Female genital tuberculosis (TB) is an important cause of significant morbidity, short- and long-term sequelae especially in infertility in which incidence varies from 5 to 15% cases in India. The causative agent is Mycobacterium tuberculosis. The fallopian tubes are mainly involved in 90 to 100% cases, endometrium in 60 to 80% cases, ovaries in 30% cases, and cervix in 15% cases of genital TB. Vagina and vulva TB is rare involving 1 to 2% cases. Diagnosis is made by detection of acid fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction (PCR) may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy is the gold standard for the diagnosis of the disease. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) for 2 months followed by rifampicin (R) and isoniazid (H) daily for 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as Directly Observed Treatment Short Course. Surgery is rarely required only for drainage of abscesses. Role of in vitro fertilization and embryo transfer is required in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is damaged.

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Context: Infertile women may experience high levels of psychological distress. The assessment of stress levels specifically related to infertility and the quality of life during infertility management needs to be evaluated. Aims: To study the psychological health of women undergoing assisted reproduction. Settings and Design: A cross-sectional study conducted between March 2014 and April 2015 at a tertiary care in-vitro fertilization setup in India. Subjects and Methods: Clinical interview and self-report measures were applied for an assessment of the psychological state of infertile women (N = 186). Anxiety was evaluated by Hamilton’s Rating Scale and Sinha’s Comprehensive Anxiety Test. Depression was assessed using Hamilton’s Rating Scale, Amritsar Depressive Inventory. Fertility and Quality of Life Questionnaire (FertiQoL) was applied to measure infertility specific stress. Overall life stress, covering all areas of life, was assessed using Presumptive Stressful Life Events Scale. Cornell Medical Index was applied to evaluate overall physical and mental health. Statistical Analysis: Student’s t-test and chi-square test were applied, and statistical significant levels were calculated at P < 0.05. Results: Clinically, significant depression was identified in 60.11–64.86% of the women. However, relatively lesser frequency of anxiety (27–37%) was observed. FertiQoL scores suggest that infertility treatment in itself is stressful, and nearly 80% of women reported increased levels of general life stresses. Conclusion: Being infertile has profound detrimental psychological impact on the life of women. Women undergoing treatment had significant high levels of psychological stress, depression and anxiety along with a lowered quality of life.

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Aim: The aim of this study is to compare the metabolic and endocrinal parameters between obese and nonobese polycystic ovarian syndrome (PCOS) women with normal controls. Materials and Methods: The study was a cross-sectional comparative study. One-hundred PCOS women were randomized into two groups: Group I obese (n = 50) and Group II nonobese (body mass index [BMI] cutoff <23 kg/m ² ). Fifty non-PCOS normal weight women formed the control Group III. Metabolic parameters (lipid profile, blood sugar profile, and serum insulin) and endocrinal parameters (serum luteinizing hormone [LH], follicle-stimulating hormone, and testosterone) were compared between the three groups. Results: Mean age of all the groups was comparable. A significantly higher waist circumference was seen in Group I; however, waist-hip ratio (WHR) was comparable between obese and nonobese PCOS groups. Between Groups I and II, mean fasting blood sugar, mean values of impaired glucose tolerance (IGT), and clinical hyperandrogenism were statistically comparable. Degree of insulin resistance (IR) in Group I versus Group II (44% vs. 36%) and of metabolic syndrome in Group I (20%) versus Group II (8%) was statistically comparable. Degree of hypertension (P = 0.001), IGT (P = 0.001), and dyslipidemia were higher in nonobese PCOS group versus normal group. Mean values of serum LH, serum fasting insulin, and serum testosterone were significantly different in nonobese PCOS women when compared with normal. Prevalence of IR (36% vs. 8%; P < 0.01) and metabolic syndrome was significantly higher in nonobese PCOS than normal controls. Conclusion: PCOS per se has evolved as a risk factor for endocrinal and metabolic derangements irrespective of the BMI status. Prevalence of IR and metabolic syndrome is high in nonobese PCOS as compared to normal controls, risks being as high as that in obese PCOS.

