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EDITORIAL |
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| Year : 2015 | Volume
: 8
| Issue : 3 | Page : 119-120 |
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From the Editor's desk
Madhuri Patil
Editor-in-Chief, Journal of Human Reproductive Sciences
| Date of Web Publication | 11-Sep-2015 |
Correspondence Address:
Madhuri Patil
Editor-in-Chief, Journal of Human Reproductive Sciences
 Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.  | Check |
DOI: 10.4103/0974-1208.165146
How to cite this article:
Patil M. From the Editor's desk. J Hum Reprod Sci 2015;8:119-20 |
After 37 years of in vitro fertilization (IVF) treatment and research, major progress has been made in improving stimulation protocols, preventing premature lutenization and fertilization procedures, and optimizing embryo culture conditions and embryo transfer. However, only marginal improvement has been observed in increasing the implantation and pregnancy rates. Disturbance in embryo–maternal dialog is the major reason for termination of 60% of all pregnancies at the end of peri-implantation period. Till date, there are no tests to determine the endometrial receptivity in the cycle of treatment. Thefirst review article is on use of endometrial receptivity array (ERA) in clinical practice to improve the implantation and pregnancy rates. This is possible due to blastocyst freezing by vitrification, which has improved the post thaw survival rate, which in turn aids in the transfer of embryos in a frozen embryo transfer according to the window of implantation detected by ERA.
We have another review article on a psychosomatic disorder in the male patients, which is a result of semen loss. This syndrome is called as "Dhat syndrome" and is very common in South East Asia. This article will enlighten our readers on diagnosing such a disorder, which is culture related and seen in the lower socioeconomic class, and the treatment modalities for the same.
Today, poor response to controlled ovarian stimulation (COS) is very common and is usually associated with advanced age, previous ovarian surgery, high BMI, or it can also be due to early ovarian aging. For optimal results in this group, various methods have been tried, one of which is use of dehydroepiandosterone (DHEA). The ovarian age of an Indian woman is about 7 years more as compared to the Caucasian population. A pilot study conducted in Delhi used DHEA as an adjuvant to gonadotropins in intrauterine insemination (IUI) cycles to evaluate its effect on gonadotropin dose and ovulation. This study has shown a beneficial role of DHEA, but well-designed, large-scale, randomized controlled trials (RCTs) are needed to assess the efficacy of this drug, as androgen supplementation prior to ovarian stimulation is not supported in all women with decreased ovarian reserve and in poor responders by the best available evidence. There is a need to identify the subgroup of poor responders who have theca cell failure but retain a relatively preserved granulosa cell function, where modulating their intrafollicular androgen environment may improve their ovarian response. Patients for whom other modalities of treatment have failed may consider this option.
Safety is the foremost thing we look at during an assisted reproductive technology (ART) cycle which includes prevention of ovarian hyperstimulation syndrome. In India, we also need to look at the cost. Moreover today, mild to moderate stimulation has been recommended for optimal outcome. Mild stimulation and low-cost IVF involves administration of oral ovulogens with gonadotropins with GnRH anatgonist or continuing clomiphene citrate or Tamoxifen till the day of human chorionic gonadotropin administration (hCG). This option is best suited for donor oocyte programs to reduce the risk of complications. The study by Gupta et al. compared clomiphene citrate plus gonadotroins with GnRH anatgonist plus gonadotropins in donor stimulation cycles. They found the fertilization rate (FR) and clinical pregnancy rate (CPR) to be higher in the extended clomiphene citrate group with reduction in gonadotropin dose and cost and increased safety.
Ovulation induction in hypogonadotropic hypogonadism may be a challenge and requires administration of human menopausal gonadotropin (hMG) along with follicular stimulating hormone (FSH). A study published in this issue looked at the FR and pregnancy rate (PR) related to the days of stimulation. The authors found no difference in the quality of oocytes, FR, and PR despite longer duration of stimulation.
There is evidence for increased pregnancy rates with endometrial scratch done before IVF, especially if done less than 60 days before the procedure. The study of Leena Wadhwa et al., compares the effect of endometrial biopsy (EB) in COS cycles with IUI. This study reported high CPR in those patients who underwent an EB in the same cycle as IUI, followed by those who underwent EB in the previous cycle. The CPR was very low in the group of patients who did not have an EB.
Y chromosome microdeletion is commonly seen in men with severe oligospermia or azoospermia. It is not regularly tested in patients with recurrent pregnancy loss (RPL). There is a study published in this issue which looked at Y microdeletion in 59 couples with RPL and compared it with the results of 20 controls. The incidence of Y microdeletion in this study was 32.5%. So, evaluation of Y microdeletion should be included in the investigation profile of RPL, as it can be an important hidden cause for RPL.
Tuberculosis is still a common infection in developing countries, and so in India. Many women in India are screened for tuberculosis using polymerase chain reaction (PCR) and probably also treated. If the evaluation is using RNA PCR or culture, the incidence of false-positive cases decrease. We know that sexual transmission of tuberculosis can occur though the incidence is very low. Male genital tuberculosis (GUTB) is usually associated with renal tuberculosis in 60–65% cases and with pulmonary tuberculosis in 34% cases. It is more common in men with HIV infection and in individuals infected with HIV and acquired immunodeficiency syndrome. In a study, husbands of 15 women suffering from GUTB were evaluated for presence of tuberculosis. None of them showed evidence of GUTB, but one had urinary tract and another one had pulmonary tuberculosis in the past. The author of this article concluded that the male partners of women with GUTB should not be screened for tuberculosis if they are asymptomatic.
We have four case reports: One on empty follicle syndrome and use of double trigger, the second one on successful embryogenesis after injection of spermatids, the third one on pregnancy outcome with coexisting mole, and the fourth one on deep vein thrombosis in a patient undergoing IVF with donor oocyte.
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