Journal of Human Reproductive Science
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    Table of Contents - Current issue
July-September 2020
Volume 13 | Issue 3
Page Nos. 171-248

Online since Tuesday, October 27, 2020

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From the Editor's Desk p. 171
Madhuri Patil
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Does the use of mobile phone affect male fertility? A mini-review Highly accessed article p. 174
Chidiebere Emmanuel Okechukwu
Presently, there is a rise in the use of mobile phones, laptops, and wireless internet technologies such as Wi-Fi and 5G routers/modems across the globe; these devices emit a considerable amount of electromagnetic radiation (EMR) which could interact with the male reproductive system either by thermal or nonthermal mechanisms. The aim of this review was to examine the effects of mobile phone use on male fertility. Related studies that reported on the effects of EMR from mobile phones on male fertility from 2003 to 2020 were evaluated. PubMed database was used. The Medical Subject Heading system was used to extract relevant research studies from PubMed. Based on the outcomes of both human and animal studies analyzed in this review, animal and human spermatozoa exposed to EMR emitted by mobile phones had reduced motility, structural anomalies, and increased oxidative stress due to overproduction of reactive oxygen species. Scrotal hyperthermia and increased oxidative stress might be the key mechanisms through which EMR affects male fertility. However, these negative effects appear to be associated with the duration of mobile phone use.
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Combined use of autologous bone marrow-derived stem cells and platelet-rich plasma for ovarian rejuvenation in poor responders p. 184
Sunita Tandulwadkar, M Selva Karthick
Background: The management of poor responders is still a challenge in modern-assisted reproductive technology. Several researches are showing encouraging results with autologous bone marrow-derived stem cells (ABMDSCs) and platelet-rich plasma (PRP) individually. Hence, we decided to study the synergistic effect of ABMDSCs with PRP. Aims and Objective: The aim of the study was to assess the safety and efficacy of intraovarian instillation of ABMDSCs combined with PRP in poor responders. Design: This was an interventional pilot study. Study Period: January 2017 to January 2019. Materials and Methods: We designed a pilot study using Patient-oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) Group 3 and 4 poor responder patients (n = 20). The study group underwent laparoscopic/transvaginal intraovarian instillation of ABMDSCs combined with PRP and the outcome was analyzed – primary outcome – antral follicular count (AFC) and mature MII oocytes and secondary outcome – Anti-Mullerian hormone (AMH) levels and number of Grade A and B embryos frozen on day 3. The Wilcoxon signed-rank test and Pearson correlation were used for the statistical analysis and P < 0.05 was considered statistically significant. Results: After 6 weeks of intraovarian instillation ABMDSCs mixed with PRP, patients were reassessed for AFC and AMH and their response to subsequent controlled ovarian stimulation (COS) cycle was observed. Statistically significant improvement was seen in AFC, MII oocytes, and Grade A and Grade B embryos. AMH was also increased in some patients, but the result was not statistically significant. Conclusion: Our results suggest that intraovarian instillation of ABMDSCs combined with PRP is safe and it optimized the recruitment of existing dormant primordial follicles to improve oocyte yield and hence the number and quality of embryos after COS in POSEIDON Group 3 and 4 poor responders.
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Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization p. 191
Puneet Kaur Kochhar, Pranay Ghosh
Context/Background: A premature luteinizing hormone (LH) surge, in in vitro fertilization (IVF) cycles with gonadotropin-releasing hormone (GnRH)-antagonist downregulation, leads to cycle cancellation. Currently, risk factors for the development of premature LH surge remain unknown. Objective: The aim of the study was to determine the incidence and identify the contributing factors for premature LH surge in IVF cycles with GnRH antagonist suppression. Design: This was a retrospective cohort study. Setting: IVF-embryo transfer program at a fertility and research center. Materials and Methods: The study included all patients undergoing IVF from December 1, 2014, to November 30, 2018, in whom GnRH-antagonist (cetrorelix 0.25 mg/d) flexible protocol was used. The primary outcome measure was the identification of premature LH surges (documented by a 2.5-fold increase in LH from the baseline above a threshold of 17 mIU/mL) with or without a decrease in E2and appearance of free fluid on ultrasound. Results: Premature LH surges occurred in 15 (2.16%) of 692 patients undergoing IVF with GnRH-antagonist suppression. Patients with premature surges had significantly lower ovarian reserve as compared to the controls (as seen from their higher age group, higher day 2 follicle-stimulating hormone (FSH), lower antral follicle counts, and lower anti-Müllerian hormone). Conclusions: Premature LH surge in a GnRH-antagonist cycle can lead to cycle cancellation and disappointment. Although this is a rare event, the incidence is higher in patients with diminished ovarian reserve. Further studies are needed to determine if giving the human chorionic gonadotropin trigger a day earlier or giving higher doses of GnRH-antagonist can benefit such cases.
