Year : 2016 | Volume
: 9 | Issue : 2 | Page : 61--62
From the Editor's desk
Dr. Patil's Fertility and Endoscopy Clinic, Bangalore, Karnataka, India
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 2016;9:61-62
|How to cite this URL:|
Patil M. From the Editor's desk. J Hum Reprod Sci [serial online] 2016 [cited 2021 Oct 25 ];9:61-62
Available from: https://www.jhrsonline.org/text.asp?2016/9/2/61/183503
This issue has two review articles on poor responders one on poor ovarian reserve and the other is a systemic review and meta-analysis on poor ovarian response. We know that the ovarian reserve is functional potential of the ovary and reflects the number and quality of oocytes within it. Success of treatment in this group even for assisted reproduction depends on various factors including adequate number of follicles being stimulated, adequate number of oocytes retrieved and quality of oocytes. But one must remember that we cannot recruit follicles that do not exist and egg quality fundamentally cannot be altered. This makes counseling very essential in this group of patients before we embark on any treatment.
The systemic review and meta-analysis is on effective treatment protocols in women with poor response. This review has not shown any benefit of using GnRH antagonist verses agonist, addition of luteinizing hormone (LH), aromatase inhibitors and dehydroepiandrosterone supplementation. There has been a significant improvement in the live birth rates with the use of growth hormone and transdermal testosterone. But as this evidence is from small number of studies, large multi-centric trials should be done before we recommend their routine use in all women with poor response.
There is another review article on postmortem sperm retrieval in context of developing countries. Posthumous reproduction by a partner is acceptable if the following conditions are met: Written consent has been given by the deceased person, the partner has received extensive counseling and a minimum waiting period of 1 year is imposed before a treatment can be started. For use by third parties, the usual conditions for gamete and embryo donation apply. Posthumous reproduction is a highly controversial issue due to the problems that can arise in the psychosocial development of children born after this procedure. We must have guidelines in place before we advocate posthumous sperm retrieval.
There is an original article on association of tumor necrosis factor-alpha 308G/A polymorphism with recurrent miscarriages. 45% of early losses and 95% of late losses are due to antiphospholipid antibodies (APLA) , acquired/inherited thrombophilia and heritable thrombophilias which include anti thrombin deficiency, protein C and S deficiency and Factor V Leiden deficiency. All these can alter the Th1 and Th2 response resulting in recurrent miscarriage. This study has looked for TNF-a 308G/A variant in women with reproductive failure. This study has shown an increase in the GG and GA genotypes in this group.
There is a good survey article on the gonadal function and fertility outcome in childhood cancer survivors. Advances in cancer treatment mean that today more than 80 percent of children diagnosed with cancer are alive at least five years after diagnosis. Many ultimately will be considered cured. As a consequence, interest is growing in the long-term health and fertility of these survivors. There also could be problems with the sexual function. Counseling for fertility preservation should be an integral part in management of cancer patients especially in the pediatric group as 4 out of 5 patients survive and lead a normal life. In India we still lack in counseling for fertility preservation, as we are more interested in treating the cancer first. This article looks at the gonadal function of childhood cancer survivors and the options available for fertility. We need to work a lot more in this field to create awareness.
Pre-implantation genetic screening is being proposed to improve the effectiveness of in vitro fertilization by screening for embryonic aneuploidy Though Fluorescent in situ hybridisation analysis (FISH) based PGS showed adverse effects on IVF success, emerging evidence from new studies using comprehensive chromosome screening technology appears promising. This is because FISH screened only 5 chromosomes, where as microarray comparative genomic hybridization can screen for all 24 chromosomes along with the sex chromosomes. Gaurav Majumdar- et al in their pilot study in poor prognosis patients have shown an improvement in the clinical outcome with the use of by microarray comparative genomic hybridization (array CGH).
There is another randomized control trial to investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the live-birth rate for normal responders in GnRH-antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles. Several studies published have shown an improved probability of conception and live birth without increasing the risk of significant OHSS with the use of dual trigger. The study by Nalini et al did not show any advantage in regards to here is no significant difference in the outcomes in terms of- the number of mature oocytes, fertilization rate, and number- of usable embryos by day 3 on using either dual trigger or hCG.
Hysteroscopy in infertile women allows comprehensive evaluation of the uterine cavity with appropriate treatment to improve live birth rate (LBR). But hysteroscopic surgeries for sub mucous myoma and uterine congenital anomalies can result in intra uterine adhesions (IUA). These IUA can further decrease the implantation rate (IR) and pregnancy rate (PR) instead of its positive impact on IVF outcome by treating intrauterine pathologies that could interfere with implantation. A prospective study on 51 patients on effect of myomectomy on endometrial cavity has shown an incidence of IUA to be 21.57%. As IUA reduce the chance of pregnancy these authors advocate a second look hysteroscopy in all cases desiring fertility to diagnose and treat these adhesions early.
Despite advances in the stimulation protocols and technology used in the IVF laboratory the IR and PR had not improved in the last 3 decades. This could be because we are unable to identify the endometrial receptivity and traditionally used method of morphologic embryo selection is not predictive enough of its implantation potential. Time-lapse embryo monitoring allows continuous, non-invasive embryo observation without the need to remove the embryo from optimal culturing conditions. The extra information on the cleavage pattern, morphologic changes and embryo development dynamics could help us identify embryos with a higher implantation potential. These technologic improvements enable us to objectively select the embryo(s) for transfer based on certain algorithms. The study by Deven Patel et al looked at development of euploid and aneuploid embryos using a time-lapse technology. They also looked into a model for selection of euploid embryos based on morphokinetics. There are several publications on recognizing euploid embryos by keeping a track of time interval between two stages (time to division to 5 cells (t5)), time period of the third cell cycle (CC3), and time from 2 cell division to 5 cell division (t5-t2). But this study did not observe any significant difference in the time lapse parameters between the normal and abnormal embryos. They also concluded that time lapse technology cannot substitute for array CGH to select euploid embryos for transfer.
We also have 4 case reports - Pregnancy at 65, risks and complications, successful birth of South India's first twins after preimplantation genetic screening of embryos, an eventful journey from menarche to successful motherhood and a rare balanced non-robertsonian translocation involving acrocentric chromosomes.