Year : 2017 | Volume
: 10 | Issue : 2 | Page : 71--72
From the editor’s desk
Dr. Patil’s Fertility & Endoscopy Clinic, Bangalore, India
Clinical Director, Dr. Patil’s Fertility and Endoscopy Clinic, Bangalore, Karnataka
|How to cite this article:|
Patil M. From the editor’s desk.J Hum Reprod Sci 2017;10:71-72
|How to cite this URL:|
Patil M. From the editor’s desk. J Hum Reprod Sci [serial online] 2017 [cited 2020 Apr 1 ];10:71-72
Available from: http://www.jhrsonline.org/text.asp?2017/10/2/71/212783
Though 3D ultrasound has replaced hysterosalpingography and hysteroscopy as a diagnostic tool, we present a study in this issue regarding the role of hysteroscopy as a diagnostic tool in women with abnormal hysterosalpingography or in those with normal hysterosalpingography but have failed to conceive. Hysteroscopy is still required by few infertile women who have an intrauterine disease (polyps, fibroids, adhesions, and septum), which needs to be treated.
The effects of vitamin D on the reproductive tract are largely mediated through the vitamin D receptor (VDR). VDR expression has been demonstrated in various cells of the male reproductive tract, including the spermatozoa and germ cells, and in the female reproductive tissues, including the ovaries, placenta, and endometrium. The exact role of vitamin D and its requirement by oocytes, granulosa, theca, trophoblasts, and sperm is still not known. The effect of vitamin D deficiency in women with polycystic ovary syndrome (PCOS) was noticed to be more pronounced. It results in excessive androgen production in these women. Vitamin D also has the potential to modulate inflammation and hormone levels, both of which are key aspects for female reproductive function, though its impact on cytokine production by trophoblasts is still unknown. In this issue, there is a study published by Manish Banker et al. which compares the effect of vitamin D deficiency in donor and recipient groups, which were further divided as vitamin D deficient and or those supplemented with vitamin D. No statistically significant difference was observed in the reproductive outcomes when both the groups were compared. The study by Indu Lata et al. examines the antimullerian hormone (AMH) levels and vitamin D deficiency and found that no correlation exists.
Most controlled ovarian stimulation protocols use antral follicle count (AFC) and AMH to predict response. Both AFC and AMH basically measure the same thing, but AMH is considered as a more sensitive marker to define follicle excess than AFC because it appraises more follicle classes. Both serve as markers of poor, normal, or hyperresponse. Most clinicians give importance to AMH values in the prediction of hyperresponse only in women with PCOS. Radha Vembu studied the cutoff values of AMH in women with PCOS and those without PCOS to predict hyperresponse and found that the cutoff value of serum AMH to predict the hyperresponse in the PCOS group was 6.85 ng/ml and in the non-PCOS group was 4.85 ng/ml.
Young women with PCOS often have insulin resistance (IR) and hyperinsulinemia, which increases the risk of infertility, type 2 diabetes, and cardiometabolic problems. Lifestyles that include healthy nutrition and daily exercise are most important in the PCOS treatment plan to decrease IR. Metformin may play an important role in decreasing the IR by its tissue-specific actions as well as the molecular mechanisms involved in the liver, muscle, endothelium, and ovary. Both lean and obese women with PCOS experience a marginal benefit on metabolic syndrome and hyperandrogenemia with the use of metformin. Because the side effects and beneficial effects shown by metformin in earlier trials could not be replicated, it is a suitable adjuvant drug for lifestyle improvement but cannot be used as a replacement for increased exercise and improved diet. Past studies have shown that treatment with metformin in women with PCOS may lead to beneficial effects in terms of BMI, plasma homocysteine concentrations, and fasting blood sugar with no remarkable effect on lipid profile. An original article in this issue investigated the effect of metformin treatment on the serum levels of homocysteine, folic acid, and vitamin B12 in patients with PCOS. This study concluded that metformin levels reduce vitamin B 12 levels, which then increase the homocysteine levels. This effect is more pronounced in obese women with BMI >25 kg/m2.
