Journal of Human Reproductive Science
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   2010| January-April  | Volume 3 | Issue 1  
    Online since May 10, 2010

 
 
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ORIGINAL ARTICLES
Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study
Sachin A Narvekar, Neelima Gupta, Nivedita Shetty, Anu Kottur, MS Srinivas, Kamini A Rao
January-April 2010, 3(1):15-19
DOI:10.4103/0974-1208.63116  PMID:20607003
Background: Management of repeated implantation failure despite transfer of good-quality embryos still remains a dilemma for ART specialists. Scrapping of endometrium in the nontransfer cycle has been shown to improve the pregnancy rate in the subsequent IVF/ET cycle in recent studies. Aim: The objective of this randomized controlled trial (RCT) was to determine whether endometrial injury caused by Pipelle sampling in the nontransfer cycle could improve the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome. Setting: Tertiary assisted conception center. Design: Randomized controlled study. Materials and Methods: 100 eligible patients with previous failed IVF despite transfer of good-quality embryos were randomly allocated to the intervention group and control groups. In the intervention group, Pipelle endometrial sampling was done twice: One in the follicular phase and again in the luteal phase in the cycle preceding the embryo transfer cycle. Outcome Measure: The primary outcome measure was live birth rate. The secondary outcome measures were implantation and clinical pregnancy rates. Results: The live birth rate was significantly higher in the intervention group compared to control group (22.4% and 9.8% P = 0.04). The clinical pregnancy rate in the intervention group was 32.7%, while that in the control group was 13.7%, which was also statistically significant ( P = 0.01). The implantation rate was significantly higher in the intervention group as compared to controls (13.07% vs 7.1% P = 0.04). Conclusions: Endometrial injury in nontransfer cycle improves the live birth rate,clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles.
  43 9,304 491
REVIEW ARTICLE
Fertility preservation in young cancer patients
Ariel Revel, Shoshana Revel-Vilk
January-April 2010, 3(1):2-7
DOI:10.4103/0974-1208.63113  PMID:20607000
As a result of advances in treatment, almost 80% of children and adolescents who receive a diagnosis of cancer become long-term survivors. The increased survival rate of children and adolescents with cancer has resulted in a major interest in the long-term effects of cancer treatment on the possibility for future fertility. Currently established methods for the preservation of fertility are available only for pubertal males and females. Pubertal male cancer patients should be encouraged to freeze numerous sperm samples even when sperm count and motility are poor. In these cases, intracytoplasmic sperm injection is a powerful technique compared with intrauterine insemination since thawed sperm samples with poor parameters can produce relatively high fertilization rates resulting in normal pregnancies and deliveries. Married pubertal women should be proposed ovulation induction, follicular aspiration, and fertilization with husband sperm. Single women could benefit from vitrification of oocytes. This requires a delay of about 3 weeks in the commencement of chemotherapy to enable follicular growth. Fertility preservation for prepubertal patients is more of a problem. Young girls could be offered cryopreservation of gametes in the gonadal tissue. Cryopreservation of testicular tissue was suggested for fertility preservation for young boys, but this method is totally experimental and not currently offered. Discussing future fertility is part of the consultation of young female and male patients facing potentially gonadotoxic cancer therapy. It is the role of reproductive specialists to create various options in their laboratory to preserve fertility potential of cancer patients.
