Background and Objective: Hyperhomocysteinemia is a well-known risk factor for cardiovascular disease. Although metformin therapy can increase homocysteine (Hcy) levels, it frequently is used as an oral medicine in women with polycystic ovary syndrome (PCOS), who might be at risk of catching diabetes mellitus. The aim of this study was to investigate the effect of metformin on the levels of serum Hcy, vitamin B12 (vit B12), and folic acid in patients with PCOS. Materials and Methods: An interventional study was designed with 18 patients with PCOS at the Fatemehzahra infertility Hospital in Babol, Iran. Metformin treatment (500 mg twice daily) was initiated in all patients for a period of consecutive 6 months. The levels of serum Hcy, vit B12, and folic acid were measured in the participants before and after metformin treatment. Results: The mean vit B12 level showed a significant decrease in patients after 6 months of metformin treatment (P = 0.002). However, there was no significant difference in serum folic acid levels. The mean Hcy levels increased after treatment, but this difference not was statistically significant. When patients were stratified into four subgroups by their insulin sensitivity and body mass index (BMI), relatively similar results were obtained in the subgroups, except that Hcy levels in the overweight/obesity group (BMI > 25 kg/m²) after treatment showed a significant increase (P = 0.01). Conclusion: These findings indicate that metformin increases the serum Hcy concentration in patients with PCOS especially in the women with BMI > 25 kg/m². The possible mechanism for this effect would be the obvious reduction in the levels of vit B12.

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Background: Pregnancies achieved through in-vitro fertilisation (IVF) are associated with adverse first trimester outcomes in comparison to spontaneously achieved pregnancies. In view of this, it is imperative to predict the success as well as prognosticate the pregnancy outcome of an IVF cycle not only for the clinicians but also the couples undergoing IVF. Serum beta-human chorionic gonadotropin (β-hCG) value has, thus, been used as a biomarker for pregnancy outcome after IVF and also an aid in counselling and management of the patient. Aim: The main objective of this study was to compare the predictive value of the first serum β-hCG value and the pregnancy outcome after an IVF cycle (whether fresh or frozen embryo transfer) in the two subgroups of patients. Settings and Design: The study was conducted at Assisted Reproductive Technology Centre of a tertiary care hospital, and it was a retrospective cohort study. Methods and Materials: A retrospective study was performed for post-IVF pregnancies at a single IVF centre from March 2014 to February 2015 with serum β-hCG values less than or equal to 1000 mIU/ml. The initial serum values of β-hCG on the day 16 of embryo transfer were correlated with first trimester pregnancy outcome and ongoing pregnancy rate (>12 weeks gestation). Results: Of the 208 post-IVF pregnancies included in the study, the group with β-hCG more than 500 mIU/ml had statistically significant higher ongoing pregnancy rates and a lesser poor pregnancy outcome. Conclusion: The study concluded that an early serum β-hCG value can be used as a predictor of a successful or an adverse first trimester pregnancy outcome helping in better counselling and monitoring of the high-risk precious IVF pregnancies.

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Context: Human and animal data suggest that low vitamin D (25-hydroxyvitamin D) status is associated with impaired fertility, endometriosis, and polycystic ovary syndrome. Vitamin D regulates antimullerian hormone (AMH), FSH, mRNA, and expression of genes in reproductive tissues, implicating a role in female reproduction. Aims: To study the vitamin D levels in infertile females and to know the correlation of vitamin D deficiency (VDD) with serum AMH in infertile females compare to fertile females. Settings And Design: This prospective study was conducted in department of Maternal and Reproductive Health in between April 2014 and April 2016. Materials and Methods: After matching inclusion and exclusion criteria out of total 70 infertile females, 45 were found to have VDD. Of these 35 patients were identified as cases; in whom, the AMH levels were assessed. As control 35 fertile normal females were taken, in which vitamin D and AMH were taken. In both groups, correlation of VDD with AMH was studied. Statistical Analysis Used: To analyze the correlation between vitamin D and AMH linear regression test and for comparison of both the groups, two sample t tests were used. Results: The VDD was present in 64.28% of infertile females. In vitamin D deficient cases, the mean for vitamin D was 6.18 ± 2.09 and AMH was 1.94 ± 1.30. In vitamin D deficient controls, the mean for vitamin D was 4.85 ± 3.02 and AMH was 3.47 ± 2.59. On comparison, the vitamin D levels were lower in fertile than infertile females, which was significant (P = 0.04), and AMH levels were lower in cases than control group (P = 0.003). Conclusion: The VDD was present in 64.28% of infertile females. No significant correlation was found in between VDD and AMH levels in both the groups.

