Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of heterotopic pregnancy in a 22-year-old woman presented with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 10 weeks of amenorrhea, diagnosed on ultrasound examination.

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Background : Male reproductive function has recently attracted increasing attention due to reports on time-related decline in semen quality. Furthermore, regional differences in the semen quality have also been reported. Aim : To investigate the semen quality among large cohort of infertile individuals at a regional level, in terms of the sperm concentration, total sperm motility, sperm morphology and incidence of azoospermia over a period of 13 years. Setting : University infertility clinic at Kasturba Hospital, Manipal which is a tertiary healthcare centre serving the general population. Design : Retrospective analysis. Materials and Methods: This includes a total of 7770 subjects who presented for semen analysis from 1993 to 2005. The data regarding ejaculate volume, sperm density, motility, morphology and the incidence of azoospermia were collected. Statistical Analysis Used : One way analysis of variance (ANOVA), regression analysis and Chi square analysis. Results : The average sperm density among infertile men during 2004-2005 was 26.61 ± 0.71 millions/mL which was significantly lower than the average sperm density observed in 1993-1994 (38.18 ± 1.46 millions/mL). Similar trend was also observed for sperm motility (47.14% motile sperms vs. 61.16%) and normal sperm morphology (19.75% vs. 40.51%). Interestingly, the incidence of severe oligospermia (mean sperm density <10 millions/mL) observed in 2002-2005 and 1993-1997 demonstrated a significant inverse relationship ( P < 0.001). Conclusion : Our study provides the first evidence that the quality of human semen evaluated for infertility is deteriorating in the southern part of the India over the years, probably due to environmental, nutritional, life style or socioeconomic causes.

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Context : There is a continuous controversy regarding the obstetric perinatal outcome of twin pregnancies conceived after assisted reproductive techniques (ART). There is an ongoing discussion whether theses parameters may show poorer results as compared to spontaneous conception. Aims: To evaluate the outcome of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. Settings and Design : Prospective case-control study. Materials and Methods :In this prospective case-control study of 2-year duration, obstetric and perinatal outcomes were compared in 36 ART twin pregnancies (Group A) with 138 twins who conceived naturally (Group B). The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. Statistical Analysis : The continuous variables were analyzed by Student's t -test and categorical variables were analyzed with Fisher's exact test. Results : Pregnancy-related complications like pregnancy-induced hypertension, antepartum hemorrhage, were similar in both groups. Incidence of cesarean section, preterm delivery, and hospital stay was significantly more in Group A vs. Group B, P < 0.001. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, sepsis, and longer hospital stay (4.8 days vs. 1.6 days, P < 0.001). Conclusions : Increased rates of cesarean section and preterm delivery are the main reasons for increased obstetric risk in pregnancies conceived through ART. Preterm birth and neonatal prematurity-related complications were the main cause for longer stay in hospital in ART-conceived twins.

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Background : It has been hypothesized that microdeletions of Yq may account for a significant proportion of men with infertility. Three nonoverlapping regions, referred to as "azoospermia factors" (AZFa, b, c from proximal to distal Yq) have been defined as spermatogenesis loci and deletions in these regions have been shown to be pathogenically involved in male infertility associated with azoospermia or severe oligospermia. Aims: Evaluation the frequency of Y chromosome microdeletions in Iranian population. Materials and Methods: Fifty infertile men were selected. Semen analysis was done and on the basis of the mean sperm count, all patients were categorized into azoospermia and oligozoospermia, groups. Blood samples were obtained for DNA extraction and chromosomal analysis. Genomic DNA was extracted from blood lymphocytes and amplified by sequence tagged sites-polymerase chain reaction (STS-PCR) method to determine the presence of microdeletions in AZF locus. A total of 34 STS primers including two controls were selected to identify microdeletions of Y chromosome on each subject. Results and Conclusion: 26/50 cases (52%) showed deletion of at least one of the STS Marker. Totally 41 microdeletions was observed. A total of 17 cases (34%) had deletion in one STS. Four oligospermia cases (8%) had deletion in 2 STS site. Three azoospermia cases (6%) had again deletion in 2 STS site, but in different STSs. One case had three deletions in three STS site and finally one individual had seven deletions in AZF locus. The overall frequency of Y chromosome microdeletions observed in the present study was found to be 26/50 (52%). Comparison of our data with the result of other investigators world wide shows that the incidence of Yq microdeletions in Iranian population is much higher than international frequency. Our data agree with other studies regarding microdeletions of AZFc, but for microdeletions of AZFa (14.6%) our results is much higher and differ significantly with many studies.