  15 5,596 526
ORIGINAL ARTICLE
Effect of forced swimming stress on in-vivo fertilization capacity of rat and subsequent offspring quality
Ghasem Saki, Fakher Rahim, Ozra Allah Vaysi
January-April 2010, 3(1):32-34
DOI:10.4103/0974-1208.63120  PMID:20607006
Aims: This study aimed to determine the effect of 50 days of forced swimming stress on fertilization capacity of rat and subsequent offspring quality. Setting and Design: The prospective study designed in vivo. Materials and Methods: Total 90 Wistar rats including 30 adult male (3 months of age, weighing 210 ± 10.6 g) and 60 female rats (3 months of age, weighing 230 ± 12.2 g) were engaged in this study. Male rats were randomly divided in two equal groups (n=15): Control and experimental groups. Animals of the experimental group were submitted to forced swimming stress for 3 min in water at 32oC daily for 50 days. Then all adult male rats were mated with normal females (2 per each male) for 7 days. Female rats were sacrificed and autopsy was performed on day 20 of pregnancy when uterus and ovaries were examined for the number of corpora lutea, dead and live fetuses, embryo resorption, implantation sites, and fetus weight. Conclusion: Results of this study have important implications for families attempting pregnancy. Stress pursuant to life events may have a negative impact on in vivo fertilization capacity of male rats and subsequent offspring quality.
  7 3,366 261
ORIGINAL ARTICLES
Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination
K Jayakrishnan, Aby K Koshy, R Raju
January-April 2010, 3(1):20-24
DOI:10.4103/0974-1208.63117  PMID:20607004
Context: Women with primary infertility and no obvious pelvic pathology on clinical evaluation and imaging are either treated empirically or further investigated by laparoscopy. Aims: The role of diagnostic laparoscopy in women who fail to conceive after empirical treatment with ovulation induction and intrauterine insemination was evaluated. Settings and Design: Retrospective study at a private infertility center. Materials and Methods: A study of patients who underwent diagnostic laparoscopy between 1 st January 2001 and 31 st December 2008 was performed. Those patients who had no detectable pathology based on history, physical examination, and ultrasound and had treatment for three or more cycles in the form of ovulation induction and IUI were included in the study. Moderate and severe male factor infertility and history of any previous surgery were exclusion criteria. Statistical Analysis Used: Data were statistically analyzed using Statistics Package for Social Sciences (ver. 16.0; SPSS Inc., Chicago). Results: Of the 127 women who underwent diagnostic laparoscopy and hysteroscopy, 87.4% ( n= 111) of patients had positive findings. Significant pelvic pathology (moderate endometriosis, pelvic inflammatory disease, and tubal pathology) was seen in 26.8% of cases. Conclusion: One in four women had significant pelvic pathology where treatment could possibly improve future fertility. Diagnostic laparoscopy has a role in infertile women with no obvious abnormality before they proceed to more aggressive treatments.
  6 3,330 320
LETTERS TO EDITOR
Cellular phone and germ cell: A comment
Viroj Wiwanitkit
January-April 2010, 3(1):52-52
DOI:10.4103/0974-1208.63126  PMID:20607012
  4 2,116 158
ORIGINAL ARTICLES
Efficacy of vitamin C and ethanolic extract of Sesamum indicum in promoting fertility in male Wistar rats
EA Ashamu, EO Salawu, OO Oyewo, AW Alhassan, OA Alamu, AA Adegoke
January-April 2010, 3(1):11-14
DOI:10.4103/0974-1208.63115  PMID:20607002
Aims: This study investigates the efficacy of ethanolic extract of Sesamum indicum (EES), vitamin C (VC), and EES + VC in promoting fertility and finding a possible link between their profertility effects and their antioxidant activities. Materials and Methods: Forty adult male Wistar rats [Body weight (BW) 186.56 ± 0.465 g] were randomly analyzed into four groups of ten rats each: Control, EES G (EES only), VC G (vitamin C only), and EES + VC G (EES in conjunction with vitamin C). Control was given 5 ml/kg BW/day of normal saline orally; EES G was administered 0.3 g/kg BW/day of EES; VC G was administered 15 mg/kg BW/ day of VC; while EES + VC G was administered both 0.3 g/kg BW/day of EES and 15 mg/kg BW/day of VC. All treatments were for 10 weeks. Statistical Analysis Used: Independent-sample T test was used to analyze the obtained results. Results: The results obtained showed that EES, VC, and more importantly EES + VC are capable of significantly increasing BW gain, seminal parameters, testosterone level, and body antioxidant activities. Conclusions: These findings lead to the conclusion that EES + VC as well as ESS and VC promote fertility due to both their testosterone-increasing effects and their antioxidant effects.