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Introduction: Clomiphene citrate (CC) has an important place in therapy for management of ovulatory dysfunction. The objective of the present survey was to understand the knowledge, attitude, and practice (KAP) of Indian gynecologists toward the use of CC. Materials and Methods: A prospective, cross-sectional, observational, questionnaire-based KAP survey conducted among Indian gynecologists. Out of 22 multiple-choice questions (MCQs), 9 questions were related to efficacy, 5 to safety, and 8 to perception about CC usage in routine clinical practice. Data were summarized by percentages in frequency tables and graphs. Results: Seven hundred seventy-one gynecologists in total across India participated in this survey. The majority of the participants preferred CC in treatment of ovulatory dysfunction associated with polycystic ovary syndrome (PCOS). The ovulation rate was reported to vary 21-60% and the pregnancy rate was noticed to be 11-30% by the majority of the participants. CC was reported to have very good to excellent efficacy and tolerability. Resistance to CC was encountered sometimes. Commonly encountered adverse effects included abdominal/pelvic discomfort or pain, ovarian enlargement, and nausea and vomiting. Frequent complications included multiple gestation, ovarian hyperstimulation syndrome (OHSS), and spontaneous abortion. Quite a few doctors reported congenital malformations with CC therapy. A majority of participants preferred CC in a dose of 50-100 mg/day for 5 days starting on the second or third day of the cycle. Most participants advised natural conception to patients receiving CC therapy. Metformin and gonadotropins were the preferred drugs coadministered with CC treatment. Conclusion: The present KAP survey highlighted CC as a commonly used agent for ovulatory dysfunction, with very good to excellent efficacy and tolerability.

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Objectives: To assess and correlate the oocyte morphological characteristics and embryo development in women with normal serum anti-Mullerian hormone (AMH) levels for different age groups women undergoing in vitro fertilisation (IVF). Materials and Methods: It is a retrospective study. A total of 92 women undergoing IVF treatment with normal AMH levels within two different age groups were included in the study based on retrospectively collected data from medical records. Based on age, women were subdivided into two groups: Group A with age >23 to <30 years (n = 40) and Group B with age >30 to <38 years (n = 52). The oocyte morphological characteristics were assessed and scored based on previously published method with minor modifications. Oocytes and embryo development were correlated in both groups with different age women (>23 to <30) Group A and (>30 to <38) Group B. Results: Patients’ demographic characteristics did not show significant difference in Groups A and B, except age (P < 0.05). Number of oocyte retrieved, number of mature MII oocytes and fertilization rate have not changed in both the groups. Good quality embryo development significantly improved in Group A than that in B (P < 0.05). Even mature oocyte number in both the groups was not statistically significant. However, oocyte morphological characteristics such as (1) oocyte overall morphology, (2) zona pellucida color and thickness, (3) size of perivitelline space (PVS), (4) presence of granules and (5) morphology of polar body and pattern of cytoplasm were significantly affected in Group B older age group women when compared with younger group women (Group A). Conclusion: AMH seems to be a better predictor of quality of oocytes and subsequently embryo development in older age group women when compared to the younger group women. Normal AMH level is a better predictor for ovarian reserve and along with this, it may help to predict oocyte quality and embryo development in older women undergoing IVF. Statistical Analysis: A student t test was applied to compare the means of two groups by online GraphPad software (www.graphpad.com/quickcalcs/, GraphPad Software, La Jolla, CA, USA). A P < 0.05 was considered statistically significant. Ethics: This is a retrospective study, and informed, signed consent was obtained from every couple prior to IVF treatment. Further, permission to use their data for analysis with guarantees of confidentiality was obtained. This study was exempted of institutional review board approval, since it involved only the analysis of medical records from established clinical practices.

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Background: Clinical trials to assess the benefits of acupuncture on in vitro fertilisation (IVF) treatment have differed in study design, protocol, outcome measures and commercial bias. This heterogeneity has precluded any firm conclusion regarding the efficacy, or otherwise, of acupuncture in this field. To address this, 15 international acupuncturists with experience in treating women during IVF participated in Delphi questionnaires and reached a consensus protocol to be used in future research. We were among the first to adopt this newly agreed standard protocol. The aim of this study was to address whether the agreed acupuncture consensus protocol is beneficial for IVF outcomes and may be offered to women undergoing IVF. Methods: An randomised controlled trial, in which 157 women were randomised to receive either acupuncture treatment three times in the treatment cycle in addition to our standard IVF protocol (n = 79) or no acupuncture treatment (n = 78) in their first or second IVF cycle. They were between 23 and 43 years with body mass index below 30. The study group (n = 79) received acupuncture based on the Delphi consensus protocol, between days 6 and 8 of ovarian stimulation, and twice on the day of embryo transfer, before and after transfer. The IVF practitioner was blinded to the randomisation. The primary end point was live birth. Results: Fifteen out of 79 women in the intervention group withdrew from the study compared to 9/78 women from the control group (P < 0.001). A per-protocol analysis revealed that the rate of live births (27/64, 42% vs. 11/69, 15.94%, P = 0.001) and positive pregnancy tests (34/64, 53% vs. 19/69, 27.53%, P = 0.013) were significantly higher in the acupuncture group compared with the control group. Conclusion: The results of this study imply that acupuncture may be offered as a possible method of improving IVF outcome. This study followed a widely approved consensus protocol hoping to settle disagreement in the literature and resolve previous disparity. Trial Registration: ClinicalTrials NCT02683967.

