Living mindfully helps one gain a deeper understanding into realities of life. It enables people to witness suffering, desire, attachments, and impermanence without any fear, anxiety, anger, or despair. This is considered the hallmark of true psychological insight. As a skill, mindfulness can be inculcated by anyone. Mindfulness helps in attending, getting aware and understanding experiences in a compassion and open-minded way. Research suggests that applying mindfulness in daily life has been known to tame our emotional mind and enabled people to perceive things “as they are” without ascribing expectations, judgments, cynicism, or apprehensions to them. This review unravels the therapeutic power of mindfulness meditation in the context of infertility distress. It serves to integrate the evidence on the effectiveness of mindfulness-based psychological interventions to improve the emotional well-being and biological outcomes in Infertility.

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Background: Based on the role of bone marrow (BM) stem cells in regeneration of endometrium, refractory cases of Asherman's syndrome (AS) and endometrial atrophy (EA) may benefit with BM-derived intrauterine stem cell instillation. Aims and Objectives: To evaluate the role of BM-derived autologous stem cell therapy in endometrial regeneration and restoration of menstruation and fertility in refractory cases of AS and EA. Setting: This study was conducted at a tertiary care center. Design: This was a prospective, single-arm longitudinal study. Materials and Methods: Twenty-five cases with refractory AS or EA were included. BM-derived mononuclear stem cells were instilled into the subendometrial zone followed by oral estrogen therapy for 3 months. Menstrual flow and endometrial thickness (ET) were assessed at 3, 6, and 9 months and 5 years. Results: Statistical analysis was carried out using statistical software STATA version 12.0. Mean prestem cell transfer ET (mm) was 3.3 ± 1.0. At the end of 3 months, there was a significant increase in ET (mm) to 5.1 ± 1.9 (P = 0.001), but there was no significant change at 6 months (5.6 ± 1.5; P = 0.164), at 9 months (6.1 ± 1.7; P = 0.135), or at the end of 5 years. Six of the seven amenorrheic patients resumed menses. Three patients had a successful pregnancy outcome. Conclusion: Intrauterine stem cell treatment is a promising novel approach for refractory cases of AS and EA.

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Background: Few studies have assessed the impact of serum human chorionic gonadotropin (hCG) levels before oocyte retrieval and luteinizing hormone receptor (LHR) mRNA expression. Aims: The objective was to assess the correlations between serum hCG levels at 12-h posttrigger granulosa cell LHR mRNA expression during the in vitro fertilization (IVF) cycle with oocyte maturation rate and to determine the cutoff level of serum hCG at 12-h posttrigger. Settings and Design: A cross-sectional was conducted for this study at the IVF center of Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. Materials and Methods: Recombinant follicle-stimulating hormone was used on day 2 of the menstrual cycle with multiple doses of a gonadotropin-releasing hormone antagonist. Recombinant hCG was used to trigger ovulation. At 12-h posttrigger, hCG serum levels were measured using an enzyme-linked immunosorbent assay. Statistical Analysis: Pearson's correlation coefficient was used to evaluate the correlation between oocyte maturation rates, serum hCG levels, and LHR mRNA levels. Cutoff values were determined using a receiver operating characteristic (ROC) curve. Results: Serum hCG levels were positively correlated (r = 0.467;P < 0.01), and LHR mRNA expression was weakly correlated (r = 0.073; P = 0.701) with oocyte maturation. The cutoff of serum hCG for a high maturation rate was 77 mIU/mL, with an area under the ROC curve of 0.765 (95% confidence interval: 0.598–0.939) andP < 0.001. Conclusion: Oocyte maturation is correlated with serum hCG levels with 77 mIU/mL as the cutoff point for oocyte retrieval.

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Context: The patient-centered infertility care (PCIC) approach emphasizes the patient's role in choosing the most appropriate clinical approach in infertility care. The concept can improve the patient satisfaction with care performed as well as the efficacy of the treatment. In addition, this concept can also lead to improve collaboration between patient and care provider, ultimately supporting a more cost-effective health-care scheme. Aims: This study was developed in order to determine patients' experience in their PCIC.Settings and Design: This is a descriptive study. We conducted the study in two fertility care clinics, Clinic A and Clinic B. Subjects and Methods: The Patient-Centeredness Questionnaire-Infertility (PCQ-I) was used, consisting of 7 essential themes. The questionnaire was completed by consenting patients in two infertility clinics. Statistical Analysis Used: The questionnaire was analyzed using the Statistical Package for the Social Sciences 21 version statistical software. Results: Eighty-eight Clinic A patients who completed the questionnaire responded that the best element of their treatment received was communication (correlation with global score [CGS]: 0.747), whereas the least acceptable aspect was the low accessibility (CGS: 0.211). A total of 20 Clinic B patients responded that the best element of their treatment received was respect for the patient's value (CGS: 0.866), whereas the least acceptable aspect was also the low level of accessibility (CGS: 0.193). Conclusions: The PCQ-I can be used to evaluate patients' experience during treatment and may help the health-care provider to improve their performance.