  4 3,782 250
CASE REPORTS
Congenital malformation of fetus in a pregnancy following spontaneous ovulation in a case of premature ovarian failure
Priya Selvaraj, Kamala Selvaraj, Megha Agrawal, Gunjan Singh
January-April 2010, 3(1):35-37
DOI:10.4103/0974-1208.63121  PMID:20607007
Premature ovarian failure (POF), that is, amenorrhea before 40 years of age can be attributed to a variety of etiologies. Approximately 1% of women before 30 years are diagnosed with POF. Spontaneous ovulation leading to pregnancy in POF is even a rarer entity. We report a case where congenital malformations were diagnosed in a fetus following spontaneous ovulation in a case of POF. A 33-year-old woman presented to our center with primary infertility. On complete work up, she was diagnosed with POF and conceived with hormone replacement therapy and donor oocyte program. She delivered a healthy female baby through caesarean section. The patient reviewed later with amenorrhea of 40 days and pregnancy was confirmed. However, during antenatal follow-up congenital anomalies in fetus were diagnosed sonographically. The decision for termination of pregnancy was taken. To conclude, we recommend large-scale retrospective analysis that would define medical guidelines in cases of pregnancy following spontaneous ovulation in POF.
  3 2,997 159
ORIGINAL ARTICLES
The degree of serum estradiol decline in early and midluteal phase had no adverse effect on IVF/ICSI outcome
Sachin A Narvekar, Neelima Gupta, Nivedita Shetty, Anu Kottur, MS Srinivas, Kamini A Rao
January-April 2010, 3(1):25-30
DOI:10.4103/0974-1208.63118  PMID:20607005
Background: Estradiol levels fall rapidly in the luteal phase of ART cycles. So far, the effect of this estradiol decline on pregnancy outcome has remained controversial. Aim: To study the effect of early and midluteal estradiol decline on pregnancy and miscarriage rate. We also sought to determine whether estradiol fall was related to increased risk of bleeding per vagina in the first trimester among pregnancies which crossed 12 weeks. Setting: Tertiary Assisted conception center. Design: Retrospective study. Materials and Methods: We analyzed data of 360 consecutive patients who underwent IVF-ET/ICSI cycles using one of the three protocols: Midluteal downregulation, short flare, and antagonist protocol. Statistical Methods: Statistical evaluation was performed with the Student's t test, Chi square, Fischer's exact test, analysis of variance, and Mann-Whitney tests were appropriate using SPSS for Windows, Standard version 11.0. Results: The mean % EL-E2 and % ML-E2 declines were not significantly different in the pregnant and nonpregnant groups when analyzed separately in the three protocols. Also, the degree of midluteal estradiol decline did not correlate with pregnancy outcome. Moreover, the mean % early and midluteal estradiol decline did not differ significantly in patients with preclinical, clinical abortions, and ongoing pregnancy. The estradiol decline was not found to influence the risk of bleeding in the first trimester. Conclusions: Our results show that the degree of estradiol fall in the luteal phase of ART cycles does not influence pregnancy and first trimester miscarriage rate.
  3 3,663 217
CASE REPORTS
Endometrial carcinoma in a young subfertile woman with polycystic ovarian syndrome
K Jayakrishnan, R Anupama, Aby Koshy, R Raju
January-April 2010, 3(1):38-41
DOI:10.4103/0974-1208.63122  PMID:20607008
Adenocarcinoma of the endometrium is a morbid condition in women under 40 years of age with an incidence of 25%. However, patients with anovulatory polycystic ovarian syndrome are at risk of developing endometrial carcinoma. The disease is often advanced when diagnosed, thereby depriving the woman of the option for fertility sparing conservative approach. In young women with menstrual abnormalities and polycystic ovarian disease and/or infertility, an endometrial evaluation should be performed. Carcinoma endometrium should be kept in mind while evaluating young women with polycystic ovary syndrome for abnormal uterine bleeding. Only strictly selected patients should, therefore, be indicated for long-term progestogen treatment and careful evaluation before and after treatment should be performed.