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Fibroids of the uterus, the most common benign pelvic tumors in women, as a sole cause of infertility has been debatable, as the incidence of fibroids as the cause of infertility in the absence of other obvious causes has been reported to be just 2-3%. Thus the management of myomas in the setting of infertility has also been controversial. However myomectomy has been considered ideal in a woman with sub fertility because the surgical removal of fibroid has definitely demonstrated improvement in pregnancy rate especially after assisted reproduction. Assisted Reproductive Technologies have resulted in an increase in the incidence of higher order multiple pregnancies which in turn is complicated by increased perinatal morbidity and mortality. Thus embryo reduction is offered to decrease the complication of prematurity and preterm birth due to multiple gestation. The technique of multifetal pregnancy reduction is not without risks especially in the presence of other pathology like multiple myomas. Herein we present a case of long duration infertility in the presence of multiple fibroids uterus which gets complicated by triplet gestation after IVF. Embryo reduction in the presence of these myomas is is a challenge both to the clinician in terms of the procedure and the patient because of the risks but subsequently has a successful pregnancy outcome.

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Here we present a rare case of complex uterine anomaly with Obstructed Hemivagina and ipsilateral renal agenesis (OHVIRA), also known as the Herlyn-Werner-Wunderlich syndrome (HWWS). A 16-year-old girl presenting with dysmenorrhea underwent ultrasonography, intravenous urogram (IVU), and magnetic resonance imaging (MRI) of kidney, ureter, and bladder (KUB). An abdominopelvic MRI was found to be very effective in reaching appropriate diagnosis with the avoidance of interventions like laparoscopy or laparotomy, which was needed in the past to diagnose this rare anomaly. We also discuss the embryopathogenesis of this anomaly and review the literature.

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Objective: To evaluate and compare the effects of letrozole and low-dose gonadotropin combination with clomiphene citrate (CC) and low-dose gonadotropin combination prior to intrauterine insemination (IUI) in patients with unexplained infertility. Design: Prospective, randomized, clinical study. Setting: Academic tertiary institute. Patient(s): A total of 94 patients in the age group of 21-37 years with unexplained infertility were randomized using computer-generated random number table to receive follicle-stimulating hormone (FSH) injection and human menopausal gonadotropin (hMG) injection, along with either letrozole or CC. Intervention(s): All the patients received 150 IU of purified urinary FSH on day 2 of the cycle and from day 3 to day 7 of the cycle 5.0 mg/d of letrozole or 100 mg/d of CC were administered; this was followed by administration of 150 IU of hMG on day 9. Ovulation was triggered with human chorionic gonadotropin (hCG) injection (5,000 IU) when the dominant follicle(s) reached 18 mm in diameter. A single IUI was performed 36 h later. The luteal phase was supplemented with micronized progesterone vaginally. Main Outcome Measure(s): Pregnancy rates and the incidence of multiple pregnancies were our primary outcome. The secondary outcome included the number of dominant follicles, grade of perifollicular blood flow, endometrial thickness, endometrial blood flow pattern, side effects, and complications. Result(s): There were no differences in demographic characteristics between the two groups. Pregnancy occurred in four out of 47 patients (120 cycles) in the letrozole group (pregnancy rate: 8.5% per patient and 3.3% per cycle) and eight out of 47 patients (121 cycles) (pregnancy rate: 17% per patient and 6.6% per cycle) in the CC group; the differences were not statistically significant. None of the regimes resulted in a multiple gestation gestation. The number of follicles per cycle was significantly higher in the CC + gonadotropin group as compared to the letrozole + gonadotropin group (1.77 ± 0.99 vs. 1.39 ± 0.617, P < 0.001). There was no statistically significant difference in perifollicular blood flow, endometrial thickness, and endometrial blood flow pattern between the two groups. No side effects were observed in either group. There was one case of ectopic gestation in the CC group. Conclusion(s): The use of lower dose of gonadotropins and oral agents together resulted in decreased medication costs, lesser monitoring [ultrasound (USG) visits], and good primary and secondary outcomes. However, more randomized controlled trials are needed to prove the efficacy of one regime over the other.

