Journal of Human Reproductive Science
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   2016| January-March  | Volume 9 | Issue 1  
    Online since March 14, 2016

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The endometrium in assisted reproductive technology: How thin is thin?
Nalini Mahajan, S Sharma
January-March 2016, 9(1):3-8
A thin endometrium is encountered infrequently (2.4%) in assisted reproductive technology cycles. When it does occur it is a cause of concern as it is associated with lower implantation rate and pregnancy rate. Though pregnancies have been reported at 4 and 5 mm it is apparent that an endometrial thickness <6 mm is associated with a trend toward lower probability of pregnancy. Hormone replacement therapy – frozen embryo transfer (FET) cycles appear to give better results due to an improvement in endometrial receptivity (ER). The etiology of thin endometrium plays a significant part in its receptivity. A number of treatments have been tried to improve endometrial growth, but none has been validated so far. Confirming ER of a thin endometrium by an ER array test before FET offers reassurance.
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Jain point: A new safe portal for laparoscopic entry in previous surgery cases
Nutan Jain, Sweta Sareen, Swati Kanawa, Vandana Jain, Sunil Gupta, Sonika Mann
January-March 2016, 9(1):9-17
INTRODUCTION: The present study was performed to assess the safety and feasibility of a new laparoscopic entry site in cases suspected of adhesions due to previous surgery. MATERIALS AND METHODS: It is a retrospective study undertaken at a tertiary care referral center for advanced gynecological laparoscopic surgery from January 2011 to December 2014. RESULTS: In 624 patients with a history of previous abdominal surgeries, the laparoscopic entry site was through a newly devised point. It is a point in the left paraumbilical region at the level of umbilicus, in a straight line drawn vertically upward from a point 2.5 cm medial to anterior superior iliac spine. Intra-abdominal adhesions were found in 487 (78.0%) patients, and umbilical adhesions in 404 (64.7%) patients with past abdominal surgeries. CONCLUSION: There were no significant entry-related, intra-operative, or postoperative complications with the use of this entry point. It is also suitable as a main working port during the course of surgery.
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Correlation of serum estradiol level on the day of ovulation trigger with the reproductive outcome of intracytoplasmic sperm injection
N Siddhartha, N Sanjeeva Reddy, Monna Pandurangi, M Tamizharasi, V Radha, K Kanimozhi
January-March 2016, 9(1):23-27
BACKGROUND: Serum estradiol (E2) levels are measured in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), to assess the ovarian response and to predict ovarian hyperstimulation syndrome. The impact of peak E2levels on IVF-ICSI outcome was found to be inconsistent in the previous studies. AIM: To evaluate the impact of the serum E2levels on the day of ovulation trigger with the reproductive outcome of ICSI. SETTINGS AND DESIGN: Retrospective observational study. ART Center, at a Tertiary Care University Teaching Hospital. SUBJECTS AND METHODS: Eighty-nine infertile women, who underwent ICSI with fresh embryo transfer over a period of 3 years, were included in the study. The study subjects were grouped based on the serum E2level on the day of ovulation trigger:- Group I - <1000 pg/ml, Group II - 1000–2000 pg/ml, Group III – 2000.1-3000 pg/ml, Group IV – 3000.1–4000 pg/ml, and Group V >4000 pg/ml. The baseline characteristics and controlled ovarian hyperstimulation (COH) outcome were compared among the study groups. STATISTICAL ANALYSIS USED: Chi-square test, Student's t-test, ANOVA, and logistic regression analysis. RESULTS: The study groups were comparable with regard to age, body mass index, ovarian reserve. Group V had significantly higher number of oocytes retrieved than I and II (18.90 vs. 11.36 and 11.33; P = 0.009). Group IV showed significantly higher fertilization rate than I, III, and V; (92.23 vs. 77.43, 75.52, 75.73; P = 0.028). There were no significant differences in the implantation rates (P = 0.368) and pregnancy rates (P = 0.368). CONCLUSION: Higher E2levels on the day of ovulation trigger would predict increased oocyte yield after COH. E2levels in the range of 3000–4000 pg/ml would probably predict increased fertilization and pregnancies in ICSI cycles.