  2 3,574 220
Successful birth of an IVF baby in a patient with Parkinson's disease
Asha Baxi, Hansali Neema, Apoorva Pauranik
January-April 2010, 3(1):42-43
DOI:10.4103/0974-1208.63123  PMID:20607009
Parkinson's disease, although rare in young patients, may be encountered in the reproductive age group. We report a rare combination of this disease with infertility, which has not been previously reported. The case record of a 29-year-old woman with infertility and Parkinson's disease are retrospectively reviewed. An IVF indicated for tubal factor infertility resulted in a successful singleton pregnancy. She delivered a healthy male baby without experiencing any worsening of her Parkinsonism. The course of pregnancy remained unaffected by the Parkinson's disease and anti-Parkinsonian drugs. The details of the infertility management, antenatal and postnatal course, and medications are described. With careful evaluation, counseling, and monitoring, IVF may be safely used in women with Parkinson's disease.
  - 2,082 158
First successful birth of twins in India following the transfer of vitrified oocytes
Priya Selvaraj, Kamala Selvaraj, Kalaichelvi Srinivasan
January-April 2010, 3(1):44-48
DOI:10.4103/0974-1208.63124  PMID:20607010
We report the first twin pregnancy and birth in India after the transfer of embryos generated from vitrified and thawed oocytes to a 41-year-old woman who was in a donor program. Embryos were generated from the microinjection of pre-prepared sperms into vitrified oocytes. Twin male babies weighing 750 and 860 g were born by emergency cesarean section. Vitrification is one of the most promising options in cryopreservation and preservation of embryos and oocytes.
  - 2,449 164
Symptomatic unilateral pleural effusion: A rare presentation of ovarian hyperstimulation syndrome
Korula George, TK Aleyamma, MS Kamath, A Chandy, Ann M Mangalaraj, K Muthukumar, V Londhe
January-April 2010, 3(1):49-51
DOI:10.4103/0974-1208.63125  PMID:20607011
Isolated pleural effusion is a rare presentation of ovarian hyperstimulation syndrome. The pathogenesis of this disorder has not been fully elucidated. It supports the role of systemic factors rather than transudation of fluid from the surface of enlarged ovaries. This article describes a rare case of isolated pleural effusion following controlled ovarian hyperstimulation during an in-vitro fertilization cycle.
  - 2,781 161
COMMENTARY
Commentary
Hong Ye
January-April 2010, 3(1):30-31
  - 1,588 110
EDITORIAL
From the Editor's desk
Kamini A Rao
January-April 2010, 3(1):1-1
DOI:10.4103/0974-1208.63112  PMID:20606999
  - 1,820 213
ORIGINAL ARTICLES
A randomized controlled study to evaluate the cost-effectiveness in sperm extraction using carbon dioxide and carbon dioxide free system in relation to intrauterine insemination pregnancy
Rajesh Bhakta, Pratap Kumar, Satish Kumar Adiga, Gurprasad Kalthur
January-April 2010, 3(1):8-10
DOI:10.4103/0974-1208.63114  PMID:20607001
Objectives: To evaluate the effectiveness of two different systems i.e. circulating water bath and carbon dioxide (CO 2 ) incubator in extracting motile sperm for IUI programme and their effect on pregnancy outcome.Methods: The study was performed on sixty-two patients recruited for ovulation induction followed by intrauterine insemination (IUI) in University fertility clinic. The patients were randomly divided into two groups and sperm preparation was performed with either water bath or CO 2 incubator system. The efficiency of the two systems was analyzed in relation to pregnancy outcome. Results: There was no significant difference in the efficacy of water bath and CO 2 system with respect to the quality of sperm extracted and pregnancy outcome. Although pregnancy rate was marginally higher in water bath group, it was not statistically significant. Conclusion: CO 2 -free system can be a cost-effective approach in IUI programme which does not compromise with pregnancy rate.
  - 2,305 177
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