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   Table of Contents - Current issue
January-June 2019
Volume 6 | Issue 1
Page Nos. 1-51

Online since Wednesday, September 18, 2019

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Editors View Point 2019 p. 1
Kuldeep Jain
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Profertility counselling: when, where and how p. 2
Umesh N Jindal
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Effect of modifiable risk factors on semen parameters p. 10
Saumya Prasad, Swatantra Nagendra Rao, Sudha Prasad
Objective: This article examines the potential effects of lifestyle factors on male reproductive health. Evidence of a global decline in human sperm quality over recent decades has been accumulating. Environmental, occupational and modifiable lifestyle factors may contribute to this decline. This review focuses on key lifestyles factors such as diet, caffeine intake, tobacco chewing and alcohol intake. Method: A comprehensive literature search was performed to identify the major lifestyle factors associated with male infertility and semen quality. Database searches were limited to reports published in English only. Results: A prudent diet consists of high intake of fish, fruit, vegetables and legumes. Fat in diet is also as essential as other component of the diet. Although largely the evidence is observation based, evidence appears to support an approach of moderation carbohydrate and fats with better semen parameters. A good intake of antioxidants in diet and supplement correlates with higher sperm numbers and motility. The other very important modifiable factors are tobacco chewing, alcohol and caffeine intake. Nicotine in tobacco is found to suppress sperm progressive motility; it also reduces the percentage of viable spermatozoa and increases the altered chromatin compactness. Alcohol consumption leads to increased testosterone level due to change in oxidation metabolism of steroids in liver. Alcohol oxidation increases the Nicotinamide adenine dinucleotide (NAD) ratio which causes the re-dox state in favour of conversion of androstenedione into the reduced steroids testosterone and oestradiol. Caffeine intake has been associated with sperm DNA defects, aneuploidy and DNA breaks. Conclusion: The major lifestyle factors discussed in the present review are the potential issues that can possibly impair male infertility. However, their negative impact can be overcome by behavioural modification and better lifestyle changes.
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Hyperandrogenism − approach and management p. 16
Pikee Saxena, Nihita Pandey
Hyperandrogenism accounts for a number of distressing symptoms in the patient. Evaluation of the underlying cause is the key to the correct management of this common endocrine disorder. In this review, we analyse hyperandrogenism in terms of pathophysiology, evaluation and management options for the patient. Various Pubmed studies spanning multiple decades have been studied and evaluated in order to formulate an algorithm for diagnosis of the causes of hyperandrogenism and also to devise a management protocol for the same. The myriad underlying causes of hyperandrogenism make it imperative to have a detailed understanding of its pathophysiology so as to more effectively treat it.
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Association of body mass index (BMI) and sub-fertility among young women in Karachi, Pakistan p. 23
Mubashir Zafar
Objective: The aim of the study is to determine the association of body mass index (BMI) with sub-fertility among young women in Karachi Pakistan. Methods: It is a case control study in which 284 participants were selected through simple random sampling technique and 142 divided into cases and control group. Cases were nulliparous women who were not able to conceive after 24 months of unprotected intercourse and controls were primigravida women. Validated questionnaire was given to patients, height and weight was measured and BMI was calculated. Odds ratio (OR) was calculated with logistic regression. Results: Mean age of the study participants were (25.3 years standard deviation ± 2.5). After adjustment of the covariates, women with high BMI (BMI 30 and above) were more than four times {OR 4.20 (95% confidence interval, CI, 1.59–10.14)} and women with BMI 25 to 29.9 were more than one times sub-fertile {OR 1.19 (CI 0.45–3.13)} compared to normal (BMI 20.0–22.4). The women with less frequency of intercourse (1–2 times/week) were more than three times {OR 3.73 (CI 1.75–7.94)} were sub-fertile. Conclusion: There is need for inventions to control BMI which increase fertility level among women. Nutritional modification requires to counter infertility because obese women require higher doses of medication and produce fewer follicles.
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A study to determine the prefreeze motility parameters suggesting a favorable outcome p. 29
Charu Goyal, Umesh Jindal, Sanjeev Maheshwari, Simmi Maheshwari
Introduction The recovery of functionally intact spermatozoa from thawed samples is dependent on the cryopreservation process and initial quality of the semen sample. Material and Methods 100 semen samples were cryofrozen by conventional slow freezing method. With reference of post thaw PR ≥0.4 (ratio of post thaw progressive motility/ pre thaw progressive motility) samples were grouped into poor freezability ejaculates (PFE, n = 19) with ratio < 0.4 and good freezability ejaculates PR ≥0.4 (GFE, n = 81). Results There was no statistical significance of survival of sperms with age of husband and sperm count prior to cryopreservation. The semen samples which had curvilinear velocity in the range of 56.47- 97.95 um/s-1, straight line velocity 42.811 - 72.649 um/s-1 and average path velocity 39.77- 70.11um/s-1 before freezing have good survival of sperms after thawing. Conclusions Assessment of the prefreeze velocity parameters by CASA to predict the survival of sperms post thawing so that proper counseling of patients regarding cryosurvival of sperms could be done during semen cryopreservation.
