Year : 2016 | Volume
: 9 | Issue : 4 | Page : 213--214
From the Editor's desk
Clinical Director, Dr. Patil's Fertility and Endoscopy Clinic, Bangalore, Karnataka, India
Clinical Director, Dr. Patil«SQ»s Fertility and Endoscopy Clinic, Bangalore, Karnataka
|How to cite this article:|
Patil M. From the Editor's desk.J Hum Reprod Sci 2016;9:213-214
|How to cite this URL:|
Patil M. From the Editor's desk. J Hum Reprod Sci [serial online] 2016 [cited 2017 Mar 29 ];9:213-214
Available from: http://www.jhrsonline.org/text.asp?2016/9/4/213/197628
This issue has a very interesting article on laparoscopic peritoneal vaginoplasty for absent vagina in cases of in Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS). The different surgical methods used for this condition has several disadvantages, which include stenosis, poor lubrication, scarring, and contracture leading to dyspareunia. This study has shown successful peritoneal metaplastic conversion to normal vagina by the progenitor cells, which were identified in normal peritoneum using SOX2/OCT4 markers. Use of laparoscopic peritoneal vaginoplasty will revolutionize the treatment of absent vagina.
We know that implantation most critical step in reproduction. It is a complex process where blastocyst becomes intimately connected with maternal endometrium/decidua and requires a competent embryo at blastocyst stage, receptive endometrium and synchronized dialogue between maternal and embryonic tissues. We also know that factors involved in regulation of blastocyst implantation are incompletely understood. Even after 40 years of in-vitro-fertilization (IVF) treatment and research, major progress has been made only in improving stimulation protocols and fertilization procedures, optimizing embryo culture conditions and preventing premature luteinization. However there has been only marginal improvement in implantation rates (IR) and pregnancy rates. So today the clinician is working towards the goal of improving both implanation and live birth rates (LBR). Aneuploidy is one of the major factors, which affect embryo implantation. A study published by Aditi Kotdawalal looks at the use of array comparative genomic hybridization (aCGH) to screen embryos for identification of euploid embryos for transfer to improve and increase the IR and LBR.
Hysterosalpingography (HSG) is the commonest method for tubal evaluation before any infertility treatment. Many patients dread this investigation as it is a painful procedure and usually general anaesthesia is not recommended. A prospective randomized study by Shikha Jain et al evaluated the use of paracervical block with 2% lignocaine for pain relief in women undergoing HSG. They recorded the pain perception during the procedure and found no benefit of paracervical block with 2% lignocaine, in terms of pain relief, in women undergoing HSG.
Functional and intact uterine cavity is a pre-requisites for successful implantation and continuation of pregnancy. Therefore the uterine cavity should be free of lesions such as adhesions, polyps, fibroids and septae. There are different methods to identify these lesions, which include, HSG, saline infusion sonohysterography (SIS) and hysteroscopy. This issue has a study which compares accuracy of saline infusion sonohysterography (SIS) with hysteroscopy in the diagnosis of intrauterine pathologies in women with recurrent implantation failure (RIF). This study concluded that SIS was accurate in detecting endometrial polyp and submucosal myoma but was deficient to diagnose septum and intra uterine adhesions (IUA). But today with the use of 3 and 4 dimention ultrasonograohy, which is like a vitual hysteroscopy does SIS, HSG or hysteroscopy have a role in diagnosing intra uterine lesions? Today hysteroscopy should be done only for therapeutic reasons where an intra uterine lesion is suspected and not used as a diagnostic modality when non-invasive techniques like ultrasound are available.
There is study by Manish Banker et al, which looked at the pregnancy outcomes and maternal and perinatal complications of pregnancies following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) using own oocytes, donor oocytes, and vitrified embryos. This study reported high LBR in oocyte donation cycles, which can be attributed to younger age of oocyte donor, which reduces the risk for aneuploidies. They also concluded that the incidence of pregnancy induced hypertension (PIH), gestational diabetes (GDM), prematurity, and low birth weight (LBW) is higher in oocyte donation cycles and may be due to advanced maternal age, different placentation and immune tolerance and higher incidence of multiple pregnancy. So is it justified to perform oocyte donation cycles rampantly in women who have a low ovarian reserve but not tried IVF with their own oocytes, have less than 3 implantation failure after an IVF/ICSI cycle and are of advanced age before trying with their own eggs.
We know that endometriosis is an enigmatic disease, which can affect the quality of life in women with this disease apart from resulting in infertility, pain and sexual dysfunction (FSD). A study by Vineet V. Mishra et al evaluated female sexual dysfunction in women diagnosed with endometriosis at laparoscopy by a questionnaire. They reported an overall incidence of 47.06% and found that 100% patients with severe endometriosis had FSD as against 33% with minimal endometriosis. They then concluded that the incidence of FSD increases with severity of disease and this should be addressed when treating endometriosis.
Techniques and media used for sperm processing can affect the outcome of intra uterine insemination or IVF/ICSI procedures. There is study in this issue, which looked at the motility, viability, and DNA integrity of human spermatozoa using different sperm preparation media. There was insignificant difference in the parameters like motility and vitality using different media but a significant difference was found in the DNA fragmentation index. High DFI over time reported with the use of VitaSpermTM medium as compared to Ham's F10 and Sperm Preparation Media. This study should then promt every clinician and lab personell to use the best media, with least effect on the sperm parameters for an optimal outcome.
Apart from these original articles we have four case reports. These include a case of heterotopic cervical pregnancy after ICSI, Mullerian agenesis due to 46,XX gonadal dysgenesis. The other interesting cases reported are conserving uterine surgery in a case of cervicovaginal agenesis with unicornuate uterus and spontaneous conception in 40-year-old infertile woman with polycystic ovaries after
complete reversal of endometrial intraepithelial neoplasia.