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The effect of follicle-stimulating hormone administration on the day of human chorionic gonadotropin trigger on assisted reproductive technique outcomes in patients undergoing In vitro fertilization-embryo transfer: A retrospective cohort study p. 196
Chithira Pulimoottil Vignarajan, Neeta Singh, Perumal Vanamail
Aim: The aim is to study the effect of follicle-stimulating hormone (FSH) administration on the day of human chorionic gonadotropin (hCG) trigger on the assisted reproductive technique (ART) outcomes in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Settings and Design: Retrospective cohort study was conducted in the ART center of our hospital. Materials and Methods: Two hundred and ninety IVF/ICSI cycles performed between September 2012 and August 2017 were included in the study. Patients who received 375 IU of FSH on the day of hCG trigger (149 cycles) were compared with those who did not receive FSH on the day of trigger (141 cycles). Statistical Analysis Used: Chi-square test and Student's t-test were used. Results: The FSH co-administered group had a significantly higher number of oocytes retrieved, mature oocytes, and fertilization rate compared to those who did not receive FSH on the day of trigger (p < 0.001). The total number of embryos, the number of grade 1 embryos and the number of embryos available for cryopreservation were also significantly higher in the FSH administered group (p < 0.001). Implantation rate, clinical pregnancy rate, and live birth rate were not significantly different between the two groups. Conclusions: This study has shown that FSH administration on the day of the trigger may be considered in IVF cycles receiving hCG trigger to improve the oocyte recovery and maturity if the patient is not at increased risk of ovarian hyperstimulation and serum estradiol on the day of the trigger is <4500 pg/ml. However, there is only an increase in the total number of oocytes retrieved and the number of mature oocytes but no significant change in the implantation, clinical pregnancy, and live birth rates.
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Comparative analysis of surgically retrieved sperms in cases of obstructive and nonobstructive azoospermia treated for infertility p. 201
Deepa Talreja, Chirag Gupta, Hrishikesh Pai, Nandita Palshetkar, Rupin Shah
Background: Azoospermia is a highly evolving subject in the last few decades. In the past, use of donor sperm was the only option providing a realistic chance of conception for couples affected by azoospermia. Introduction of sperm retrieval techniques and assisted reproductive technologies, especially intracytoplasmic sperm injection (ICSI), has provided these men a chance to father their genetically own child and changed the management approach significantly. Objective: The objective was to compare the sperm retrieval rate (SRR) and ICSI outcomes of surgically retrieved sperms in cases of obstructive and nonobstructive azoospermia (NOA) as well as to evaluate the efficacy of sperm retrieval techniques. Materials and Methods: A total of sixty azoospermic patients were included in the study. The patients were divided between OA (16) and NOA groups (44). A retrospective outcome analysis was done on SRR and ICSI results among them. Results: The overall SRR in patients with NOA and OA was 47.7% and 100%, respectively (P < 0.001). On subgroup analysis, higher serum follicle-stimulating hormone has shown significantly decreased sperm retrieval. The size of testes was not found to be related to sperm retrieval. Fertilization and embryo formation rate were found to be higher in OA cases in comparison to those of NOA cases. Clinical pregnancy rate showed no significant difference. Conclusion: Various sperm retrieval techniques can provide new dimensions for successful ICSI and managing azoospermia patients. Although SRRs as well as ICSI outcomes are lower in NOA patients than patients with OA, still they are potentially fertile. A systematic approach especially in patients with NOA is an important step. Microdissection testicular sperm extraction is an attractive option for NOA patients in order to increase the chances of successful sperm retrieval.
