Journal of Human Reproductive Science
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   2008| July-December  | Volume 1 | Issue 2  
    Online since November 19, 2008

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Polycystic ovaries and infertility: Our experience
Lavanya Rajashekar, Deepika Krishna, Madhuri Patil
July-December 2008, 1(2):65-72
DOI:10.4103/0974-1208.44113  PMID:19562048
Background: Polycystic ovary syndrome (PCOS) is one of the most common (15-20%) endocrine disorders in women of childbearing age. Although it is a major cause of infertility, its etiology remains unknown and its treatment difficult. Aim: To evaluate the incidence, treatment and outcome of patients with PCOS. DESIGN: Retrospective analysis. Materials and Methods: PCOS patients (914 of the 1057) attending the outpatient department (OPD) from June 2003 to February 2008 were evaluated for this study. Of the 914 patients investigated, 814 came for treatment and these patients were studied for hormonal disturbances and their response to various modalities of treatment. Results: Of the 2270 infertility patients, 46.50% (1057) had PCOS, out of these, 86.47% (914) were investigated and 77% (814) came for treatment. Our overall pregnancy rate was 48.40% (394/814). The pregnancy rate per cycle with timed intercourse (TI) was 44.77% (47/105), 17.09% (286/1673) with intrauterine insemination (IUI), 29.82% (51/171) with in vitro fertilization (IVF) and 22.22% (10/45) with frozen embryo transfer (FET). The maximum number of pregnancies (85.29%, 284/333) were achieved in the first three treatment cycles. The abortion rate was 19.01% (73/384) and the incidence of ectopic pregnancy was 5.47% (21/384). Complications seen were in the form of ovarian hyperstimulation (OHSS), retention cyst on day two and multiple pregnancies in 11.71% (228/1946) of the total treatment cycles. Conclusion: Most PCOS symptoms could be adequately controlled or eliminated with proper diagnosis and treatment. Thus, ovulation induction (OI) protocols and treatment modalities must be balanced for optimal results.
  8,891 856 12
Recognising, understanding and managing endometriosis
Ian S Fraser
July-December 2008, 1(2):56-64
DOI:10.4103/0974-1208.44112  PMID:19562047
Endometriosis is defined as the presence of tissue lesions or nodules, histologically similar to the endometrium, at sites outside the uterus. It is a highly variable condition that has a wide spectrum of symptoms. The aetiology of endometriosis is probably multifactorial, with a strong familial component recognised. Women with endometriosis have multiple disturbances of function in the eutopic endometrium that women without the disease do not have. A firm diagnosis of endometriosis is rarely possible in general practice. The 'gold standard' for the diagnosis of pelvic endometriosis is currently a diagnostic laparoscopy.
  6,652 589 5
The outcome of ART in males with impaired spermatogenesis
VS Mangoli, SP Dandekar, SK Desai, RV Mangoli
July-December 2008, 1(2):73-76
DOI:10.4103/0974-1208.44114  PMID:19562049
Aims: This study was conducted to evaluate the outcomes of assisted reproductive technology (ART) procedures, viz., intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in males with impaired spermatogenesis. Settings and Design: The subjects of the study were infertile couples who were undergoing ART treatment due to male factor indications. The project was designed to correlate the outcome of the ART treatment and its efficacy in different study groups. Methods: Males were grouped as: 1. oligozoospermia (n = 153), 2. asthenoteratozoospermia (n = 158), 3. obstructive azoospermia (n = 110) and 4. nonobstructive azoospermia (n = 58). Patients from groups 1 and 2 were considered for IUI, IVF and ICSI. Those from group 3 were considered for IVF and ICSI and the 4th group underwent only ICSI treatment. Results: Oligozoospermia showed lower pregnancy rates with IUI than with both IVF and ICSI. An average minimum native and postharvest count was obtained to get an acceptable IUI outcome. Asthenoteratozoospermia had the lowest pregnancy rate with IUI as compared to IVF, whereas ICSI showed significantly higher pregnancy rates in this group. Obstructive azoospermia showed significant improvement with ICSI over IVF. In nonobstructive azoospermia, ICSI resulted in a 27.58% pregnancy rate. Conclusion: The IUI outcome was impressive though less effective whereas there was no difference between the IVF and ICSI outcomes in oligozoospermia. In asthenoteratozoospermia, ICSI showed a significant advantage over IUI and IVF, with IUI resulting in poor outcome in this group. In obstructive azoospermia, ICSI had a distinct advantage over IVF whereas in nonobstructive azoospermia, ICSI, the only option, was found to be effective and helpful in achieving an acceptable pregnancy rate.
  5,737 341 7
Interstitial ectopic pregnancy: A rare and difficult clinicosonographic diagnosis
R Rastogi, GL Meena, N Rastogi, V Rastogi
July-December 2008, 1(2):81-82
DOI:10.4103/0974-1208.44116  PMID:19562051
Ectopic pregnancy in the interstitial part of the fallopian tube is a rare event. This condition presents a challenge for clinical as well as radiological diagnosis. Although routine two-dimensional ultrasound can be suggestive, three-dimensional ultrasound is highly accurate in diagnosis. Hence, the authors report a rare case of interstitial ectopic pregnancy diagnosed preoperatively by three-dimensional ultrasound and managed laparoscopically.
