weight, body mass index, and endocrine status in both the groups were similar at baseline. The total number of follicles during stimulation was statistically significantly greater in the letrozole group (6.81 ± 1.0 vs. 6.1 ± 1.5; P = 0.002). The number of follicles ≥18 mm was statistically significantly higher in the letrozole group compared with the CC group. There was no statistically significant difference in pretreatment endometrial thickness between the two groups, but endometrial thickness at the time of hCG administration was statistically significantly greater in the letrozole group (9.82 ± 0.7 vs. 8.13 ± 0.56; <0.0001). Ovulation occurred in 25 subjects (37.87%) in the letrozole group and 13 (19.67%) in the CC group, with a statistically significant difference between the two groups (P = 0.024). Serum E2 concentrations were statistically significantly lower in the letrozole group (P = 0.001). Conclusion: The effect of letrozole showed a better endometrial response and ovulation rate compared with CC. Letrozole may have a role as a first-line treatment for anovulatory patients with PCOS.
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CASE REPORT Top

Successful in vitro fertilization pregnancy in a case of unicornuate uterus with diminished ovarian reserve: A case report Highly accessed article p. 98
Shikha Jain, Kanad D Nayar, Deepak K Jain
DOI:10.4103/fsr.fsr_8_17  
The occurrence of Mullerian anomalies with concomitant gonadal abnormalities is very rare. Very limited number of case reports are published in the literature, and the exact incidence is not known. In this report, we present a case of unicornuate uterus with non-communicating rudimentary horn along with absence of adnexa on one side and smaller ovary on other side, leading to diminished ovarian reserve. The patient conceived with in vitro fertilization (IVF) with oocyte donation and delivered a healthy child at 38th week of gestation. Establishing an accurate diagnosis and management by IVF followed by adequate supervision of resulting pregnancy may lead to successful obstetric outcome in women with unicornuate uterus with diminished ovarian reserve.
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