Journal of Human Reproductive Science
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   2013| April-June  | Volume 6 | Issue 2  
    Online since August 28, 2013

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Current evidence supporting "letrozole" for ovulation induction
Sujata Kar
April-June 2013, 6(2):93-98
DOI:10.4103/0974-1208.117166  PMID:24082649
Aromatase inhibitor "letrozole" was first introduced as a potential ovulation induction (OI) drug almost a decade back. Large number of studies has been published using letrozole for OI: In polycystic ovary syndrome (PCOS) women, clomiphene citrate (CC) resistant women, for intrauterine insemination and also in various protocols of mild stimulation for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Letrozole appears to be a good option, with its oral route of administration, cost, shorter half-life and negligible side effects. However, the verdict on efficacy and safety of letrozole is still uncertain. This review explores the current scientific data supporting letrozole for OI.
  9 7,868 538
Non-invasive metabolomic analysis using a commercial NIR instrument for embryo selection
Ioannis A Sfontouris, George T Lainas, Denny Sakkas, Ioannis Z Zorzovilis, George K Petsas, Trifon G Lainas
April-June 2013, 6(2):133-139
DOI:10.4103/0974-1208.117174  PMID:24082655
Context: Metabolomics was introduced in human in vitro fertilization (IVF) for noninvasive identification of viable embryos with the highest developmental competence. Aims: To determine whether embryo selection using a commercial version of metabolomic analysis leads to increased implantation rates (IRs) with fetal cardiac activity (FCA) compared with morphology evaluation alone. Setting and Design: Randomized controlled trial from April to December 2010 at a private IVF unit. The study was terminated prematurely due to the market withdrawal of the instrument. Materials and Methods: IVF patients ≥18 and ≤43 years with ≥4 × 2PN were randomly allocated to metabolomic analysis combined with embryo morphology (ViaMetrics-E; metabolomics + morphology group) or embryo morphology alone (morphology group). Cycles with frozen embryos, oocyte donations, or testicular biopsy were excluded. Statistical Analysis: Categorical and continuous data were analyzed for statistical significance using 2-tailed Fisher's exact test and t-test, respectively. Statistical significance was accepted when P < 0.05. Results: A total of 125 patients were included in the study; 39 patients were allocated to metabolomics + morphology group and 86 patients to morphology group. Patients were stratified according to the day of embryo transfer (Days 2, 3, or 5). IRs with FCA were similar for Days 2 and 3 transfers in both groups. For Day 5 transfers, IRs with FCA were significantly higher in the metabolomics + morphology group (46.8% vs. 28.9%; P = 0.041; 95% confidence intervalp [CI]: 1.09-34.18). Pregnancy and live births rates were similar for Days 2, 3, and 5 in both groups. The study was terminated early following the voluntary market withdrawal of ViaMetrics-E in December 2010. Conclusions: Metabolomic analysis using the commercial near-infrared (NIR) instrument does not appear to have a beneficial effect on pregnancy and live births, with improvement in IR with FCA for Day 5 transfers. However, no solid conclusions can be reached due to the lack of adequate study power. Identifier: NCT01490515
  8 3,523 145
Magnetic resonance imaging in obstructive Müllerian anomalies
Kamal Kumar Sen, Dhivya Balasubramaniam, Vikrant Kanagaraj
April-June 2013, 6(2):162-164
DOI:10.4103/0974-1208.117167  PMID:24082660
Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures. It is characterized by the triad of didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis. Magnetic resonance imaging (MRI) is a sensitive, non-invasive diagnostic modality for demonstrating anatomic variation and associated complications.
  7 4,787 158
Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India
Mohamed C Ashraf, Sankalp Singh, Dharma Raj, Sujatha Ramakrishnan, Sandro C Esteves
April-June 2013, 6(2):111-123
DOI:10.4103/0974-1208.117175  PMID:24082652
Context: Non-obstructive azoospermia (NOA) is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR) coupled with intracytoplasmic sperm injection (ICSI) is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE) has been applied with encouraging results. Aims: We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR. Settings and Design: Case series of men with NOA treated in a tertiary healthcare center. Materials and Methods: An Assisted Reproductive Technology (ART) facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP). Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes. Statistical Analysis: Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR. Results: The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%. Conclusions: We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF) laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring.
