Correspondence Address:
Madhuri Madhuri
Editor, Journal of Human Reproductive Science Dr. Patil«SQ»s Fertility & Endoscopy Clinic, No. 1, Uma Admiralty, First Floor, Near Jal Bhavan, Bannerghatta Road, Bangalore - 560029
India

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We know that there are several other sperm characteristic apart from count and motility that are important for fertilization, embryogenesis, and achievement of pregnancy. These include normal morphology, normal intact acrosome, straight line velocity and linearity, ability to bind to zona pellucida and to penetrate the zona pellucida, ability to fuse with the oolemma and activate the oocyte, and then its ability to form a pronucleus. Normal spermatogenesis can be affected by increasing paternal age, endocrine imbalance, anatomical and histological defects, environmental and/or occupational hazards resulting from exposure to toxic compounds, and environmental pseudo or xenoestrogens. They could also be related to exposure to anti-androgens during development, less consumption of omega-3 fatty acids, stress, genetics, and epigenetics factors. The review article on male infertility discusses the trend of male infertility management in India and globally. One must remember that spermatogenesis cannot be readily altered for therapeutic benefit, and the main problem to be solved in future is effective treatment of defective sperm production or function and to improve implantation and pregnancy rates with various modalities of treatment. Effective treatment of male infertility is remote possibility in most cases as pathogenesis remains obscure and one has to resort to treatment at gamete level and that is assisted reproductive technology (ART). Further research is required on the investigation of specific spermatozoal factors, which will contribute to the development of novel and more personalized approaches to test and treat male factor infertility.

Today, we know that polycystic ovarian disease (PCOS) is one of the most common causes for anovulation and infertility related to it. The European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine in a combined meeting had declared that there is no role of metformin in the treatment of anovulation in PCOS. However, a randomized trial by Dr. Sujata Kar from the eastern part of India has concluded that metformin was as good as clomiphene citrate (CC) in terms of live birth rate (LBR) and the combination of CC and metformin gave the highest ovulation and LBR. She has suggested that there should be larger multicentric trials in Indian context to compare metformin with CC and placebo to consolidate the role of metformin in young infertile PCOS women in India.

There was another study on the PCOS which compared the incidence of metabolic syndrome (MBS) in PCOS and non-PCOS population separately and correlated it with body mass index (BMI). This study found a higher incidence of MBS in women with PCOS; however, they also concluded that obesity is an independent and stronger risk factor for developing MBS. This study also suggested that lifestyle modification is advisable above BMI of 23 kg/m 2 in normal population and 22.5 kg/m 2 in women with PCOS to prevent PCOS and obesity-related long-term health consequences.

Oocyte competence is the ability of the oocyte to complete maturation, undergo successful fertilization, and reach blastocyst stage. We also know that mitochondrial function in oocytes and thus its competence and early embryogenesis could be influenced by intrafollicular milue. There is an original article by Chimote, which aimed at identifying markers of oocyte competence by measuring the levels of dehydroepiandrosterone sulfate (DHEA-s) in follicular fluid (FF). They concluded that FF DHEA-s level influences the oocyte maturation process and is predictive of fertilization, embryo development to the blastocyst stage, and LBRs in non-PCOS women undergoing conventional in-vitro fertilization (IVF) cycles.

Implantation is the most critical step in reproduction, a complex process where blastocyst becomes intimately connected with the maternal endometrium and decidua, and requires competent embryo at blastocyst stage, receptive endometrium, synchronized dialogue between maternal and embryonic tissues, and optimal embryo transfer technique. Over the last 37 years after the birth of the first IVF baby, major progress has been made in improving stimulation protocols and fertilization procedures, optimizing embryo culture conditions, and preventing premature luteinization; however, only marginal improvement has been seen in the implantation and pregnancy rate. All ART specialists would like to improve implantation and pregnancy rates and for this they use several methods. One article has analyzed the use of embryonic glue (hyaluronan-enriched embryo transfer medium) to increase the implantation and pregnancy rates in ART cycles. This study concluded that the use of embryonic glue did not increase implantation and pregnancy rates when used in all patients undergoing ART treatment but had a definite beneficial effect in patients with recurrent implantation failure. The other original article looks at endometrial scratch as a technique to improve the implantation rates. Endometrial injury increases growth factors and cytokines, thus improving the endometrial receptivity which increases the implantation rates. This effect is more prominent if the endometrial injury is done 45 days before the embryo transfer, that is, in the preceding menstrual cycle.

Various etiologies are implicated in recurrent pregnancy loss (RPL), which include factors that are known to be causative, as well as those implicated as possible causative agents. The accepted etiologies include parental chromosomal abnormalities, untreated hypothyroidism, uncontrolled diabetes mellitus, certain uterine anatomic abnormalities, and antiphospholipid antibody syndrome. The probable etiologies include additional endocrine disorders, heritable and/or acquired thrombophilias, immunologic abnormalities, infections, and environmental factors. There is a study published in this issue, which evaluates the prevalence and role of inherited thrombophilia in early pregnancy loss, specifically in the first trimester. The potential association between RPL and heritable thrombophilias is based on the theory that impaired placental development and function secondary to venous and/or arterial thrombosis could lead to miscarriage. This study concludes that thrombophilia is a causal factor for miscarriages in the first trimester of pregnancy, and treating these women with unfractionated heparin throughout pregnancy and 4-6 weeks after delivery can prevent RPL.

We have four case reports of which two are on ovarian hyperstimulation syndrome (OHSS). One is on novel follicle-stimulating hormone receptor mutation in a case of spontaneous OHSS with successful pregnancy outcome
and other on early onset OHSS despite the use of segmentation
approach and OHSS prophylaxis. 
The third case report is on nonclassic congenital adrenal hyperplasia misdiagnosed as Turner syndrome, and the last is a rare case of Mayer-Rokitansky-Kuster-Hauser syndrome with multiple
leiomyomas in hypoplastic uterus.

Wishing all our readers a happy and fruitful 2016.