Background: Insufficient nutrition and inappropriate diet have been related to many diseases. Although the literature confirms the hypothesis that particular nutritional factors can influence the quality of semen, until today, there are no specific dietary recommendations created for infertile males. Since the male contribution to the fertility of a couple is crucial, it is of high importance to determine the dietary factors that can affect male fertility. Aim: The aim of the present study was to evaluate differences in sperm quality parameters, sperm oxidative stress values and sperm acrosome reaction between vegan diet consumers and non-vegans. Setting and Design: Prospective study in a University Medical School. Materials and Methods: The present study was undertaken to evaluate the sperm quality parameters of vegan diet consumers (10 males who had a strictly vegetable diet with no animal products) and compare them with non-vegans (10 males with no diet restrictions). Semen quality was assessed following the World Health Organization (2010) criteria. Acrosome and DNA integrity has been evaluated using the immunofluorescence technique. Statistical Analysis: All variables were analysed by IBM SPSS version 24. Mean differences among groups were compared by Mann–Whitney U-test. Results: Obtained results showed that total sperm count (224.7 [117–369] vs. 119.7 [64.8–442.8]; P = 0.011) and the percentage of rapid progressively motile sperm were significantly higher in the vegan group compared with the non-vegan group (1 [0–7] vs. 17.5 [15–30]; P < 0.0001). Furthermore, the oxidation-reduction potential (0.4 [0.3–0.9] vs. 1.5 [0.6–2.8]; P < 0.0001) and the proportion of spermatozoon with DNA damage (14.7 [7–33.5] vs. 8.2 [3–19.5]; P = 0.05) were significantly higher in the non-vegan group in comparison to the vegan group. Conclusions: Results obtained in this study provide additional evidence about the favourable effect of a plant-based diet on sperm parameters. To confirm our preliminary findings, further studies including larger cohorts are warranted.

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Preimplantation genetic testing (PGT) for monogenic disorders and assisted reproductive technology have evolved and progressed in tandem. PGT started with single-cell polymerase chain reaction (PCR) followed by fluorescent in situ hybridisation for a limited number of chromosomes, later called 'preimplantation genetic diagnosis (PGD) version 1'. This review highlights the various molecular genetic techniques that have evolved to detect specific inherited monogenic disorders in the preimplantation embryo. Literature review in English was performed in PubMed from 1990 to 2021, using the term 'preimplantation genetic diagnosis'. With whole-genome amplification, multiple copies of embryonic DNA were created. This helped in avoiding misdiagnosis caused by allele dropout. Multiplex fluorescent PCR analysed informative short tandem repeats (STR) and detected mutations simultaneously on automated capillary electrophoresis sequencers by mini-sequencing. Comparative genomic hybridisation (CGH) and array CGH were used for 24 chromosome aneuploidy screening. Subsequently, aneuploidies were detected by next-generation sequencing using single-nucleotide polymorphism arrays, while STR markers were used for haplotyping. 'PGD version 2' included accurate marker-based diagnosis of most monogenic disorders and detection of aneuploidy of all chromosomes. Human leukocyte antigen matching of embryos has important implications in diagnosis and cure of haemoglobinopathies and immunodeficiencies in children by means of matched related haematopoietic stem cell transplantation from an unaffected 'saviour sibling' obtained by PGT.

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Oocyte cryopreservation is a boon for women undergoing assisted reproductive technology. With the evolution in the technique of cryopreservation over the last three decades, there has been an exponential rise in the number of oocyte cryopreservation cycles for diverse indications. Apart from cancer patients, it has also been promoted as a mode of fertility insurance to overcome the age-related decline in fertility as well as post-surgical decline following endometriosis surgery. The objective of the review is to evaluate its clinical applications, ideal age at freezing, optimal oocyte number, freezing method of choice, efficacy, safety and recent advances. In the last decade, vitrification has surpassed slow freezing for oocyte cryopreservation. Although closed system of vitrification provides the aseptic environment, open vitrification is commonly followed in practice. Early to mid-thirties is a reasonable age group for planned oocyte cryopreservation, although it might be recommended at a younger age, in patients with diminished ovarian reserve. The patients should be motivated to preserve around 14–20 mature oocytes for successful live birth. Various studies have shown comparable fertilisation and pregnancy rates between Intracytoplasmic sperm injection with fresh and frozen-thawed oocytes. The available evidence has shown no increase in the incidence of congenital abnormalities in babies born through vitrified oocytes. In the future, image analysis using artificial intelligence, and spindle visualisation using poloscope may further enhance the outcome of oocyte cryopreservation.