  5,659 343 5
Empty follicle syndrome-Still an enigma
Deepika Krishna, Lavanya Rajashekar, Madhuri Patil
July-December 2008, 1(2):86-89
DOI:10.4103/0974-1208.44118  PMID:19562053
Empty follicle syndrome (EFS), although rare with an incidence of 0.2-7%, is a frustrating condition where no oocytes are retrieved in in vitro fertilization (IVF), even though ultrasound and estradiol measurements show the presence of many potential follicles. It is a complex phenomenon that cannot be explained by low bioavailability of human chorionic gonadotrophin alone; neither can it be reliably diagnosed by the measurement of serum beta-human chorionic gonadotrophin (bhCG) on the day of oocyte retrieval (OR), except possibly when the bhCG concentration is very low. Here we report a case who underwent intracytoplasmic sperm injection (ICSI) for her partner's severe oligoasthenozoospermia. Controlled ovarian hyperstimulation (COH) was done in her first cycle of ICSI, using a gonadotrophin-releasing hormone (GnRH) agonist long protocol with follicle-stimulating hormone (FSH) and human menopausal gonadotrophin (HMG). However, as we were unable to retrieve any oocytes, her COH protocol was changed in the subsequent cycle with a successful outcome.
  5,027 378 2
Changes in serum calcium, magnesium and inorganic phosphorus levels during different phases of the menstrual cycle
Puja Dullo, Neeraj Vedi
July-December 2008, 1(2):77-80
DOI:10.4103/0974-1208.44115  PMID:19562050
Background: The menstrual cycle is a complex process involving the interaction of the hypothalamus, the anterior pituitary, the ovaries and the uterus. The hormonal changes occurring during this cyclic process not only affect oocyte maturation and the endometrial and vaginal environments but can also have an effect on a number of other physiological and biochemical phenomena. Aim and Method: We investigated the changes in serum calcium, magnesium and inorganic phosphorus levels during different phases of the menstrual cycle in fifty healthy young women. We found subtle but significant variations in these levels in the menstrual, follicular and luteal phases. Result: The serum calcium level was highest in the follicular phase whereas the serum magnesium level was lowest in the follicular phase; the serum inorganic phosphorus levels was highest in the menstrual phase. Conclusion: These variations could be due to the impact of the changing estrogen and progesterone secretion on the parathyroid glands.
  4,626 395 2
Ovarian tissue cryopreservation: An update
Ethiraj B Prasath
July-December 2008, 1(2):50-55
DOI:10.4103/0974-1208.44111  PMID:19562046
Ovarian tissue cryopreservation and transplantation have been considered as promising means of fertility preservation for women who have survived cancer, with livebirths being reported from this technique. Ovarian tissue cryopreservation can be offered to patients with different types of cancer. Among the cryoprotectants, glycerol appears to give the poorest results. The techniques of cryopreserving ovarian tissue and alternative approaches have been reviewed in this article. The readers are reminded that this technique is still experimental and informed consent to be obtained from patients after counseling with medical information on the risks involved.
  3,826 447 1
Magnetic resonance imaging diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome
MJ Govindarajan, Revathi S Rajan, Arjun Kalyanpur, Ravikumar
July-December 2008, 1(2):83-85
DOI:10.4103/0974-1208.44117  PMID:19562052
Magnetic resonance imaging (MRI) is the mainstay in the imaging evaluation of Mullerian agenesis, but is not routinely being utilized, particularly in India. Though sagittal MRI clearly demonstrates the absence or hypoplasia of the uterus and the axial images demonstrate the normal ovaries, it is the ability to identify and objectively evaluate other associated anomalies that makes MRI a unique diagnostic modality. It is also noninvasive and has multiplanar capabilities at the same time having a very high soft tissue resolution. We presume it can be used as a comprehensive imaging package for evaluating these patients at one sitting. We report a case of Mullarian agenesis presenting as primary amenorrhea stressing the role and benefits of MRI.
  3,799 309 3
Successful pregnancy in a patient with pseudomyxoma peritonei following in-vitro fertilization using donor eggs
SA Narvekar, PK VijayKumar, N Shetty, MS Srinivas, KA Rao
July-December 2008, 1(2):90-92
DOI:10.4103/0974-1208.44119  PMID:19562054
Pseudomyxoma peritonei is a rare, chronic relapsing disease with a guarded prognosis. Here, we describe such a case of a young patient presenting with primary infertility, who conceived following in-vitro fertilization with donor egg and had a successful pregnancy outcome. Literature regarding fertility and pregnancy outcome in this condition is reviewed.
  2,821 175 2
From the Editor's desk
Kamini A Rao
July-December 2008, 1(2):49-49
DOI:10.4103/0974-1208.44110  PMID:19562045
  1,537 137 -
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