Year : 2014 | Volume
: 7 | Issue : 3 | Page : 157--158
From the Editor's desk
Editor-in-Chief, Journal of Human Reproductive Sciences, Dr. Patil's Fertility & Endoscopy Clinic, No. 1, Uma Admiralty, First Floor, Near Jal Bhavan, Bannerghatta Road, Bangalore - 560029, India
Editor-in-Chief, Journal of Human Reproductive Sciences, Dr. Patil«SQ»s Fertility & Endoscopy Clinic, No. 1, Uma Admiralty, First Floor, Near Jal Bhavan, Bannerghatta Road, Bangalore - 560029
|How to cite this article:|
Patil M. From the Editor's desk.J Hum Reprod Sci 2014;7:157-158
|How to cite this URL:|
Patil M. From the Editor's desk. J Hum Reprod Sci [serial online] 2014 [cited 2017 Dec 14 ];7:157-158
Available from: http://www.jhrsonline.org/text.asp?2014/7/3/157/142473
This issue has two review articles one on recurrent miscarriages and other on gonadotropin-releasing hormone (GnRH) analogs. Implantation failure and recurrent miscarriages are a major dilemma, since its potential causes are often complex and poorly understood. Recurrent miscarriage is distressing both to the infertile couple and physician responsible for treatment. The first review article on recurrent miscarriages discusses the various etiologies and treatment options. One must remember that the etiology of recurrent miscarriage is complex and ill-understood and treatment options are vague and, therefore, maximum effort should be deployed to isolate the potential correctable factors that may be responsible.
Most protocols for ovarian stimulation using gonadotropins incorporate GnRH agonist and antagonist co-treatment, to prevent a premature rise in luteinizing hormone (LH) in in vitro fertilization (IVF) cycles. Its use in intrauterine insemination (IUI) cycles is controversial, though the pregnancy rates may be slightly higher with the use of analogues. But one must remember that use GnRH agonist in IUI cycles is associated with a higher incidence of ovarian hyperstimulation syndrome and multiple pregnancies. On the other hand, the GnRH antagonist may not be cost-effective as, one knows that to achieve one extra pregnancy the numbers needed to treat is 20. Protocols using GnRH antagonists are effective in preventing a premature rise of LH and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol. The review on GnRH analogs discusses their role in the management of endometriosis, uterine leiomyoma's, hirsutism, dysfunctional uterine bleeding, premenstrual syndrome, assisted reproduction, and some hormone-dependent tumor's, other than ovulation induction.
One original article describes the use of laparoscopic peritoneal pull-through in creation of neo-vagina in patients with vaginal agenesis as seen in patients of Mayer Rokitansky Kustner Hauser syndrome. Apart from giving excellent normal vaginal function, the ovary became accessible per vaginum for oocyte retrieval.
As most women are delaying their childbearing for social reasons, today we come across several cases with poor ovarian reserve (POR). This group of women requires some method to improve their reproductive outcome. A pilot study on "impact of dehydroepiandrosterone" on clinical outcome in poor responders' is published by Jirge. This study concludes that dehydroepiandrosterone results in an improvement in oocyte yield, embryo quality, and live birth in a group of women with POR having undergone at least two previous failures due to POR.
Result of any assisted reproductive technique (ART) is dependent on the oocyte quality, embryogenesis and embryo quality. Predicting oocyte quality could predict the results of ART. Earlier publications have shown that estradiol and progesterone concentration were significantly higher in large follicles with meiotically competent oocytes compared with those containing meiotically incompetent oocytes. Testosterone levels were increased in polycystic ovary syndrome follicles compared with normal patients, with no difference between corresponding sub-groups of follicles with meiotically competent oocytes. There was another paper, which said that higher follicular fluid estradiol may be a marker for oocytes that will fertilize normally with intracytoplasmic sperm injection. We have an article by Carpintero on follicular steroid hormones as marker of oocyte quality and development potential. This article concluded that follicular environment rich in estradiol, progesterone, and testosterone is a key to good oocyte development. High rates of progesterone and to a lesser extent, testosterone would be crucial for determining good oocyte quality, key for normal fertilization and success in assisted reproduction. Unlike other publications, which did not correlate the hormonal levels with the pregnancy rates, this paper concluded that oocytes immersed in a follicular environment rich in progesterone and testosterone and those with higher levels of estradiol obtained higher pregnancy rates.
There is another comparative study published which looks at the clinical pregnancy rates between cleavage stage embryo transfer (ET) at day 3 and blastocyst stage transfer at day 5. This study has shown that in younger patients with good ovarian response extended culture to day 5 can be offered as blastocyst transfer is found to have good clinical pregnancy rates. We know that early embryo reflects quality of gametes whereas blastocyst reflects gene expression, differentiation, and developmental control. Blastocyst transfer with good implantation potential allows us to go ahead with single ET, thus preventing multiple pregnancy. Though there is a small but significant increase in live birth rate after blastocyst transfer, the cumulative pregnancy rate is higher with cleavage transfers as more embryos are available for cryopreservation. Mehta et al. have found measuring of serum plasminogen activator inhibitor-1 (ng/ml) by enzyme-linked immunosorbent assay (ELISA) method on day of human chorionic gonadotropin, day of ET and days 7 and 14 of ET has a good predictive potential of clinical pregnancy.
We have two articles on male infertility. The first article describes proteomic analysis of seminal plasma proteins, which helps in distinguishing a fertile sample from a subfertile one. This study observed that there are 10 seminal proteins that are up-regulated in the subfertile population. The other article is on quantitative evaluation of p53 as a new indicator of DNA damage in human spermatozoa. High DNA fragmentation index (DFI) predicts a significantly reduced probability for in vivo and in vitro fertility when the DFI is >30%. Oxidative stress is the main cause of increased DFI and is responsible for subfertility in several cases and can also result in recurrent pregnancy loss and repeated implantation failures. DFI s evaluated either by TUNNEL and Comet assay or using the acridine orange test or Halo sperm. p53 ELISA assay could become a new and more precise indicator of DNA damage in human spermatozoa.
We have three case reports, one on spontaneous successful pregnancy in the case of posthypophysectomy hypopituitarism, the second on laparoscopic gonadectomy in a case of complete androgen insensitivity syndrome, and third on embryo cryopreservation in case of promyelocytic leukemia, incidentally diagnosed during ovarian stimulation for IVF.