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Background: Limited information is available on the aetiology and semen profiles of male infertility in Indian population. Aim: The aim of this study is to study the clinical and semen characteristics of men attending the infertility clinic and also to understand the impact of World Health Organization (WHO) 2010 reference values on the diagnosis of male infertility. Setting and Design: A retrospective study evaluating the medical case records (January 2005 to December 2015, [n = 1906]) of men attending infertility clinic in Mumbai, India. Materials and Methods: The aetiology was classified based on the andrology evaluation and other investigations. Semen profiles were compared during the years 2005–2010 and 2011–2015 using WHO 1999 and WHO 2010 criteria, respectively. Statistical Analysis: The Chi-square and Mann–Whitney U tests were performed using Open Source Epidemiological software and Social science calculators. Results: The aetiology of male infertility was determined in 62% of the men; while the cause remained undetermined in 38%. Varicocele (25%), urogenital infections (10%), sexual dysfunctions (8%) and vas aplasia (8%) were identified as major aetiologies in our cohort. Men with sexual dysfunctions and vas aplasia were significantly higher during the years 2011–2015 as compared to 2005–2010. Men having normozoospermia (10%) and azoospermia (3%) were increased, whereas those having oligoasthenozoospermia (17%) were reduced in 2011–2015 as compared to 2005–2010. According to WHO 1999 criteria , 12-15% of men showed abnormal semen profiles. The semen parameters of these men became normal on using WHO 2010 reference values. Conclusions: Varicocele is the most common aetiology in infertile men. Idiopathic infertility was seen in a higher proportion among the infertile men.

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Background: Ovarian reserve declines with age. However, there are considerable ethnic differences in the decline of ovarian reserve between individuals. Aim: This study aimed to make age-specific percentile charts of anti-Mullerian hormone (AMH) and antral follicle count (AFC) in Indian infertile women and to find the proportion of young women with low ovarian reserve. Setting and Design: This was a retrospective data analysis of AMH and AFC of 5525 infertile women from August 2015 to December 2018. Materials and Methods: Infertile women aged 20–44 years, with body mass index 18–32 kg/m² and having both ovaries were included in the study. Women with pituitary/adrenal disorders, malignancy, total AFC >40, tuberculosis, endometriosis, autoimmune disorders, smoking, chemotherapy, radiotherapy and recent ovarian surgery were excluded from the study. Statistical Analysis: Comparison between groups was done by Chi-square test. Results: About 14.5% of women <35 years and 50.5% of women >35 years had low AMH values (<1.1 ng/ml). In addition, 5.6% of women <35 years and 23.6% of women >35 years had a low AFC of ≤5. In this study, 55.7% of women who had low AMH and 50.7% who had low AFC were <35 years of age. The median AMH values were 4.23 ng/mL in 20–25 years' age group, 3.48 ng/mL in women aged 26–30 years, 2.43 ng/mL in women aged 31–35 years, 1.28 ng/mL in women aged 36–40 years and0.52 ng/mL in 40–44 years' age group. The median AFCs were 20, 18, 14, 10 and 6 for each of the age groups, respectively. Conclusion: This study suggests that approximately more than half of the infertile women who were tested to have low ovarian reserve were <35 years of age.

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The application of stem cells in infertility is still experimental. Thin endometrium is an important cause of cancelled or less successful frozen embryo transfer cycles. Clinically, numerous strategies have been adopted to promote endometrial regeneration including extended oestrogen administration, low-dose aspirin, pentoxifylline, tocopherol, vaginal sildenafil citrate and intrauterine perfusion with granulocyte colony-stimulating factor. However, even with the use of these therapies, the endometrium in some patients still remains unresponsive. Latest research shows that autologous bone marrow-derived stem cells (ABMDSCs) can be used for regeneration of damaged endometrium. We present a case report of patient with thin endometrium who was successfully treated with the combined use of ABMDSCs mixed with platelet-rich plasma, leading to successful in vitro fertilization conceived pregnancy. Patient consent and due ethical clearance were taken before starting the procedure.

