Year : 2020 | Volume
: 13 | Issue : 1 | Page : 1--2
From the editor's desk
Dr. Patil's Fertility and Endoscopy Clinic, Bengaluru, Karnataka, India
Dr. Madhuri Patil
Dr. Patil's Fertility and Endoscopy Clinic, Bengaluru, Karnataka
|How to cite this article:|
Patil M. From the editor's desk.J Hum Reprod Sci 2020;13:1-2
|How to cite this URL:|
Patil M. From the editor's desk. J Hum Reprod Sci [serial online] 2020 [cited 2020 Sep 24 ];13:1-2
Available from: http://www.jhrsonline.org/text.asp?2020/13/1/1/281976
Emotional distress is seen in about 40% of the patients undergoing assisted reproductive technology (ART). This may be due to relational strain in between the couple due to infertility, fear and negative attitudes to treatment, and psychological vulnerability and ability to withstand demands of treatment. The emotional distress during treatment is highest around oocyte pick up and in waiting period till the first beta human chorionic gonadotropin (hCG) testing is done. Unsuccessful in vitro fertilization (IVF) provokes grief and mourning whereas a successful IVF decreases the emotional distress. We are also aware that emotional stress increases with the number of unsuccessful treatment cycles and women are more vulnerable than men. This issue has a review article on how mindfulness-based interventions help in protecting the quality of life and psychological well-being of the couple undergoing infertility treatment. On similar lines, we have another original paper on patient-centered infertility care. Patient-centered care is responsive to patients' needs and values; it may benefit infertile patients in making decisions about medical testing and treatment for infertility. The results of this original study were based on a questionnaire called “Patient-Centeredness Questionnaire-Infertility (PCQ-I)”. This questionnaire included seven themes for the analysis. The themes included accessibility, information, communication, patient involvement, respect for patient values, continuity in treatment, and health-care provider competence. This paper concluded that most patients gave a lot of importance to communication and respect to patient's values. As infertility is a chronic stressor with severe long-lasting negative social and psychological consequences, achieving a pregnancy and live birth after assisted reproduction technology treatment is associated with increased mental well-being. This group of patients are generally satisfied with both communication and good fertility treatment. This makes counseling about treatment options, success rates, and cost involved an important and integral part of fertility treatment. Thus, patient-centered infertility care with good counseling will reduce both the dropout rates and improve the outcome of treatment.
There is an original paper on use of sliding sign and gel sonovaginography (SVG) to predict posterior deep infiltrating endometriosis (DIE) in women undergoing laparoscopy. In women with severe endometriosis, the disease may progress as a deep infiltrating lesion involving the posterior compartment of the pelvis. This study has shown that both sliding sign and gel SVG has a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy.
The endometrium is a complex and dynamic tissue, which undergoes periods of growth with morphological and functional changes that are related to the cyclic release of sex hormones, estrogen and progesterone. It has a basal layer and a functional layer; it is the functional layer that is shed during menstruation. Intrauterine adhesions as a result of infection or previous surgery prevent implantation, thus resulting in infertility. Intrauterine adhesions also known as Asherman's syndrome at times are refractory to hysteroscopic adhesiolysis. Stem cells have been shown to contribute to the repair and regeneration of the endometrium. There are studies which have used either platelet-rich plasma or autologous stem cells (from bone marrow or menstrual blood) which have influenced the therapeutic outcome. Stem cell therapy can result in regeneration of the endometrium with decrease in fibrotic area and increase in the number of glands and angiogenesis, which in turn increases the endometrial thickness. The prospective study by Neeta Singh et al. showed beneficial effect on the restoration of menstruation and fertility with the use of bone marrow-derived stem cells in women with refractory Asherman's syndrome and endometrial atrophy.