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Clinical manifestations of chromosomal anomalies and polymorphic variations in patients suffering from reproductive failure p. 209
Leena Rawal, Sumit Kumar, Shiba Ranjan Mishra, Vandana Lal, Saurabh Kumar Bhattacharya
Background: Human reproduction is the most intricate event as ~ 20% of human pregnancies end in miscarriages for which chromosomal anomalies are a common factor. The chromosomal variations associated with reproductive failures include translocations, inversions, supernumerary marker chromosomes, heterochromatic polymorphisms, etc., Till date, the significance of heteromorphic variants in reproductive failures is unclear. Aim: The aim of this study is to investigate the role of chromosomal anomalies and polymorphic variations in reproductive failure. Materials and Methods: Chromosomal analysis using GTG banding was performed on 638 couples (1276 individuals). Results: In the present study, 138 of 1276 individuals showed chromosomal variations with respect to heterochromatic variants and Robertsonian translocations. The most common variants observed across the population studied were the pericentric inversion of the chromosome 9 [inv(9)(p11q13), 3.68%] followed by pstk + on the short arm of chromosome 15 (15pstk+, 1.95%) and Robertsonian translocation of chromosomes 13 and 14 [rob(13;14)(q10;q10), 1.25%]. The maximum percentage of heterochromatic variation was observed in females with recurrent pregnancy loss (Groups A, 4.78%) and males with wives having recurrent miscarriages (Group B, 3.68%) and the minimum was recorded in patients with in vitro fertilization (IVF) failures (Group C, 0.23%) and couples having a history of the malformed child (Group F, 0.23%). Conclusions: High level of chromosomal polymorphic variations in patients with reproductive failures warrants their in-depth analysis to nail down the causative factors. Hence, cytogenetic analysis coupled with genetic counseling becomes indispensable for patients suffering from infertility, reproductive failures and pregnancy losses before IVF treatment to rule out the carrier status.
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Cytogenetic analysis of 570 couples with recurrent pregnancy loss: Reporting 11 years of experience p. 216
Reza Alibakhshi, Parham Nejati, Sara Hamani, Narges Mir-Ahadi, Nazanin Jalilian
Objectives: Recurrent pregnancy loss (RPL) is a serious complication of pregnancies, affecting almost 2%–5% of couples. Among numerous underlying causes, chromosomal anomalies in one of the partners are regarded as important issues, with varying frequencies among different populations. In this study, we aimed to determine the prevalence of chromosomal abnormalities and chromosome polymorphisms in couples with a history of RPL from Kermanshah province, west of Iran. Materials and Methods: In this 11-year retrospective study, a total of 1140 cases with two or more spontaneous abortions were recruited and studied according to standard cytogenetic analysis. Results: From a total of 1140 reviewed blood samples, 1011 people (88.5%) had a normal karyotype and 129 people (11.5%) had chromosomal aberrations. These aberrations were found in 62 females and 67 males. The prevalence of chromosomal abnormalities was as follows: 18 (1.5%) structural aberrations, 1 numerical anomaly and 110 (9.6%) apparently normal polymorphic variants. Conclusions: Our findings could determine the underlying cause of RPL in 1.5% of the population while the majority still remained unexplained. This emphasizes the importance of searching for other genetic and nongenetic causes of RPL in apparently idiopathic cases of RPL.
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Parent perspective on childhood development after assisted reproductive technology: A national survey p. 221
Karissa C Hammer, Zoran J Pavlovic, Marika R Raff, Danielle E Bradley, Christina N Cobb, Stephanie E Elliot, Louis L Fogg, Jennifer E Hirshfeld-Cytron
Context: There is limited understanding about parent perspectives of newborn development after assisted reproductive technology (ART). The use of ART is known to increase the risk of premature delivery and low birth weight. Both of these factors are associated with developmental delay. To our knowledge, no study has investigated how parents perceive their child's development after use of ART. Aims: To investigate how the parent perspective of childhood development after ART use compares to the parent perspective of spontaneously conceived children. Settings and Design: This is a digital survey collecting data on parent perspective of newborn development after ART and spontaneous conception. Subjects and Methods: Invitation to participate was sent via E-mail to users of a (Ovia Health's) mobile parenting application (Ovia Parenting). Surveys were collected from August 30, 2018, to September 12, 2018, and a total of 1881 surveys were collected. Statistical Analysis Used: Analysis was performed with Chi-square cross-tabulations and ANOVA. Results: Overall, 13,600 (12%) of users who were delivered the E-mail engaged with the content. Of those users, 2739 (20%) initiated the survey and 1881 (69%) completed the survey and were included in the analyses. When comparing spontaneous conception to ART, parents reported similar developmental milestones at most ages. A significant difference existed at 12 months where those who had used ART were more likely to report their child met all milestones. This difference did not persist for subsequent ages. Conclusions: From the parent perspective, children conceived using ART methods should be expected to meet the same age-based developmental milestones as their spontaneously conceived peers.