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Aim: This study aims to evaluate the effect of endometrial polyp resection by office hysteroscopy during in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatment cycle on pregnancy rate. Setting and Design: A retrospective observational study (case series). Materials and Methods: Twenty-five patients from a total of 346 patients that started IVF/ICSI treatment due to different causes of infertility over the period from January 2018 to December 2019 underwent an office hysteroscopy during ovarian stimulation (day 7–8) due to suspected endometrial polyp by transvaginal ultrasound and confirmed at day 7 of ovarian stimulation were retrospectively investigated. Results: Eighteen patients from the 25 patients that started IVF/ICSI treatment; endometrial polyp was confirmed by office hysteroscopy and resected, egg collection performed after 4–5 days after the hysteroscopy, embryo transfer done Double ET) at Day 3 and 5, the clinical Pregnancy rate was 56% (10 from the 18). No hysteroscopy-related adverse events were reported. Conclusion: Office hysteroscopy during ovarian stimulation in the IVF/ICSI treatment cycle may be useful in confirming the diagnosis and resection of endometrial polyp suspected by transvaginal ultrasound and is safe on the endometrium in terms of receptivity and improvement of the pregnancy rate. As the sample size of our study is relatively small, a well-designed large RCT is required to confirm our results before clinical advice is released.

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Background: Antimullerian hormone (AMH) is a key marker of ovarian reserve and predictor of response to fertility treatment. Aim: To understand the prevalence of low ovarian reserve in Indian women seeking infertility treatment, compare their AMH with age-matched fertile Indian controls and understand ethnic differences with Caucasian women. Setting and Design: Retrospective observational study done as collaboration between our in vitro fertilization centre and a laboratory with Pan-India presence. Materials and Methods: Women aged 20–44 years were selected as Group A (seeking infertility treatment n = 54,473), Group B (conceived naturally in the past; n = 283) and Group C (data of Caucasian women; n = 718). Serum AMH levels were measured and descriptive analysis done. Statistical Analysis: Descriptive statistics and Chi-square test. Results: In Group A, 28.7%, 48.7% and 70.6% of women aged <30 years, 30–34 years and 35–39 years had serum AMH levels ≤2 ng/mL and the proportions were higher than Group B. The rate at which median AMH decreased was 1.1–2 times faster in Group B as compared to Group C. The decrease in median AMH across age groups in Group A was similar to Group B. Conclusions: Indian women in their late twenties and early thirties visiting fertility centers showed a worrisome trend of low AMH. Our study can be used as a reference for those women considering postponing pregnancy. It may be time to look at intangible cultural factors linked to social habits, ethnicity, diet, genetic predispositions, and environmental factors like endocrine disrupting chemicals contributing to premature ovarian senescence.

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Background: Women with abnormal hysterosalpingography (HSG) are anxious regarding the presence of tubal pathology. It is important to know the predictive value of HSG and the need for subsequent laparoscopy following an abnormal report. In the era of assisted reproductive technology, the role of invasive testing such as diagnostic laparoscopy is being increasingly questioned due to its invasiveness and associated risks. There is a need to explore the positive predictive value (PPV) of HSG in detecting bilateral tubal block in our population as PPV changes with the prevalence of disease. Aim: The aim of this study was to evaluate the diagnostic accuracy of HSG in identifying tubal blockage in subfertile women. Setting and Design: This was a prospective diagnostic study conducted in the department of reproductive medicine and surgery in a university-level hospital. Materials and Methods: The study included 199 subfertile women who had undergone HSG earlier and were planned for laparoscopy from April 2017 to January 2021. Findings of HSG and laparoscopy were compared with HSG as index test and laparoscopy as reference test, and the outcomes analysed were PPV of HSG for a bilateral tubal block, bilateral hydrosalpinx, abnormal HSG (unilateral or bilateral tubal block) and agreement between HSG and diagnostic laparoscopy in detecting normal and abnormal findings. Statistical Analysis: Kappa statistics, Stuart–Maxwell tests of marginal homogeneity and prevalence-adjusted bias-adjusted kappa (PABAK) statistics were used. Results: The PPV for a bilateral block with HSG was 20.9% (95% CI: 13.7–29.7). The PPV of HSG for bilateral hydrosalpinx was 50.0% (95% CI: 6.8–93.2). PABAK was estimated to be 0.42 (95% CI: 0.30–0.55), suggestive of moderate agreement between the tests. Findings of laparoscopy in women with at least one patent tube in HSG showed that in 12.3% of cases, the management was likely to change due to the operative findings. Conclusion: The current study showed low PPV for bilateral tubal block diagnosed with HSG which translates into a need for further confirmation by laparoscopy. In one out of every eight women with at least one patent tube on HSG, performing laparoscopy changed the management.