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Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: A clinic-based study
Ansha Patel, P. S. V. N. Sharma, Pratapkumar Narayan, VS Binu, N Dinesh, Praveena Joglekar Pai
January-March 2016, 9(1):28-34
BACKGROUND: According to the existing literature on infertility, stress appears to be inevitably associated with infertility diagnosis and treatment in sub-fertile individuals. The epidemiological data on the prevalence and predictors of infertility-specific stress in cultural specific scenario are scarce. The objective of the present study was to estimate the prevalence of infertility-specific stress and identify predictors of infertility-specific stress in women diagnosed with primary infertility. MATERIALS AND METHODS: This cross-sectional study was conducted on 300 infertile married women, diagnosed with primary infertility. The tools used for the assessment were “semi-structured questionnaire ” compiled by the authors, “ICD-10 Classification of Mental and Behavioral Disorders (Clinical Descriptions and Diagnostic Guidelines), ” and “Psychological Evaluation Test for infertility. ” STATISTICAL ANALYSIS: Data were analyzed using SPSS (version 15). Chi-square test was used for univariate analysis followed by multiple logistic regressions between stress and the predictor variables. RESULTS AND DISCUSSION: The prevalence of stress among women was 80%. Univariate analysis revealed that predictors of stress were years of marital life, duration of infertility, infertility type, history of gynecological surgery, cycles of ovulation induction with timed intercourse and intra-uterine inseminations, present and past psychiatric morbidity, coping difficulties, gynecological diagnosis, and severity of premenstrual dysphoria. Multivariate analysis showed leading associations of stress with infertility type and coping difficulties.
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Endocrinal and autoimmune linkage: Evidences from a controlled study of subjects with polycystic ovarian syndrome
Sheetal Arora, Kiran Sinha, Sachin Kolte, Ashish Mandal
January-March 2016, 9(1):18-22
BACKGROUND: Polycystic ovary syndrome (PCOS) is a metabolic syndrome, characterized by anovulation, hyperandrogenism, and polycystic ovary. With serological markers of autoimmunity found elevated in PCOS, there is a possible link between autoimmunity and PCOS. AIM: The study aimed to investigate the possible correlation between autoimmune markers of autoimmune thyroiditis (AIT) and PCOS. SETTING AND DESIGN: This case control study was conducted at the Department of Pathology of a tertiary care academic center during a 1-year period. MATERIALS AND METHODS: Fifty-five subjects with clinical PCOS and 51 age matched control non-PCOS subjects were recruited and subjected to clinical, biochemical, and endocrinal evaluation for AIT. All subjects underwent blood glucose and serum sampling for luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, dehydroepi androsterone, thyroxine, thyroid stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin (Tg), and insulin. STATISTICAL ANALYSIS: Statistical analysis was performed using SPSS version 12 for Windows. The quantitative variables are described as mean ± standard deviation. To compare quantitative variables between two groups, unpaired t-test was used. The Chi-square/Fischer's exact test was used to compare qualitative variables. ANOVA was used to compare the PCOS and non-PCOS groups. P < 0.05 was considered significant. RESULTS: Significantly higher prevalence of AIT (anti-Tg antibodies) was noted in subjects with PCOS as compared to non-PCOS control subjects (P < 0.05). The PCOS subjects had higher insulin resistance index and also twice the level of LH: FSH ratio as compared to controls. CONCLUSION: Higher prevalence of AIT in PCOS subjects suggest possible role of autoimmune phenomenon in the etiopathogenesis of PCOS. More data from longitudinal follow-up studies is required to clearly establish this possible link.
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Association of large scale 4977-bp "common" deletions in sperm mitochondrial DNA with asthenozoospermia and oligoasthenoteratozoospermia
Prafulla S Ambulkar, Ajay R Chuadhari, Asoke K Pal
January-March 2016, 9(1):35-40
OBJECTIVE: To determine the association of large-scale mitochondrial DNA (mtDNA) deletions with abnormal sperm or abnormal flagellar movement of human spermatozoa in asthenozoospermia and oligoasthenoteratozoospermia (OAT) subjects using percoll gradients fractionation and long-range polymerase chain reaction (PCR). DESIGN: We investigated sixty infertile men and thirty normal healthy fertile controls. Of sixty infertile men, 39 were asthenozoospermia and 21 were OAT. MATERIALS AND METHODS: Percoll gradients discontinuous technique was used for separation of spermatozoa on the basis of their motility. Long-range PCR was used for detection of “common ” 4977-bp deletions, and primer shift technique was used for confirmation of deletions. RESULTS: Overall fourteen subjects (14/60; 23.3%) of which eight (8/39; 20.5%) asthenozoospermia and six (6/21; 28.6%) OAT had shown deletions of 4977-bp. Deletions were more common (23.3%) in 40% fraction than 60% (11.6%) and 80% (5%) fractions. Sequencing results had shown deleted region of mtDNA. CONCLUSION: Abnormal spermatozoa had more number of mtDNA deletions than normal sperm, and abnormal spermatozoa had lost genes for the oxidative phosphorylation. Our findings suggest that large-scale 4977-bp mtDNA deletions in the spermatozoa from the infertile subjects cause the asthenozoospermic and OAT pathophysiological conditions in infertile males.