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To report the clinical, hormonal, and genetic features of a female with multiple endocrine neoplasia type 1 (MEN1) with multiple uterine leiomyomas. The study was conducted at a tertiary care endocrinology unit. A 27-year-old female was diagnosed with prolactinoma, primary hyperparathyroidism (PHPT), and multiple uterine leiomyomas. In view of prolactinoma and PHPT, a clinical diagnosis of MEN1 syndrome was made. She also had multiple uterine leiomyomas for which myomectomy was done. Genetic analysis revealed a novel mutation c.1763C>T, p.S588L of MEN1 gene. The association of uterine leiomyomas with MEN1 is exceptionally rare. This is the first report of multiple uterine leiomyomas in a patient with MEN1 from our country and the first report of this mutation in the MEN1 gene in the world. We conclude that in the presence of multiple uterine leiomyomas and endocrine tumor, clinical examination and laboratory evaluation may uncover the diagnosis of MEN1 syndrome in these patients.

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Background: Twin pregnancy is an iatrogenic complication following in vitro fertilization (IVF) that can be decreased using elective single-embryo transfer. However, the risks associated with twin pregnancy following IVF as compared to singleton IVF pregnancy need to be further evaluated. Aim: This study aims to compare the maternal, perinatal, and neonatal complications in singleton and twin pregnancies following IVF-intracytoplasmic sperm injection (ICSI). Settings and Design: Retrospective observational cohort study using previously collected routine patient data. Materials and Methods: Singleton and twin deliveries following IVF/ICSI from January 2014 to August 2015 were included. Data were collected from patient records and the obstetricians of the patients. Statistical Analysis Used: SPSS was used for analysis. Student's t-test and Fisher's exact test were used for continuous and categorical data, respectively. Significance was kept at 0.05. Results: There were 897 singleton and 382 twin deliveries (total of 1661 babies). The mean gestational age at delivery was lower in twin deliveries (34.9 ± 3.1 weeks) as compared to singleton deliveries (36.8 ± 3.2 weeks, P < 0.001). The overall incidence of maternal complications was higher in twin pregnancies (29.3% vs. 21.3%, odds ratio = 1.53, 95% confidence interval = 1.17–2.01; P= 0.003). The mean birth weight of babies was significantly lower (2.02 ± 0.58 kg vs. 2.71 ± 0.68 kg; P < 0.001) and the incidence of stillbirth plus neonatal death was higher (7.5% vs. 4.6%, P = 0.01) in the twin group as compared to the singleton group. Conclusion: Twin deliveries, following IVF/ICSI deliver at lower gestational age, have lower birth weight and have higher odds of stillbirth plus neonatal death as compared to singleton deliveries following IVF/ICSI.

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Background: Nearly 0.6%–7% of patients undergoing in vitro fertilization embryo transfer (IVF ET) will not be able to yield any oocyte despite successful ovarian stimulation and this condition is called as empty follicular syndrome (EFS). EFS is a dreadful situation for clinicians as well as patients, seems to be an unavoidable clinical condition despite a proper ovarian stimulation. Materials and Methods: This was a retrospective observational study conducted at a tertiary hospital; 1103 patients who underwent IVF ET between January 2016 and May 2017 were included in the study. Study Outcome: To estimate the incidence of empty follicle syndrome (EFS) and to study the associated factors. Results: There were 53 (4.8%) cases of EFS out of 1103 cycles of IVF ET; 43 (3.9%) cases were false EFS and 10 (0.9%) cases were genuine EFS. Mean age of EFS group and oocyte retrieved group was 30.17 years and 29.12 years respectively. Recurrence rate of EFS during the next IVF cycle was 36.8%. Decreased ovarian reserve was associated with an increased chance of EFS (54.7%) with a recurrence rate as high as 57%. Conclusion: The incidence of EFS is not an uncommon clinical scenario; it depends upon ovarian reserve to a great extent. Young age is not immune for the occurrence of EFS as there is a similar incidence in comparatively younger age group in our study. EFS is seen in all etiological groups of infertility, but only respite is that there is a chance of about 63.2% oocyte retrieval during repeat IVF cycle.