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Background: Uterine anomalies arise if there is agenesis of one or two mullerian ducts, or absence of fusion or reabsorption of the septum between these ducts. The process may be partial or total and affect one or multiple parts of the tract. Aims: This study was done to assess the distribution of various types of mullerian anomalies in infertile women, their classification based on ESHRE and AFS, associated anomalies, types of diagnostic modalities used, surgical interventions done(if any), various types of infertility treatment used and their outcomes. Setting and Design: A retrospective analysis in a tertiary level hospital. Materials and Methods: This was a retrospective study in which the women found to have mullerian anomalies were recruited from infertility clinic from July 2019 to March 2020.They were classified according to ESHRE and AFS criteria and their records were analyzed after taking various factors like age, ovarian reserve, duration of infertility, treatment given , associated ovarian and tubal factors and pregnancy outcomes. Statistical Analysis: Analysis was performed in Excel. Results: There were 30 women with mullerian anomalies. Unicornuate uterus was most common anomaly .Four women required septoplasty in view of septate uterus. Five women had associated renal anomalies in form of shrunken kidney and ectopic kidney. Most of these women were considered for controlled ovarian stimulation followed by intrauterine insemination. In our study 16.6% women had successful pregnancy outcome. Conclusion: Mullerian anomalies continue to attract infertility specialist as they pose challenge in making clear diagnosis and its management as obstetrics outcomes are excellent after septum resection in women with septate uterus and conservative management in women with other anomalies. Proper work up of infertility and its management varies from case to case and associated factors like endometriosis, male factor, polycystic ovarian syndrome etc.

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Primary Ovarian Insufficiency (POI) or Diminished Ovarian Reserve (DOR) are the two conditions that affects women leading to infertility due to the lack of follicular growth and ovulation. Egg / Oocyte donation remains an option for these patients. However, with the development in Reproductive medicine various novel technologies like Ovarian Cryopreservation, Fragmentation, in vitro activation with drug treatment or even drug free autotransplantation enables the possibility of activating the pool of primordial follicles that can lead to successful pregnancy outcomes. Here, we report a case of women with POI, in which drug free in vitro activation of follicles was performed, followed by autotransplantation, which resulted in successful pregnancy. This is first case report from India that shows the procedure works and can be tried for women with POI.

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In this case report, we present the case of a 31-year-old man who presented with primary infertility, azoospermia and occasional sexual dysfunction. History and general physical examination were unremarkable. Local examination showed bilateral low volume testes and remaining aspects of the male reproductive tract were unremarkable. Detailed investigation showed a hypergonadotropic hypogonadism suggestive of primary testicular failure. Genetic screening showed a 46XX karyotype and Y chromosome testing was positive for sex-determining region (SRY) gene. Ultrasound abdomen was normal renal system and adrenal glands. A diagnosis of 46XX testicular disorders of sex development (DSD) was made. The incidence of this disorder is estimated to be 1:20,000 males. Such syndromic male partners generally have normal external genitalia and discover this disorder only in adulthood because of infertility. Such men have small volume testes, azoospermia and hypergonadotropic hypogonadism. Genetic and endocrine consultations are necessary to manage hypergonadotropic hypogonadism. Testicular sperm extraction is not recommended as there are deletions in all regions of Y chromosome, and adoption or assisted reproduction technology with a sperm donor are fertility options.

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Background: The use of in vitro maturation (IVM) has allowed patients with polycystic ovary syndrome (PCOS) to have a positive fertility outcome, as it allows utilisation of immature oocytes to mature in vitro. Aim: The aim of the study is to establish an optimum intra-cytoplasmic sperm injection (ICSI) timing for IVM oocytes (germinal vesicles [GV] →, metaphase I [MI]→ and metaphase II [MII]) using time lapse system (TLS) for patients with PCOS. Setting and Design: Patients included in this study were diagnosed with PCOS, ≤35 years of age, anti-Müllerian hormone levels >6 ng/ml and antral follicle counts <40. Furthermore, we included only GV oocytes at the time of denudation in our study. Materials and Methods: Patients were minimally stimulated and their oocytes were retrieved. In vitro maturated oocytes were monitored using TLS to a maximum of 30 h. MII oocytes were further cultured and injected at five different time intervals (1–2 h, 3–4 h, 5–6 h, 7–8 h and >8 h) to observe for fertilisation, cleavage and utilisation rate. Statistical Analysis: Chi-square test was applied to compared the treatment groups Results: Amongst 328 oocytes retrieved from 27 female patients, 162 oocytes were in the time-monitored cohort and 162 oocytes were grouped as the control cohort. Maturation rate between GV→ MII was highest at 18 h in the time-monitored cohort MII (n = 57). Utilisation rate was highest when ICSI was performed between 5 and 6 h after the first polar body extrusion, n = 17 (63%). Conclusion: This study provides valuable insight into the optimal maturation timing using a TLS to yield the good number of oocytes. In addition, optimising ICSI timing is important to provide the best utilisation rate in an IVM cycle to achieve synchrony between nuclear and cytoplasmic maturation.