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Antisperm protein targets in azoospermia men
Mohammad-Sadegh Soltani Zangbar, Sara Keshtgar, Jaleh Zolghadri, Behrouz Gharesi-Fard
January-March 2016, 9(1):47-52
BACKGROUND: The number of couples that meet the definition of infertility at reproductive ages is increasing worldwide. One of the most known conditions of infertility in males is azoospermia, defined as complete absence of spermatozoa in the semen. Azoospermia manifests in two forms, namely obstructive and non-obstructive azoospermia. Although the presence of antisperm antibody (ASA) has been reported in 88% of the patients with obstructive azoospermia (OA), interestingly, there is no data regarding ASA targets in OA individuals. AIM: The present study aimed to identify sperm antibody targets in a group of OA men. SETTINGS AND DESIGN: The present study was carried out on 27 OA infertile men and 27 healthy fertile age-matched males as cases and controls, respectively. SUBJECTS AND METHODS: The sperm proteome was separated using two-dimensional gel electrophoresis technique, transferred onto the polyvinylidene fluoride membrane, and blotted with the sera of a group of OA men. Then, it was compared with the membranes blotted with the sera of a group of healthy fertile men. Matrix-assisted laser desorption/ionization time-of-flight/time-of-flight (MALDI TOF/TOF) mass spectrometry was used to identify the different blotted spots and finally the results of the mass analysis were confirmed using reverse transcriptase polymerase chain reaction method. RESULTS: The results indicated that OA patients might produce antibody against two sperm proteins, Tektin-2 and triose phosphate isomerase. Moreover, the expressions of the two targeted proteins were confirmed at RNA level. CONCLUSIONS: The findings of the present study revealed two functionally important sperm proteins as antibody targets in azoospermic men.
  2,301 130 -
Successful pregnancy following single blastocyst transfer in a renal transplant recipient
V Arun Muthuvel, Manipriya Ravindran, Aravind Chander, Chandralekha Veluswamy
January-March 2016, 9(1):53-55
Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients.
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Lactobacillus acidophilus maintained oxidative stress from reproductive organs in collagen-induced arthritic rats
Sarika Amdekar, Vinod Singh
January-March 2016, 9(1):41-46
CONTEXTS: Nonsteroidal anti-inflammatory drugs (NSAIDs) induced organ damage is a well-known fact. Previous studies suggest that Lactobacillus scavenge the free radicals from liver and kidney and also protect animals from arthritis. AIMS: Comparing protective properties of Lactobacillus acidophilus in reducing oxidative stress from reproductive organs developed during collagen-induced arthritis in animal model. METHODS: Arthritis was induced in Wistar rats. Oral administration of L. acidophilus, indomethacin, and distilled water were all started on the same day. Arthritis scores were calculated for each group. Oxidative stress parameters were estimated in testis and ovary homogenates. Histopathology of ovary and testis was also performed. RESULTS AND CONCLUSION: L. acidophilus decreased arthritis score (P < 0.001) as well as maintained normal histology of reproductive organs. L. acidophilus maintained oxidative stress parameters from ovaries and testis (P < 0.001). These results provide strong evidence that NSAIDs increase oxidative stress in reproductive organs while L. acidophilus not only scavenges free radicals from reproductive organs but also protects rats from arthritis symptoms.
  2,072 95 -
Rare combination of anomalies and its management with conservative and effective approach
Saravanan Thirumalai Thangarajan, Minati Choudhury, TV Padmanabhan, N Shanmuganathan
January-March 2016, 9(1):56-58
Transverse vaginal septum is a rare anomaly that results from incomplete fusion of urogenital sinus, and the vaginal parts of the Mullerian duct. Cervical atresia/dysgenesis is still a rare uterovaginal anomaly that can be congenital or acquired leading to fertility problems. Transverse vaginal septum when it coexists with cervical dysgenesis, it becomes a rare combination where management becomes highly complex. This case report deals with interdisciplinary role of conservative surgical management and custom made prosthetic appliances in the management of transverse vaginal septum and cervical atresia at an early stage and perhaps this goes to be the first-line treatment option with the expertise in laparoscopic surgery along with prosthetic management.
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From the Editor's desk
Madhuri Patil
January-March 2016, 9(1):1-2
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