Myleran (Busulfan) is a chemotherapeutic agent which results in decreased ovarian reserve in the female and can also affect spermatogenesis in the male. Thymus vulgaris (Thym) is a species of flowering plant in the mint family Lamiaceae with potent antioxidant property. We have a study in this issue which looked at the effect of Thymus vulgaris on the reproductive function in male rats from Myleran-induced reproductive damage. This study concluded the beneficial effects of Thymus vulgaris on the sperm parameters and histological pictures. The effect was probably by decrease in oxidative stress and lipid peroxidation. Further studies may be required in the humans to advocate its use, especially in those males who undergo gonadotoxic chemotherapy.
Mode of ovulation triggering significantly affects messenger RNA (mRNA) expression in the granulosa cells. Oocyte maturation may be affected by the dose of hCG used for triggering oocyte maturation. An original study from Indonesia looked at the correlation between serum hCG levels 12-h posttrigger and granulosa cell LH receptor mRNA expression with oocyte maturation rate. This study found a positive correlation between serum hCG levels 12-h posttrigger and oocyte maturation rate. A higher level of serum hCG at 12-h posttrigger was associated with a higher percentage of mature oocytes and a cutoff value of 77 mIU/ml was found to be optimum. It was also observed that the rate of oocyte maturation was very weakly correlated with LHR expression of granulosa cells.
Prasad Lele et al. looked at the incidence of empty follicle syndrome (EFS) in their patients undergoing IVF and embryo transfer (ET) over a period of 17 months. They reported an incidence of 3.9% for false EFS and 0.9% for genuine EFS. They also reported a very high (36.8%) recurrence rate in the next cycle despite maximum of the cases initially reported were of false EFS. Most of the recurrence was seen in women with decreased ovarian reserve, though the age of these women on an average was 30 years. Epidermal growth factor-like growth factors such as amphiregulin, epiregulin, and betacellulin are potent stimulators of oocyte maturation and cumulus expansion and dysfunction of these pathways impairs ovulation in vivo. It is also known that oocyte in an empty follicle fails to complete its growth/maturation, since MAPK3 has a strong inhibitory effect on programmed cell death which is downregulated in women with EFS. IGFBP-5 which also has an anti-apoptotic function is also downregulated in EFS. As the incidence of recurrence in repeat cycles was very high and nothing has been mentioned about the protocol used in the next cycle, probably use of dual trigger or increased dose of hCG or prolonging the interval between ovulation trigger and oocyte retrieval may have been of some help in preventing EFS.
The neonatal and maternal outcomes are definitely better for women with singleton pregnancy as compared to twin pregnancy which has higher rates of preterm births, low birth weight, and small for gestational babies. Twin gestation is also associated with higher incidence of respiratory complications, sepsis, and jaundice in the baby and that of preeclampsia, premature rupture of membranes, and cesarean section in the mother. A retrospective study by Reena Gupta et al. also reported a higher incidence of still birth and neonatal deaths in twins conceived after IVF as compared to singletons. These results support single-ET to minimize the risks associated with twin pregnancies.
We have four case reports in this issue. One is on live birth following transmyometrial ET in a case of difficult ET. Although technically difficult, it may be the only option in a very small percentage of patients. The second case report was a case of complex chromosomal rearrangement in a patient with repeated miscarriage which was familial. A karyotype of the parents as well as the fetus will give information about the genetic cause of miscarriage and should be regularly done, especially after treatment for infertility.
The third case report is that of Sirenomelia following intracytoplasmic sperm injection with ET. The fourth case is that of multiple endocrine neoplasia type 1, a rare autosomal dominant disorder, which is characterized by the presence of functioning and nonfunctioning tumors or hyperplasia of the pituitary gland, parathyroid glands, and pancreatic islet cells and also may be associated with adrenal or thyroid tumors and nonendocrine tumors, such as lipomas, angiofibromas, and leiomyomas. The case report published had hyperprolactinemia with pituitary microadenoma, primary hyperparathyroidism with parathyroid adenoma with multiple leiomyomas.