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Background: Sperm maturation takes place through contact between sperm and proteins produced in the epididymal lumen. CD52 had been characterised in the sperm; however, the expression and its regulation in the epididymis are mostly unknown. Aim: This study aimed to analyse the expression and regulation of CD52 in the mouse epididymis. Setting and Design: Experimental design was used in this study. Materials and Methods: Epididymis tissues from mice strain Deutch Democratic Yokohama were used as sources of total RNA. Bioinformatic tool was used to predict signal peptides. Quantitative real-time reverse transcription–polymerase chain reaction was used to analyse tissue distribution, androgen, testicular factors dependency and postnatal development. Statistical Analysis: One-way analysis of variance was used to analyse differences between treatment and control untreated group. P < 0.05 was determined as a significant difference. Results: CD52 amino acid sequence contains a signal peptide, indicating it is a secretory protein. CD52 exhibited region-specific expression in the epididymis, with the highest level being in the cauda. CD52 expression was regulated by androgen indicated by a significant downregulation at day 1 and day 3 following a castration (P < 0.05). Dependency on androgen was confirmed by injection of exogenous testosterone which prevented downregulation by 50%. Moreover, lumicrine factors also influenced CD52 expression indicated by ligation of efferent duct which also reduced expression at day 1 to day 5 following the ligation (P < 0.05). CD52 expression was developmentally regulated. This was shown by increase in the level of expression starting at day 15 postnatally. Conclusion: CD52 shows characteristics of genes involved in sperm maturation in the epididymis.

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Background: Recurrent pregnancy loss (RPL) is a common occurrence that affects up to 15% of couples in their reproductive years. In both males and females with RPL and infertility, chromosomal abnormalities play a significant impact. Aim: The study was designed to examine the involvement of chromosomal anomalies and the frequency of certain chromosomal variants persistent among couples experiencing RPL. Setting and Design: This case–control study was conducted on 1000 couples from January 2015 to September 2020 in the state of Odisha, India, strictly adhering to principles of Helsinki Declaration (1975). The study was performed at the School of Biotechnology, KIIT University in collaboration with inDNA Life Sciences Private Limited. Materials and Methods: A cohort of 1148 individuals with a history of RPL were selected for the study and they were screened with respect to fertile controls for the presence of any chromosomal anomaly using G-banding, nucleolar organizing region (NOR)-banding and fluorescence in situ hybridisation wherever necessary. Statistical Analysis: The connection between distinct polymorphic variations and the occurrence of RPL was assessed using Fisher's exact test. Significant was defined as a P ≤ 0.005. Results: One hundred and thirty-four individuals were found to harbor chromosomal anomalies. This study elucidates that along with balanced chromosomal translocations, the involvement of polymorphic variants also plays a significant role in cases of RPL. Conclusion: The cumulative occurrence of chromosomal anomalies and variants across our cohort of 1148 individuals indicates that the chromosomal assessment of all couples experiencing RPL must be performed by all the clinicians. This study aids us in identifying chromosomal polymorphisms as major players of RPL in addition to novel chromosomal translocations.