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Background: It is essential to determine the cut-off value of serum anti-Mullerian hormone (AMH) to predict the hyper response in assisted reproductive technology (ART). There are few studies mentioning the cut-off value for the hyper response in infertile women but not specifically for polycystic ovary syndrome (PCOS) and non-PCOS groups. With this in background, this study was conducted. Aim: To determine the cut-off value of serum AMH to predict the hyper response in women with PCOS and non-PCOS undergoing a controlled ovarian stimulation (COS) in ART. Objective: To compare the outcome of stimulation in PCOS and non-PCOS groups. Materials and Methods: All 246 women enrolled for Intra Cytoplasmic Sperm Injection (ICSI) fulfilling the selection criteria were recruited. On the day 3 of the cycle, the serum AMH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol and antral follicle count (AFC) were measured. They underwent COS as per the unit protocol. They were divided into PCOS and non-PCOS groups as per the Rotterdam’s criteria. The mean age, duration of infertility, Body Mass Index (BMI), Ovarian reserve markers and outcome of stimulation were compared. Using the Statistical Package for the Social Sciences version 16.0 software, the significant difference was measured by multivariate analysis, as well as a one-way analysis of variance with Tukey’s post-hoc test was used. Results: Among 246 women, 31.3% were in PCOS group, and 68.7% were in non-PCOS group. Comparison of PCOS and non-PCOS groups showed a significant difference in the age with the mean age being 29.2 and 31.5 years, respectively. The mean AMH and AFC were 2-fold higher in PCOS group. The mean number of follicles, oocytes retrieved, MII and oocytes fertilised were significantly higher in PCOS group. The pregnancy rate was 52.6% in PCOS and 30.9% in non-PCOS group. In the PCOS group, 22.1% had ovarian hyper stimulation syndrome (OHSS), and only 4.7% had OHSS in non-PCOS group (P = 0.0005). Receiving Operator Curve (ROC) curve was plotted to predict the hyper response, which showed a cut-off value of 6.85 ng/ml with a sensitivity of 66.7% and a specificity of 68.7% for PCOS group and 4.85 ng/ml with a sensitivity of 85.7% and a specificity of 89.7% in non-PCOS group. Conclusion: The cut-off value of serum AMH to predict the hyper response in PCOS group is 6.85 ng/ml and in non-PCOS group is 4.85 ng/ml.

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Aim: To compare the findings and diagnostic accuracy of Hysterosalpingography (HSG) and hysteroscopy in infertile women. Setting and Design: Prospective comparative study in a tertiary care Centre. Material and Methods: 108 women with primary or secondary infertility were recruited. In all women after basic infertility workup, both HSG and hysteroscopy were performed. Results: Out of 108 women, in 3 women HSG couldn’t be done and in one woman there was uterine perforation on hysteroscopy. HSG showed normal uterine cavity in 77.8% (81/105) women and abnormal in 22.85% (24/105). Hysteroscopy findings were normal in 70.09% (75/107) and abnormal in 29.91% (32/107). Hysteroscopy detected incidental findings in 15.38% (16/104) cases. HSG showed irregular uterine cavity in 14.15% (15/105) women but on hysteroscopy; normal cavity was present in 6 (40%) women and abnormality was detected in 9 (60%) women. The sensitivity, specificity, positive predictive and negative predictive value of HSG in evaluating uterine cavity abnormalities were 44.83% (95% confidence interval (CI); 0.26–0.64), 86.67% (95% CI; 0.76–0.93), 56.52% (95% CI; 0.34–0.76) and 80.25% (95%CI; 0.69–0.88). Positive likelihood ratio and negative likelihood ratio of HSG in detecting uterine cavity abnormality was 3.36 and 0.64 respectively. The agreement between HSG and hysteroscopy was 75%. This was statistically significant (P value = 0.001) with fair strength of agreement between HSG and hysteroscopy. (k value= 0.336). Conclusion: Hysteroscopy should be performed in all infertile patients as it can detect significant number of incidental findings missed by HSG.

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Aims: This study is aimed at determining the prognostic factors influencing successful pregnancy following intrauterine insemination (IUI). Settings and design: Retrospective analysis. Materials and Methods: A total of 2123 cycles undergone by 871 couples during the period of 5 years (2011–2015) were retrospectively studied. Statistical Analysis Used: Each of the factors was compared with pregnancy outcome (PO) using statistical analysis with a confidence interval of 95% in SPSS software version 19. Chi-square test and logistic regression analysis method were used to determine the significance of each factor with the PO. Results: Among the various factors included in our study population, male habits (P = 0.004), male occupational environment (P = 0.025), male age (P = 0.002), and female age (P = 0.001) were found to significantly influence the PO following IUI. Conclusion: Our results indicate that avoiding smoking and alcohol consuming prior and during the IUI treatment along with working in low-heat-generating environment might lead to better success following the treatment.