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Objective : To study the efficacy of gonadotrophin releasing hormone (GnRH) antagonist in In-vitro-fertilization/Intracytoplasmic sperm injection (IVF/ICSI) cycles. Type of Study : Observational study. Setting: Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu. Materials and Methods: GnRH antagonists were introduced into our practice in November 2005. Fifty-two women undergoing the antagonist protocol were studied and information gathered regarding patient profile, treatment parameters (total gonadotrophin dosage, duration of treatment, and oocyte yield), and outcomes in terms of embryological parameters (cleavage rates, implantation rates) and clinical pregnancy. These parameters were compared with 121 women undergoing the standard long protocol. The costs between the two groups were also compared. Main Outcome : Clinical pregnancy rate. Results : The clinical pregnancy rate per embryo transfer in the antagonist group was 31.7% which was comparable to the clinical pregnancy rate in women undergoing the standard long protocol (30.63%). The costs between the two groups were comparable. Conclusions : GnRH antagonist protocol was found to be effective and comparable to the standard long protocol regimen. In addition it was simple, convenient, and patient friendly.

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Background : Rejection of semiallogenic foetus in recurrent spontaneous abortion (RSA) has been postulated to be a consequence of genetic and immunological phenomena. Aim: To evaluate the role of human leukocyte antigen (HLA) alleles in RSA in Indian couples. Settings and Design : A case-control study. Materials and Methods : Eighty-one randomly selected couples with unexplained three or more RSAs and a control group of 97 couples with live birth belonging to the same ethnic background, referred to the Gynaecology Department, KEM Hospital were included in the case-control study. Serological HLA A and B typing was done followed by molecular subtypes, defined using PCR-SSOP technique for HLA A, B, and C in 40 couples and DRB1* and DQB1* in 28 couples which were then compared with appropriate case 46 and 88 controls. Results : Serologically A3 (15.43% vs . 4.43%; odds ratio (OR) = 4.34; P = 0.0002) and B17 (25.3% vs . 11.34%; OR = 3.49; P = 0.0001) were increased. Haplotype A1-B17 was significantly increased. Molecular subtyping revealed that A*030102 (11.25% vs . 4.34%; OR = 3.00; P = 0.07), B*5701 (11.25% vs . 1.08%; OR = 13.10; P = 0.003), Cw*120201 (25% vs . 4.34%; OR = 10.50; P = 2.05E-05), HLA DRB1*030101 (17.85% vs . 3.40%; OR = 7.6; P = 0.0001), DRB1*150101 (32.14% vs . 13.63%; OR = 4.8; P = 0.0003), and DQB1*060101 (35.71% vs . 29.34%; OR = 2.3; P = 0.004) were significantly increased in patients. A differential association was noticed when compared with reported world RSA patients. Conclusion: The HLA alleles A*030101, B*5701, Cw*120201, DRB1*030101, and DRB1*150101 as well as their associated ancestral haplotype may play a significant role in development of RSA in India.

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This is a case report of a 32-year-old woman, being treated for secondary infertility, with history of previous ectopic pregnancy, who presented to the emergency obstetrical room in a state of hypovolemic shock. A diagnosis of ruptured ectopic pregnancy was confirmed in view of history of 14 weeks amenorrhea with a positive urine pregnancy test and positive colpopunture. She was immediately shifted for an emergency exploratory laparotomy. Intraoperatively, the authors were surprised to encounter a right lateral wall rupture uterus and ~14 weeks foetus with the placenta lying freely in the peritoneal cavity. That was suggestive of a right interstitial ectopic which had grown up to 14 weeks, invaded the uterine cavity thus forming an angular ectopic, which ended up as the catastrophic event. The authors here wish to highlight that angular pregnancy is rare but it has catastrophic consequences including maternal mortality. Had the patient presented early, in view of history of previous ectopic, an ultrasonography and color Doppler would have been useful in early detection. And a fertility conserving management in the form of Methotrexate therapy or Selective Uterine artery embolization could have been done.

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Hysterosalpingography accurately delineates the uterine and tubal lumen, and hence is routinely performed for the evaluation of infertility.We observed a case of infertility where uterine cavity was normal but fallopian tubes were bifurcated at the ampullary region. Mullerian duct anomalies are reported in literature, but maldevelopment of fallopian tube in isolation is rare. This abnormality can present as infertility, ectopic pregnancy, in association with urinary tract anomalies or as failure of sterilisation method.

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Ovarian pregnancy after in-vitro fertilization is rare and can be easily missed unless there is a high index of suspicion. Here we present such a case which was missed initially but was later successfully managed laparoscopically.

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Aim : To evaluate the credibility of single blastocyst transfer (SBT) method in selected group of patients. Settings and Design : Retrospective analysis of SBT cases based on computerized data in a private Fertility research centre. Materials and Methods : A total of 604 cases of SBTs, done during June 2000 to June 2006, have been analyzed retrospectively to assess the credibility of the method as a method of choice in selective high fertile group of patients. Women between 28 and 42 years have been included in the retrospective analysis, who had adequate number of eggs for fertilization, between 6 and 12. Results and Conclusions : Grade I blastocyst transfer resulted in 46.6% of clinical pregnancy and grade II blastocyst transfer resulted in 17.4% of clinical pregnancy rates. Overall pregnancy rate was 64%. Pregnancy loss, as early and late fetal wastages, was 11.06%.

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