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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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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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Study question: Oocyte donation is an increasingly popular treatment option for pregnancy and parenthood in women with poor ovarian reserve or advanced age. Indian literature still lacks a formal study focusing on expectations and experiences of oocyte donors. Aim: To assess demography, expectations and experiences of oocyte donors in northern India by an interview-based questionnaire. Material and Methods: This is a prospective cross-sectional study at a tertiary care IVF centre from August 2018 to January 2019. Sample size was 65 oocyte donors found fit and willing for egg donation. Interviews were taken using structured questionnaire at the time of registration and after successful oocyte retrieval. Results: Mean age of donors was 25 years. Most of the donors were housewives (70%) and rest were in a private job. Only 29% of donors were educated above tenth standard. Almost all the donors (96%) were commercial donors introduced by paid agents or friends. Most of the donors had very poor understanding of details of the oocyte retrieval procedure. Only 36% of donors felt that compensation given is adequate, rest expected a higher compensation. Average compensation given to donors was INR 15,000–25,000, which was 5000–10,000 less than their expectations. All donors were satisfied with the procedure and did not feel exploited or anxious or depressed but few complained of discomfort experienced in visits and minimal complications like pain, nausea, and fever. None of the donors developed signs/symptoms of OHSS. Average number of oocytes retrieved per donor was 17. Mean dose of gonadotropins required per donor was 1495 IU. Conclusion: Our findings show that the oocyte donation has an overall good acceptance and satisfaction among the donors. However there is a need to impart more detailed information to donors in order to prevent their possible exploitation.

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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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HIV infection has nowadays become a chronic disease. Antiretroviral drug therapy has improved the life expectancy of these patients. Patients are living longer and those in reproductive group have a desire for conception. HIV infected patients may have infertility. Various treatment strategies are followed so that there is minimal or no risk of HIV transmission to the uninfected partner or their offspring. ART (assisted reproductive techniques) clinics with the necessary resources can offer services to HIV infected patients and couples who are willing to use recommended risk-reducing therapies.

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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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Background: Various parameters of embryo morphology have been routinely used to select the embryo/s with maximum implantation potential during in vitro fertilization (IVF). Hence, there is a dilemma in clinical practice as to which morphological scoring system/test to use. We performed a systemic review to determine the predictive power as well as the clinical and cost-effectiveness of existing morphological tests of embryo quality described in an IVF setting. Materials and Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic review were followed. A mixed-method analysis was performed. Qualitative and quantitative techniques were used to synthesize the final results. A narrative summary approach was used for initial data exploration and description, followed by the pooling of data, where appropriate, using Meta-DiSc software. Receiver operating characteristic (ROC) curves were plotted wherever appropriate, and the area under the curve (AUROC) was determined. Results: Day 3, day 5, and early cleavage (EC) all had similar discriminatory value for predicting implantation (AUC 0.66, 067, and 0.63 respectively). There was no evidence of improvement in pregnancy rates due to routinely doing EC. No studies were identified that determined the cost-effectiveness of any of the tests. Conclusions: All tests have low accuracy. They lack the discriminatory power to identify an embryo that will/will not lead to implantation. Appropriately designed studies are required to assess the predictive value and the clinical and cost-effectiveness of novel embryo scoring technologies.

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Color Doppler is emerging as a valuable diagnostic imaging modality in the field of reproductive medicine, primarily infertility. Reproductive disorders, including infertility and spontaneous abortions/miscarriages, have emerged as major public health problem(s) worldwide. Color Doppler energy imaging is a high throughput technology based on the total integral of energy frequency spectrum. We extracted the most relevant articles (comprehensive reviews and original research articles) for inclusion in our review by performing a comprehensive literature search using the Pubmed (last accessed on 2015 April 28) scientific database. Color Doppler is a high-throughput, sophisticated imaging technique for the assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring, endometrial receptivity, failed and/or ectopic pregnancy, male infertility, and uterine, endometrial, and ovarian vascularity. Assessments of the uteroovarian pulsatility indices (PIs), resistance indices (RIs), and endometrial color signals are important determinants of in vitro fertilization (IVF) cycles and pregnancy rates. With our clinical/scientific research experience in the field of reproductive medicine, we strongly believe that an overall public health model needs to be designed in managing infertility patients; therefore, major issues such as cost-effectiveness and technical artifacts should be addressed so as to achieve an accurate clinical diagnosis, successful IVF outcome/pregnancy, and overall patient satisfaction in a clinical research setting. Simple, safe, efficient, and affordable diagnostic modalities should be incorporated at infertility clinics coupled with well-designed patient counseling sessions and community-based public health awareness campaigns conducted so as to reduce the morbidity and mortality rates associated with reproductive disorders.