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Aim: The aim of the study was to measure patient’s satisfaction level and acceptance of conscious sedation as a method of pain relief following transvaginal oocyte retrieval (TVOR) during assisted reproduction technology treatment. We also evaluated the factors that may influence the efficacy of conscious sedation method. Setting and Design: A prospective cross-sectional study. Materials and Methods: Prospective study was conducted from October 2015 to January 2016 at a university-level hospital and 100 women were recruited. Variables for analysis included woman age, duration of procedure, number of oocytes retrieved, and transmyometrial passage of the needle. Pain assessment was done by visual analog scale (VAS). Medical complications, and patient satisfaction score [Likert’s score and client satisfaction questionnaire (CSQ)] were recorded. Results: There was a moderate positive correlation between age and pain score on day 1 post-procedure. When the duration of procedure was >12 min, immediate post-procedure pain score was significantly higher compared to those whose procedure where duration was <12 min. There was no correlation between pain score and the number of oocytes retrieved (≤5, 6–15, and ≥16) and transmyometrial passage of needle. The VAS 10-point score immediately post-procedure, after 6 and 24 h post-procedure, and on day of embryo transfer was 2.83 (±1.67), 0.78 (±1.04), 0.39 (±1.09), and 0.14 (±0.58), respectively. The Likert’s score was 3.65 (±0.82) and mean CSQ was 27.04 (±3.01). Majority of the women (86%) preferred the same pain relief method for future analgesia. There were no major complications. Conclusion: Conscious sedation was associated with high satisfaction level and acceptance rate among patients undergoing TVOR.

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Objective: To investigate the influence of site of embryo transfer (ET) on reproductive outcome. Materials and Methods: A retrospective analysis of 743 ultrasound-guided ET in fresh in vitro fertilization (IVF) cycles from a single center over a period of 4 years was conducted. The distance between the fundal endometrial surface and the air bubble was measured, and accordingly, patients were divided into four groups (≤10 mm; >10 and ≤15 mm; >15 and 20 mm; >20 and <25 mm). Setting: Tertiary Assisted Reproductive Technology (ART) center. Patient(s): All patients enrolled in the IVF program undergoing ET. Intervention(s): Controlled ovarian hyperstimulation (OS), IVF, and ET. Main Outcome Measure(s): Cleavage rate and clinical pregnancy rate. Result(s): Clinical pregnancy rate was significantly more in groups 2 and 3 compared to the other groups. Logistic regression analysis showed that one unit increase in embryos transfer will enhance the pregnancy outcome about 3.7 (adjusted odds ratio) times with 95% confidence limits 2.6 to 5.4. Similarly, pregnancy outcome will be 3.1 (95% confidence limits: 1.5–6.4) times higher for distance group >15 and <20 mm compared to less than 10-mm distance group. Ectopic pregnancy rates were similar in all the four groups. Conclusion: The present study demonstrates that site of ET has significant difference on reproductive outcome.

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Background: Vitamin D and its active metabolite, 1,25-dihydroxy vitamin D (1,25-(OH)₂D₃), play a significant role in reproduction. Aim: To assess the effect of serum 25-hydroxy vitamin D level on oocyte quality and endometrial receptivity by studying oocyte donors and their recipients. Materials and Methods: This prospective study consisted of two groups: Group A (recipient group) and Group B (donor group). All the participants of Groups A1 and B1 as well as Groups A2 and B2 were subcategorized into vitamin D-deficient (<20 ng/mL) and vitamin D replete-insufficient (20 to ≥30 ng/mL), respectively. Results: In the recipient group, out of the 192 participants, 123 were in A1 group, and 69 were in A2 group. In donor group, out of the 99 participants, 54 were in B1 group, and 45 in B2 group. In the recipient group, Group A2 had a higher clinical pregnancy rate, implantation rate and ongoing pregnancy rate, and a lower abortion rate as compared to that of A1, but these are statistically insignificant. The difference in endometrial thickness and number of embryos transferred between both groups was insignificant. In the donor group, the total number of days of controlled ovarian hyperstimulation, the dose of gonadotropins, the number of oocytes retrieved, the percentage of mature oocytes, and the percentage of usable embryos were higher in Group B2 than those in Group B1, but these are statistically insignificant. The fertilization rate was statistically insignificant between Groups B1 and B2. Conclusion: Vitamin D deficiency leads to lower reproductive outcomes, though not statistically significant and, thereby, does not have a negative influence on in-vitro fertilization–intracytoplasmic sperm injection outcomes.

