Year : 2015 | Volume
: 8 | Issue : 1 | Page : 1--2
From the Editor's desk
Editor in Chief, Journal of Human Reproductive Sciences
Editor in Chief, Journal of Human Reproductive Sciences
|How to cite this article:|
Patil M. From the Editor's desk.J Hum Reprod Sci 2015;8:1-2
|How to cite this URL:|
Patil M. From the Editor's desk. J Hum Reprod Sci [serial online] 2015 [cited 2020 Aug 12 ];8:1-2
Available from: http://www.jhrsonline.org/text.asp?2015/8/1/1/153118
Wishing all a very Happy 2015 from the editorial board!
In this issue, we have three review articles. The first one is on fertility preservation (FP), which is the most talked subject today. Apart from cancer, FP is also required for nononcological conditions like benign hematological and autoimmune diseases which are treated with antineoplastic drugs resulting in follicular atresia, leading to premature ovarian failure, in women undergoing surgery on their ovaries which may decrease the number of follicles and also those women wishing to postpone childbearing. Due to the young age of some of the women affected, attempts to preserve fertility and ovarian function are important and thus we need to identify those who might benefit from FP, and review the different techniques available, which have been elaborated in this article.
Ovarian hyperstimulation syndrome (OHSS) is one of the dreaded complications of controlled ovarian stimulation in intra-uterine insemination and assisted reproductive technology (ART) and must be completely avoided as far as possible. Today use of gonadotropin-releasing hormone (GnRH) antagonist protocol coupled with GnRH agonist (GnRHa) triggering is safe, efficient, and simple method of preventing OHSS. But we must remember that GnRHa trigger leads to lower luteal phase steroidal concentrations and requires luteal phase support with adequate E2 and P4 supplementation is essential for the optimal outcome. As the occurrence of late OHSS due to pregnancy is unpredictable, the authors of the second review article advocate cryopreservation of all embryos to be transferred in the subsequent cycle. Despite this, the authors have reported occasional case of severe OHSS.
The third review article is on gel-based proteomics technology as a powerful technique to unravel molecular complexity underlying female reproductive biology and infertility. Due to several technical limitations, it is still in the research stage and will take some more years for it to be used in clinical practice.
We have already seen that GnRHa trigger for final oocyte maturation can reduce or even prevent the occurrence of OHSS; there is an original article which looks at the different GnRH-a doses for the final oocyte maturation on cycle outcomes and OHSS rates in high-responder patients undergoing ovarian stimulation.
Today, though most clinics have shifted from using GnRHa to antagonist for prevention of luteinizing hormone surge, we have a study from China which looks at the prognostic factors which enables them to compare the clinical outcome between depot-dose, and daily low-dose GnRHa long protocols. It was found that age, embryo quality, and endometrial thickness on human chorionic gonadotropin (hCG) day were important prognostic factors in both the groups as compared to progesterone on day of hCG and fertilization rate.
Various components of follicular fluid are suggested as biochemical predictors of oocyte quality and analysis of follicular hormone (estradiol, progesterone, testosterone, and dehydroepiandrosterone sulfate [DHEA-S]) composition could be considered as an additional tool in oocyte selection to optimize the ART outcome. Follicular environment rich in estradiol, progesterone, and testosterone is the key to good oocyte development with higher pregnancy rates. The study from Spain by Nayara Lσpez Carpintero found that the variations in the levels of follicular progesterone and testosterone were similar between patients and between a given patient's follicles; however, the estradiol level variability was higher among different follicles. The amount of follicular estradiol may be considered a selection tool between the follicles of a given patient. They also concluded that DHEA-S may play a more relevant role in the selection between individuals.
Infertility is an uncommon manifestation of the genitourinary tract tuberculosis (TB) and mainly results from anatomic obstruction by granulomas or distortion of the normal anatomy by fibrosis surrounding the reproductive tract structures. The diagnosis is usually based on a suggestive history along with evidence of granulomatous infection on a tissue sample. The management depends on the site of obstruction and surgery is usually helpful only in cases with discrete ejaculatory duct obstruction. However, most other patients are candidates for in-vitro fertilization (IVF) and have a prognosis similar to that in men with other causes of obstructive azoospermia. The study published from All India Institute of Medical Sciences screened 100 men with obstructive azoospermia for genitourinary TB with a kit-based semen polymerase chain reaction (PCR) test for Mycobacterium tuberculosis. These authors concluded that a meticulous history and physical examination, particularly in men with low volume ejaculate may identify the subset that needs to be investigated for TB. They also concluded that anti-TB treatment does not resolve azoospermia in such men and thus screening for TB using semen PCR is not indicated in men with idiopathic obstructive azoospermia.
HIV is a global crisis with approximately >35 million worldwide being infected with HIV. Survival of HIV-infected has been enhanced by medical therapy with improved morbidity and mortality. This has resulted in more HIV discordant couples coming for infertility treatment. This involves a lot of social and ethical challenges as well as a lack of access to infertility treatment as most ART centers do not have separate labs for the same. Even if treatment is possible, there is a lot of depression, anxiety, and stress involved, especially more in the women than men. This probably may be related to have an infection free baby. Hence, counseling forms a very important part of treatment for these discordant couples.
There are two case reports, one on lymphangiocele in a 29-year-old male presenting with male infertility that improved after surgery and the other on monochorionic triamniotic triplets following conventional IVF and blastocyst transfer.