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Occasionally, embryo transfer may be difficult, which is often because of anatomical position of the uterus or cervical stenosis. An alternative technique in such a scenario is the transmyometrial transfer of the embryos with the help of transvaginal ultrasound. Here, we describe the first case of successful embryo transfer through transmyometrial route leading to pregnancy and successful delivery in India.

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Context: Thymus vulgaris is an herbal with potent antioxidant and it has been shown to have beneficial effects during short-term administration. Myleran (MYL) is used for treatment of certain types of tumors. MYL produces free radicals and induces disturbance in sperm parameters. Aims: This study is designed to assess the effects of T. vulgaris against damage to the male rats' reproductive features induced by MYL. Subjects and Methods: Sixty-four male Wistar rats were randomly assigned into eight groups: control group; MYL (10 mg/kg) group; T. vulgaris groups (4.5, 9, and 18 mg/kg); and MYL (10 mg/kg) + T. vulgaris groups (4.5, 9, and 18 mg/kg; separately). Treatments were administered daily intraperitoneal injection for 60 days. Total antioxidant capacity, sperm factors, malondialdehyde (MDA), testosterone, and germinal layer height were analyzed. Results: Whole variables of MYL group decreased signifcantly compared to the control group (P < 0.05) except MDA level (which increased). The T. vulgaris and T. vulgaris + MYL treatments in all doses increased all parameters significantly except MDA level (which decreased) compared to the MYL group (P < 0.05). No significant modifications were observed in all T. vulgaris groups compared to the control group (P > 0.05). Conclusions: T. vulgaris reduces the poisonous properties of MYL on male reproductive factors.

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Context: The rising incidence of endometriosis may be due to improvisation in the diagnostic techniques. Transvaginal sonography has proven to be very useful in the diagnosis of complexity of the disease and in turn to predict the intraoperative findings on laparoscopy.Aims: The aim was to study the use of sliding sign for detecting the status of the pouch of Douglas (POD) and to check for the presence of bowel and nonbowel deep infiltrating endometriosis (DIE) by gel sonovaginography. Settings and Design: This is a prospective observational study carried out patient division of Department of OBG in Kasturba Hospital Manipal. Methods: The study was carried out over a period of 2 years and included 136 women. After written informed consent, a detailed history and clinical examination was done. A detailed transvaginal sonography was done for each of the patients by a single observer on the Philips HD11XE machine two-dimensional transvaginal probe which included gel sonovaginography and real-time dynamic test called sliding sign. Statistical Analysis: Chi-square test was used in this study. Results: Sliding sign is highly specific, sensitive, and accurate for the detection of POD obliteration. It is 96.6% sensitive and 89.5% specific. It is 94.1% accurate and 94.5% positively predictive for the same. Transvaginal sonography is >92% specific for the detection of bowel and nonbowel DIE. The accuracy is over 91%. The negative predictability is 93.6% and 94.6%, respectively. Conclusions: Sliding sign is a useful, easy-to-perform, reproducible, and noninvasive modality for assessing the status of POD. Gel sonovaginography is also useful in accurately detecting the presence of deep infiltrating endometriotic deposits.

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Complex chromosomal rearrangements (CCRs) are rare structural rearrangements which involve at least three or more chromosomal breaks. The present report emphasizes the significance of parental karyotyping and the need of genetic counseling for couples with bad obstetric history (repeated abortions/miscarriages). The report includes the cytogenetic assessment of the proband and the mother, carried out at our accredited laboratory. The karyotype analysis of the proband revealed an apparently balanced translocation, identified to have been familially inherited from the mother having CCRs with double two-way translocations involving four chromosomes.

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Sirenomelia is a very rare developmental abnormality which is characterized by fusion of lower limb to form a single limb. This condition is often associated with internal organ abnormality and is considered incompatible with life. Sirenomelia is sporadically reported from across the world, but no case associated with artificial reproductive technology (ART) has not been reported. We report a case of sirenomelia in a 29-year old woman who conceived by ART, which to our knowledge is the first reported case in ART. The defect was detected early during first trimester and the pregnancy was terminated.

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