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Addition of oestradiol to progesterone for luteal phase support in GnRh antagonist IVF/ICSI cycles p. 35
Rachita Munjal, Sweta Gupta
Objective: Studies have found conflicting results with respect to the use of progesterone alone or oestrogen and progesterone as luteal phase support for in vitro fertilisation (IVF)/ICSI cycles involving use of GnRh antagonist. The purpose of the study is to determine the effect of luteal phase supplementation with oestradiol and progesterone versus progesterone alone in women undergoing IVF/ICSI-Embryo transfer (ET) in relation to the pregnancy rate. Design: This was a retrospective observational study spanning 1 year conducted at Medicover Fertility, New Delhi. A sample size of 150 women was taken. Materials and Methods: All women underwent controlled ovarian stimulation by gonadotropin and GnRh antagonist protocol. Oocyte retrieval was performed after 34 to 36 hours of hCG trigger and embryos were transferred 3 days after oocyte retrieval. According to luteal phase support protocol, two groups were made: study group (oestrogen plus progesterone, n = 75) and control group (progesterone alone, n = 75). Results: The study and control group did not differ for age, religion, duration of infertility, cause and type of infertility. Out of 75 women in the study group, 31 women conceived, the pregnancy rate being 41%. In the control group, 27 out of 75 women conceived, the pregnancy rate being 36%. Thus, the pregnancy rate was observationally higher in the study group, but the difference was not statistically significant (P value = 0.50). Conclusion: Giving oestradiol supplementation along with progesterone in the luteal phase did not improve pregnancy rates significantly. Further, more studies are required to see hormonal profile of oestradiol and progesterone levels during luteal phase and its correlation with pregnancy rate.
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Sugar-sweetened beverage intake in relation to semen quality in infertile couples − a prospective observational study p. 40
Indrani Ghosh, Pramod K Sharma, Mujibur Rahman, Kabita Lahkar
Aims: This cross-sectional study was designed to evaluate effect of sugar-sweetened beverages (SSBs) on semen parameters in infertile couples. Setting: Men attending infertility clinic. Design: prospective, observational study. Methods and material: Participants were assessed the type and frequency of SSB intake in the past month by a previously validated beverage intake questionnaire (BEVQ-15) and provided one semen sample for analysis. The primary outcome were semen parameters; namely volume (in mL), total sperm count (in millions/ejaculate), sperm concentration (in million/mL), sperm motility% (PRM+NPM+IM), progressive motility% (PRM), vitality% and sperm morphology% (per 200 spermatozoa). The main independent variable was SSB intake. Statistical analysis: Multiple linear regression models were used to predict semen parameters based on SSB intake and potential confounders, compared across quartiles using Kruskal-Wallis test. Non-linearity was examined by fitting models with linear and quadratic terms. Results: 385 men were included in the study. A significant decline in crude sperm motility% (P<0.001), progressive motility% (P<0.001), vitality% (P=0.017) and normal sperm morphology (P=0.006) with increasing SSB intake was found, along with a significant decline in volume and sperm concentration in the adjusted model (P<0.05). Significant decrease was noted in sperm motility and progressive motility percentages in both lean (BMI <25) and overweight and obese men (BMI ≥25) with increasing SSB intake. However, in presence of other potential confounders, SSBs lost its impact on semen parameters in the linear and quadratic fitted models, possibly due to interdependence of the confounders. Conclusion: Intake of SSBs negatively affect sperm parameters, except total sperm counts. But with other stronger confounders, its impact needs to further evaluated in larger populations of men.
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Secondary azospermia due to leprous involvement of testis − a case report p. 49
Nidhi Yadav, Sumit Kar, Safa Patrick, Priyanka Date, Komal Ramteke, Pooja Manwar
Leprosy is a chronic infective granulomatous disease with clinical features depending upon the host immune response. Leprosy affects cooler areas of body i.e nose, superficial nerve trunks, anterior chamber of eyes and scrotum and testis in male however; leprous involvement of scrotal skin and orchitis with resultant azoospermia has been not reported till date. Many Indian authors have reported sporadic involvement of scrotum and male genitalia in leprosy. however, simultaneous involvement of testes and scrotum leading to male infertility has been sparingly reported. In this paper, we report a case of unmarried male presenting with leprous affection of external genitalia leading to hypergonadotropic hypogonadism with absolute azoospermia. though leprosy is rare on genitalia, one should not neglect examination of genitalia in all male leprosy patients.
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