Year : 2014 | Volume
: 7 | Issue : 2 | Page : 71--72
From the Editor's desk
Editor-in-Chief, Journal of Human Reproductive Sciences
Editor-in-Chief, Journal of Human Reproductive Sciences
|How to cite this article:|
Patil M. From the Editor's desk.J Hum Reprod Sci 2014;7:71-72
|How to cite this URL:|
Patil M. From the Editor's desk. J Hum Reprod Sci [serial online] 2014 [cited 2022 Aug 14 ];7:71-72
Available from: https://www.jhrsonline.org/text.asp?2014/7/2/71/138854
This issue publishes one review article on "Omics: Current and future perspective in reproductive medicine and technology," which though long is an eye opener to molecular aspects of the physiology of the follicles, gametes, embryos as well as the endometrial receptivity. Today few of the clinics are using metabolomics of the spent culture media to select the best embryo for transfer, though not extensively used. Endometrial receptivity array, which studies the expression of genes involved in the endometrial receptivity is one of the tests that is fast-picking up in the group of patients who have had recurrent implantation failure. It tells us whether the window of implantation (WOI) is normal or displaced and if WOI is displaced one could transfer the embryos in the personalized WOI to improve the success of assisted reproductive techniques (ART).
We have nine original articles and two case reports. The first article is on autologous mononuclear stem cell implantation in sub-endometrial zone, followed by exogenous oral estrogen therapy in cases of in six cases of refractory Asherman's syndrome who did not resume menstrual cycle after hysteroscopic adhesiolysis. The autologous stem cell implantation leads to endometrial regeneration reflected by restoration of menstruation in five out of six cases thus a promising novel cell based therapy for refractory cases of Asherman's syndrome. The fact that women resumed menstruation after implantation, this treatmenst holds promise for future fertility in patients with infertility due to intrauterine adhesions. We had a similar case report published in an earlier issue, where pregnancy was achieved.
Today most clinicians want to avoid weekend oocyte retrievals (ORs), which is possible with a gonadotropin-releasing hormone (GnRH) agonist protocol. Today most cycles use GnRH antagonist to suppress the LH surge and then it may not be possible to avoid an OR on a Sunday. The article on "advancing or postponing the day of human chorionic gonadotropin (hCG) does not matter for the outcome in assisted reproductive technology" discusses its usefulness to avoid weekend OR in a GnRH antagonist cycle. This study administered hCG either on Thursday or Saturday instead of Friday to avoid Sunday retrievals and found that it did not compromise the in vitro fertilization (IVF) outcome. This study found that the number of oocytes recovered when hCG was administered on day 8 are marginally higher compared with day 9-11. The fertilization rate was not affected, and so the study concluded that, it is possible to safely avoid weekend OR, by delaying or advancing hCG administration without compromising the outcome. Probably, a randomized clinical trial comparing advancement or postponement of hCG with personalized hCG would through more light on avoiding OR on weekends.
The risk of any malignancy has two sides to it; one risk of ovarian metastasis and the other is the effect of surgery, chemotherapy and radiotherapy on the ovarian reserve. Today with the advances in cryopreservation of oocytes, ovarian cortex and ovaries have given hope to the cancer survivors to have their own genetic babies. IVF outcome variables between four cancer diagnostic groups - breast, gynecologic, lymphoma/leukemia and others were compared with age-matched male factor or tubal factor infertility group were studied in the original paper on "fertility preservation outcomes may differ by cancer diagnosis." In this study, they found that a specific cancer diagnosis as well as treatment exposures may need to be taken into account whilst counseling patients and choosing an ovarian stimulation regimen. However, there are still many unresolved questions, and there is a need of more long-term data before all patients are subjected to fertility preservation options. The main objective is to develop safe and efficient methods to preserve fertility, and the specific targets that need to be achieved are to determine the effect of cancer on the ovarian function, to detect metastasis in the frozen ovarian cortex, to develop human ovarian follicles in vitro, to isolate the ovaries by embolization and new methods to freeze ovarian cortex for the optimal outcome. Dichorionic twins are an outcome of transferring more embryos, but monochorionic twins, which account for around 0.9% of twin gestation arise from the same embryo, and the incidence is higher with blastocyst transfers.
Today the success of any IVF is determined by a single live birth as even twins are considered to be an adverse outcome. In a retrospective analysis published in this issue it was found that monochorionic diamniotic (MCDA) group had a higher miscarriage rate (50%) than the dichorionic diamniotic (DCDA) group (10%), the live birth rates were also lower in the MCDA versus DCDA group (40% vs. 90%). This study concludes that monochorionic pregnancies following ART have poorer obstetric outcomes when compared with diachronic pregnancies and therefore require intensive antenatal surveillance at a tertiary level obstetric and neonatal center may help optimize the outcome.
Endometriosis can affect fertility due to distortion of the pelvic anatomy, abnormal utero-tubal transport, altered peritoneal function, results in endocrine and ovulatory abnormalities, can directly affect the oocyte and embryo quality and also the endometrial receptivity. Ovarian endometrioma possesses great problems in an ART cycle and more so if they are recurrent and require to be removed. There are two articles on endometriosis, one discusses on how good surgical technique at laparoscopic cystectomy does not adversely affect ovarian reserve and the other is on the effect of endometriosis on implantation rates when compared with tubal factor in fresh nondonor IVF cycles. We also know that apart from endometriosis there are several factors that can affect the endometrial receptivity, which probably is one of the determining factors for success with ART apart from embryo quality and embryo transfer technique. Probably, evaluation of the endometrium by two-dimensional ultrasound with evaluation of sub-endometrial blood flow can correlate with the with pregnancy outcome in frozen-thawed embryo transfer cycles.
Several Indians use tobacco in different forms and this study from Western India has shown the prevalence of abnormal spermatozoa in tobacco chewing sub-fertile males. We also have a study in the rat on effect of resveratrol on cypermethrin-induced reproductive toxicity.
There are two case reports, one on "complete androgen insensitivity syndrome with a large gonadal serous papillary cystadenofibroma" and the other on "term delivery following pyometra after in vitro fertilization and embryo transfer."