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Background: Evaluation of uterine cavity is an important step during investigation of infertile women. The presence of uterine pathology causes impaired receptivity, failed implantation and poor pregnancy outcomes. Various investigative modalities though available; have their limitations. Hysteroscopy considered the gold standard diagnostic modality is invasive; thus, an investigation which could overcome its limitations was required. 3-Dimensional transvaginal sonography (3D TVS), which non-invasively visualizes uterine morphology, registers all three imaging planes simultaneously could be an alternative to hysteroscopy. Aim: To compare 3-D TVS with the gold standard office hysteroscopy for evaluating uterine cavity in sub fertile women. Setting and Design: It was a comparative study carried out at the Reproductive Medicine Centre of a tertiary care hospital. Materials and Methods: Over 12 months , 154 women with infertility underwent both hysteroscopy and 3D TVS. The primary outcome was to compare the sensitivity and specificity of 3D TVS in diagnosing endouterine abnormalities and assess if 3-DTVS could replace hysteroscopy for evaluation of uterine cavity. Statistical Analysis: The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of the 3-D TVS was calculated. Results: The 3-D TVS had a sensitivity of 88.46% ; specificity of 99.21% for detection of uterine abnormalities with hysteroscopy as gold standard. The Positive Predictive Value was 95.83%; Negative Predictive Value 97.69% and diagnostic accuracy was 97.4%. It was seen that of 24 lesions diagnosed by 3D TVS, hysteroscopy was in agreement with 21 lesions. Conclusion: 3D TVS with advantages of giving better spatial orientation, non-invasive, pain free, can replace hysteroscopy for screening endouterine lesions. With no statistically significant superiority of hysteroscopy over 3D TVS as seen in this study it may be deemed unnecessary in 50% patients having normal uterine cavity.

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Background: Despite the great advances in Assisted Reproductive Technologies (ART), management of poor responders has remained a great challenge. Gonadotropin releasing hormone antagonist (GnRH-ant) has been offered as a patient friendly protocol. In the literature, conflicting data exists about the effect of the GnRH-ant starting day on cycle outcomes. Aim: The aim of this study is to evaluate the effect of GnRH-ant starting day on cycle outcomes of patients with poor ovarian response defined by Bologna criteria. Setting and Design: This retrospective cohort study was conducted at an ART clinic of a tertiary hospital. Materials and Methods: A total of 361 cycles using flexible GnRH-ant, 195 in Group A (GnRH-ant administered before day 6 of stimulation) and 166 cycles in Group B (GnRH-ant started on or after day 6), were selected retrospectively for the study. Statistical analysis: Statistical analysis of data was carried out using using IBM SPSS Statistics Software (20.0, SPSS Inc., Chicago, IL, USA). Independent samples t-test and Mann–Whitney U test were used to analyze the variables. Results: Total antral follicle count was significantly higher in Group A compared to Group B (P = 0.009). Duration of stimulation was significantly shorter (P < 0.01) and total dose of gonadotropin used was lower in Group A when compared to Group B (P < 0.01). While higher number of oocytes was retrieved from Group A (P = 0.037), no between-group differences were observed in number of mature oocytes, fertilized oocytes, clinical pregnancy rate or ongoing pregnancy rate (OPR) per embryo transfer (P > 0.05). Conclusion: Early GnRH-ant start may point out a favourable response to ovarian stimulation in poor responders. However, clinical or OPRs were not different from the late GnRH-ant start group.

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Background: Evidence regarding impact of pre-ovulatory hormone levels on assisted reproductive technique (ART) outcomes in different ovarian response groups is sparse. Aims: The objective of this study was to evaluate and compare the association between pre-ovulatory hormonal profile and ART outcomes in different ovarian responses. Setting and Design: This is a single-centre retrospective cohort study of 273 non-donor fresh ART cycles between January 2013 and June 2016. Materials and Methods: Data on clinical profile, basal and peak hormonal levels, characteristics of controlled ovarian stimulation and ART outcomes were collected. Progesterone elevation (PE) was defined as pre-ovulatory serum progesterone >1.5 ng/mL or progesterone to oestradiol ratio >1. The association between peak hormonal levels and ART outcomes in poor (≤4 oocytes retrieved), intermediate (5–13 oocytes retrieved) and high (≥14 oocytes retrieved) ovarian responders was analysed and compared. Statistical Analysis: Continuous and categorical variables were summarised as median (interquartile range) and percentages, respectively, and compared using Kruskal–Wallis H-test or Mann–Whitney U-test and Chi-square test or Fisher's exact test, respectively. Results: The incidence of PE, by both criteria and clinical pregnancy rates (35.7%, 36.8% and 18.6% in high, normal and poor responders, respectively; P = 0.073), was similar among the three response groups. Except fertilisation rates in normo-responders, PE did not influence ART outcomes in any response group. Furthermore, there were no differences between peak hormone concentrations or incidence of PE between those who conceived and those who did not. Conclusion: Pre-ovulatory sex steroid levels do not seem to be the primary determinant of ART outcomes in any ovarian response category; hence, decision to freeze all embryos in the event of PE should be tailored.

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