The procedure for embryo transfer (ET) apart from embryo quality and endometrial receptivity is one of the basic and important factors determining the final outcome of an in-vitro fertilization (IVF) cycle. Approximately 30% of the failures in ART are due to the poor performance of ET. ET probably is the least successful step in IVF. The position of embryo deposition in the uterus is one of the factors determining the success of IVF. Neeta Singh and her group from New Delhi determined whether the site of embryo deposition influenced the success rate of IVF. The distance of the air bubble from the fundus of the endometrial cavity was measured in the frozen frame on ultrasonography, and depending on the distance from the fundus, the patients were classified into four groups. This group found the clinical pregnancy rate significantly improved in those with the embryo deposited between 10 and 20 mm from the fundus.
The first beta hCG levels after ET can prognosticate the pregnancy outcome. hCG levels can be measured either 11 or 14 days post-ET. Values >200 mIU/ml on 14 days post-ET or >42 mIU/ml on 11 days post-ET were more likely to be found in those having ongoing pregnancies. Women with hCG levels >600 had a higher likelihood of a multiple gestation pregnancy. Another article in this issue noted the beta hCG levels on day 16 post-ET at a cutoff value of 500 mIU/ml. The incidence of failed pregnancy and ectopic pregnancy was statistically more if the beta hCG level was <500 mIU/ml at the first visit.
There are several environmental factors influencing the sperm parameters, which include drugs, endocrine disruptors, smoking, alcohol, weight and nutrition, recreational drugs, genital heat stress, psychological stress, and usage of cellular telephone. Tobacco and alcohol are known to reduce the count, motility, and morphology of the sperm and increase the number of leucocytes in the sperm. Alcohol is also known to result in maturation arrest and sperm alterations resulting in spermatogenic arrest reversible after alcohol withdrawal.
Heat exposure increases scrotal temperature and reduces sperm quality and increases the number of abnormal sperm. There is also an increased risk of apoptosis in the spermatogenic cells. An original study from South India investigated the intrauterine insemination (IUI) results in relation to male habits and exposure to heat as well the working environment. In this study, smoking and alcohol consumption were found to be linked with low success rates after IUI. The poor outcome can be related to smoking and alcohol consumption as well as exposure to heat, which results in damage to the deoxyribonucleic acid (DNA) thus decreasing the fecundity. Thus, this group of patients may benefit by evaluating for DNA fragmentation and free oxygen radials.
Oocyte retrieval can be performed either by using sedation (pethidine, midazolam, and fentanyl) with pre-ovarian block/paracervical block or general anesthesia. The study conducted by Christian Medical College, Vellore analyzed the pain levels after oocyte retrieval using sedation and pre-ovarian block until ET. Variables for analysis included the woman’s age, duration of the procedure, number of oocytes retrieved, and transmyometrial passage of the needle. This study found a moderate positive correlation between age and pain score on day 1 postprocedure and during the course of the procedure. When the duration of the procedure was more than 12 min, immediate postprocedure pain score was significantly higher compared to those whose procedure duration was <12 min. However, there was no correlation of the duration of procedure with pain score after 6 and 24 h postprocedure and on the day of ET. They also did not find any correlation between pain score and the number of oocytes retrieved and the transmyometrial passage of aspiration needle.
A study from Nigeria inspected the effect of trona, which is commonly used as a food preservative, food flavoring agent, as a drawing effect in some local soups, and food tenderizer, on the male reproductive function in Wistar rats. This study demonstrated that trona has a dose-dependent deleterious effect on the sperm, which was due to lipid peroxidation and not due to its effect on testosterone levels.
Another study from Iran studied the effects of separate and combined exposure to 900-MHz microwaves (as representative of cell phone radiation) and heat on gene expression and spermogram of male mice. Electromagnetic waves affected the Leydig cells most resulting in significantly decreased sperm viability and motility and also inducing cell apoptosis and alteration in the levels of expression of Bax and Bcl-2 genes. This study did not demonstrate any effect of electromagnetic waves on the sperm morphology and count.
We have two case reports published in this issue, one on the “Role of Serpine gene polymorphism in recurrent implantation failure and preeclampsia” and the other on “Embryo Cryopreservation Following In-Vitro Maturation for Fertility Preservation in a Woman With Mullerian Adenosarcoma.”