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Context: Ovarian interleukins (ILs) mediate folliculogenesis, gametogenesis, fertilization, embryo development and implantation. Aims: Evaluation of the role of the quantitative levels of follicular fluid (FF) IL-1Beta (1β), IL-10 and IL-12B (p-40 subunit) in women underwent assisted reproduction. Setting and Design: Prospective observational study conducted between July 2013 and August 2015 at University Hospital’s in vitro fertilization (IVF) set up in North India. Materials and Methods: Women (n = 168) were worked up for IVF/intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. FF samples were pooled and collected from ovarian follicles of size ≥16 mm for each woman on the day of oocyte retrieval. Quantitative levels of IL-1β, IL-10 and IL-12B were estimated by enzyme-linked immunosorbent assay technique. Quantitative levels along with demography, cycle characteristics, endometrial thickness, number of retrieved oocytes, fertilization rate and embryos quality were compared between pregnant and nonpregnant groups of women. Student T-test, Mann–Whitney U-test, chi-squares test and logistic regression were applied as appropriate. Statistical significance level was calculated at P < 0.05. Results: Women (n = 168) were divided into pregnant (Group A; n = 75) and nonpregnant (Group B; n = 93) groups. The median levels of IL-1β, IL-10 and IL-12B levels were found significantly lower in women in Group A as compared to Group B [41.2 pg/mL (1.7–370) vs. 78.5 (5.6–313.58); P < 0.001**, 53.2 pg/mL (1.8–183.7) vs. 135.2 pg/mL (1.3–385.4); P < 0.001** and 115.3 pg/mL (3.8–822.9) vs. 178.3 pg/mL (36.1–1938.3); P < 0.009*, respectively]. Conclusion: Lower concentrations of IL-1β, IL-10 and IL-12B in FF were found in a protagonist with positive pregnancy outcome and can be served as a reliable predictive marker of successful IVF/ICSI-ET outcome in women underwent assisted reproduction.

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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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Chronic endometritis is an asymptomatic condition. It results from persistent inflammation of the endometrial lining caused by the presence of microorganisms in the uterine cavity. It is often associated with infertility and poor reproductive outcome. The pathogenesis of chronic endometritis and its association with infertility has been reviewed. Diagnostic modalities and treatment for chronic endometritis are also discussed.

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Introduction: Targeted manipulation of complex biochemical signaling pathways in unraveling the complexities associated with human reproductive disorders, including infertility, appears to be an attractive immunomodulatory therapeutic strategy in reproductive medicine and disease. Toll-like receptors (TLRs), a family of evolutionarily conserved pathogen recognition receptors, are emerging as pivotal players in the pathophysiology of a spectrum of human diseases, including infertility. Inflammation and infections in the female reproductive tract are common causes of infertility globally; TLR immune surveillance initiates inflammatory responses to foreign pathogens. Materials and Methods: A comprehensive literature search using PubMed and Medline scientific database(s) (last accessed June 6, 2016) was performed, and accordingly the author included the selected articles in the present review; public health research studies for developing cost-effective infertility assessment programs in low-resource settings targeting North Indian couples are ongoing so as to reduce the burden of disease as well as psychosocial factors associated with infertility. Results: Significant recent advances in microarray and next-generation sequencing technologies have enabled the application of whole-genome approaches to the study of infertility; successful implantation requires synchronization between the acquisition of implantation competency by the blastocyst and a receptive state in the uterine endometrium. Conclusion: The author speculates that immunomodulation of cell-specific ligand–receptor interaction(s) is essential for initiating the subsequent intermediate/downstream events in signal transduction pathways, eventually leading to specific cellular/biological response(s); in this context, TLR-based therapeutics and subsequent TLR-based patient-centric biomarker research studies will certainly provide a more meaningful understanding of the pathophysiological basis of reproductive disorders, primarily infertility in the 21st century.

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Intrauterine insemination (IUI) is a commonly performed procedure in the treatment of infertility. Its outcome depends on multiple factors. Semen is an important predictor for the success of IUI. Various semen parameters like sperm concentration, motility, morphology, and number of motile sperms inseminated determine the outcome of IUI. Advanced sperm function tests are required in addition to the standard semen analysis in few infertile patients.

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