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This is a rare case of serpine gene polymorphism causing thrombophilia and recurrent implantation failure following intrauterine insemination. SERPINE1 gene encodes plasminogen activator inhibitor type 1 and inhibits fibrinolysis, or clot dissolution. The 4G variant results in increased expression of SERPINE1 and consequently higher inhibition of fibrinolysis, thus leading to thrombophilia. The patient had unexplained primary infertility for 9 years. Ovulation induction was done with gonadotropin releasing hormone (GnRH) agonist long protocol. Recombinant follicle stimulating hormone (FSH) with step down protocol was used. Ovulation trigger was given with recombinant human chorionic gonadotrophin (HCG). Ovum pick up was done after 40 h of trigger. A total of 13 eggs were collected. Patient was put on Cabergoline to prevent ovarian hyperstimulation syndrome (OHSS). Four frozen embryos were transferred on day 14 after Laser-assisted hatching. EmbryoGlue was used to prevent implantation failure. Luteal phase support was given. She was put on enoxaparin and pregnancy has now been confirmed. The patient was on strict monitoring as this gene is also associated with preeclampsia during pregnancy.

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Objectives: Separate exposure to microwaves (MWs) or heat had effects on expression levels of Bax and Bcl-2 and sperm parameters in studied group. Aims: The objectives of this research were to determine the effects of separate and combined exposure to 900-MHz MW (as representative of cell phone radiation) and heat on gene expression and spermogram of male mice. Settings and Design: This experimental animal study was conducted in the school of public health. Materials and Methods: The study was done on 12 male mice randomly divided into four groups (21–23 g): control, test group 1 with separate exposure to 900-MHz MW, test group 2 with separate exposure to hot and sultry climate, and test group 3 with simultaneous whole body exposures to 900-MHz MW and hot and sultry climate. In all studied groups, gene expression and sperm parameters were measured. Results: Tissue samples in all test groups showed integrity of the seminiferous tubule followed by all types of germ line cells. Significant increases in the number of dead sperms in mice with separate exposure to heat were observed in comparison with the other studied groups (P < 0.05). The ratio of Bax expression was elevated to 0.015 ± 0.006 in mice after combined exposures to 900-MHz MW and heat. Conclusion: Separate and combined exposure to 900-MHz MW and heat may induce adverse effects on sperm parameters and gene expression of studied male mice.

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In-vitro maturation (IVM) of the immature oocytes recovered from the surgically removed ovarian tissue has been considered as a process for fertility preservation in patients with cancer. Fertility preservation for a woman with Mullerian adenocarcinoma. A 37-year-old woman with Mullerian adenocarcinoma was a candidate for ovarian resection. The immature oocytes were retrieved after ovarian resection from a 37-year-old woman with Mullerian adenocarcinoma. The oocytes underwent IVM and were fertilized using intracytoplasmic sperm injection (ICSI). Two healthy embryos were cryopreserved for future use. The immature oocytes from the ovarian tissue can be matured with IVM for generation of embryos after ICSI. The embryos can be vitrified using routine methods for fertility preservation in young women with cancer.

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Background: About half of the cases of infertility in couples have been attributed to male factor. Despite the claim in folklore medicine that trona (a sesquicarbonate or hydrated carbonate of sodium) causes fetal loss, its effect on male reproductive function has not been investigated. Aim: This study sought to provide scientific evidence on the effect of trona on sperm characteristics, male reproductive hormones and organs, and lipid peroxidation. Materials and Methods: Forty male Wistar rats of comparable weights were used for the study. Rats were randomized into four different groups. The control received 1 mL of distilled water orally, whereas those in groups 1, 2, and 3 (test groups) received orally, same volume of trona preparation corresponding to 100, 200, and 400 mg/kg body weight, respectively, for 28 days. Body weight was monitored throughout the study period, and at the end of the experiment, testicular morphometry, sperm characteristic, reproductive hormones, and malondialdehyde (MDA), an index of lipid peroxidation, were determined. Results: Sperm count, motility, progressibility, and percentage of normal sperm were significantly decreased in the trona-treated rats (P < 0.05). The percentage of abnormal sperm, luteinizing hormone, follicle stimulating hormone, and MDA were significantly increased in the treated rats (P < 0.05). Body weight, testicular morphometry, and testosterone level were comparable across all groups (P > 0.05). Conclusion: The study showed that trona has a dose-dependent deleterious effect on sperm characteristic. The antispermatogenic effect of trona was associated with lipid peroxidation but not testosterone.

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