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Complex mullerian malformation: A rare case of hypoplastic noncavitated uterus in the middle with two rudimentary horns on either side p. 235
Kamala Selvaraj, Priya Selvaraj, K Suganthi
Mullerian anomalies which cause infertility in women were described by different classification systems. We report a rare case of uterine anomaly in a 16-year-old patient presented with primary amenorrhea. Her diagnostic laparoscopy findings revealed two uterine rudimentary horns on either side of the upper pelvis with a hypoplastic noncavitated central uterus. The pathogenesis of this anomaly may not be clearly defined but it was stated that these occur due to the developmental defects in embryo. This case report is one of the rarest cases presented and may signify the Mullerian duct anomaly.
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Accessory fallopian tube in an adolescent: A rare anomaly p. 239
Kavitha Yogini Duraisamy, Saranya Ravi, Devi Balasubramaniam, Kodeeswari Ramesh
Accessory fallopian tube is a rare congenital/developmental anomaly, which has important clinical implications and is easily overlooked and missed by the surgeons. The incidence of this anomaly as stated in literature varies from 1.9% to almost 6% in infertile women. We report a case of a 14-year-old girl with dermoid cyst on the left ovary and with an accessory fallopian tube on the right side. The patient underwent laparoscopic dermoid cystectomy along with excision of the accessory fallopian tube. In spite of the presentation's rarity, gynecologists should be aware of such a condition as it has important clinical implications. The presence of an accessory tube predisposes to ectopic pregnancies, torsion, endometriosis, and infertility. Hence, routine careful inspection of the tubes, in any pelvic surgery, is recommended. Whenever encountered, it is advisable to excise these tubes after clear discussion of the implications.
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Hemoptysis: A rare presentation of mixed gonadal dysgenesis p. 242

The objective of the study was to present a case report on a phenotypic male mixed gonadal dysgenesis (MGD) who presented with hemoptysis due to secondary lung metastasis from dysgerminoma. Phenotypic male MGD (45, X/46, XY) with primary infertility and hemoptysis participated in the study. This study was conducted at a tertiary care center. Laparoscopic visualization of gonads and presence of Müllerian/ Wolffian structures were ascertained. Gonadectomy of intra abdominal dysgenetic gonad were done. Fluorescence in situ hybridization analysis was done in gonadal tissue to find the presence of Y chromosome. Intra-abdominal gonad showed dysgerminoma changes. Müllerian structures in the form of rudimentary uterus and fallopian tubes were seen. Left inguinal gonad showed normal testicular structures. Chemotherapy for secondary lung metastasis contemplated.
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A Successful Case for Deselection of Albino Embryo and Live Birth of Albinism-Free Healthy Baby Followed by PGT-M p. 245
Nayana Patel, Harsha K Bhadarka, Salil Vaniawala, Arpita Patel
In recent years, Preimplantation genetic testing for monogenic disorders (PGT-M) has gained a lot of focus in the field of assisted reproduction technology, various studies have been published in support of it and many are opposing its role. It has been criticized due to many ethical as well as scientific reasons, but there is no doubt that PGT-M has been one of the most important breakthroughs inin vitro fertilization. A critical aspect of this technology is the possibility that the biopsy itself can adversely affect the quality of embryo and compulsion of embryo freezing. Oculocutaneous albinism (OCA) is a condition which is related to skin, hair, eye color (pigments), where affected individuals typically have very fair skin and white- or light-colored hair. These patients are prone to skin cancers on prolonged sun exposure. It also reduces the pigmentation of the colored part of the eyes (the iris) and the light-sensitive tissue at the back of the eye (the retina). People with this condition usually have problem in vision such as reduced sharpness, involuntary eye movements, and photophobia. Here, we report the successful use of PGT-M and a novel protocol for the preimplantation genetic diagnosis of OCA following trophectoderm cell biopsy from blastocysts and the birth of a healthy infant to a couple having previously affected child.
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