  7 9,164 232
Follicular fluid insulin like growth factor-1 (FF IGF-1) is a biochemical marker of embryo quality and implantation rates in in vitro fertilization cycles
Bindu N Mehta, Natachandra M Chimote, Meena N Chimote, Nishad N Chimote, Nirmalendu M Nath
April-June 2013, 6(2):140-146
DOI:10.4103/0974-1208.117171  PMID:24082656
Context: Insulin-like growth factor-1 (IGF-1) has been reported to play a role in human follicular and embryonic development. However, earlier studies carried out mostly in animal models or in culture mediums supplemented with IGF-1 have been unable to directly link IGF-1 with embryo quality. Results correlating IGF-1 with pregnancy outcome have also been ambiguous so far. Aim: The aim of this study is to find if in situ follicular-fluid level of IGF-1 is predictive of embryo quality and implantation rates in in vitro fertilization (IVF) cycles. Settings and Design: Prospective study involving 120 cycles of conventional IVF-embryo transfer in infertile women. Subjects and Methods: IGF-1 concentrations were estimated in pooled follicular-fluid on the day of oocyte-pickup. Embryo quality was assessed daily at different developmental stages. Cycles were sorted into low and high follicular fluid insulin-like growth factor-1 (FF IGF-1) groups according to the median value of measurement. Embryo quality, clinical pregnancy and implantation rate were the main outcome measures. Statistical Analysis: Graph-pad Prism 5 statistical package. Results: FF IGF-1 correlates with embryo quality (Pearson r = 0.3894, r2 = 0.1516, P < 0.0001) and clinical pregnancy (Pearson r = 0.5972, r2 = 0.36, P < 0.0001). High FF IGF-1 group shows significantly higher rates of fertilization, cleavage, blastocyst formation and top grade embryos compared with low FF IGF-1 group. Clinical pregnancy rates (38.33 vs. 20%, P = 0.0272) and embryo implantation rates (21.6 vs. 10.32%, P = 0.0152) are also significantly higher in the high versus low FF IGF-1 group. Threshold value of FF IGF-1 for clinical pregnancy is >58.50 ng/mg protein (receiver operating characteristics AUC : 0.85 ± 0.03, 95% CI: 0.78-0.91). Conclusion: FF IGF-1 is a plausible biochemical marker of embryo quality and implantation rate and correlates with clinical pregnancy rates in conventional IVF cycles.
  6 3,864 131
Unilateral and bilateral cryptorchidism and its effect on the testicular morphology, histology, accessory sex organs, and sperm count in laboratory mice
Soumita Dutta, Keshab Raj Joshi, Pallav Sengupta, Koushik Bhattacharya
April-June 2013, 6(2):106-110
DOI:10.4103/0974-1208.117172  PMID:24082651
Background: Experimental unilateral cryptorchidism (ULC) and bilateral cryptorchidism (BLC) are excellent methods to study undescended testis in relation to spermatogenesis against a temperature gradient. Objectives: In case of ULC, it is possible to compare the testicular functions between normal condition and cryptorchidism in the same animal, whereas BLC shows the necessity of testicular androgens for proper maintenance of reproductive structures and functions. Materials and Methods: In the present study, experimental ULC and BLC was done on same-aged adult mature male mice and kept for 15 days and 30 days, respectively, to observe the changes due to the induced cryptorchidism on the different reproductive organs, viz., the testis and accessory sex organs along with epididymal sperm count. Reproductive tissues were collected from individual animals and histopathological studies of testis were done to investigate different cytological changes. Results: The size of the testes and accessory sex organs were found to be significantly reduced in BLC mice, whereas only testicular weight reduction was observed in ULC mice. Histopathological studies showed degenerative changes throughout the seminiferous tubules. Conclusion: Thus, the present investigation showed compensatory androgen production in ULC mice, whereas absence of androgen mediated reproductive functions in BLC animals.
  6 4,959 223
Follicular-fluid anti-Mullerian hormone (FF AMH) is a plausible biochemical indicator of functional viability of oocyte in conventional in vitro fertilization (IVF) cycles
Bindu N Mehta, Meena N Chimote, Nishad N Chimote, Nirmalendu M Nath, Natachandra M Chimote
April-June 2013, 6(2):99-105
DOI:10.4103/0974-1208.117168  PMID:24082650
Context: Oocyte quality may be a governing factor in influencing in vitro fertilization (IVF) outcomes. However, morphological evaluation of oocyte quality is difficult in conventional IVF cycles. Follicular-fluid (FF), the site for oocyte growth and development, has not yet been sufficiently explored to obtain a marker indicative of oocyte quality. Anti-Mullerian hormone (AMH) is produced by granulosa cells of preantral and early-antral follicles and is released in FF. Aim: To investigate AMH as a biochemical indicator of functional viability/quality of oocyte produced in the FF micro-environmental milieu. Settings and Design: Prospective study involving 132 cycles of conventional IVF-embryo transfer (ET) in infertile women. Subjects and Methods: AMH concentration was estimated in pooled FF on day of oocyte pickup. Cycles were sorted into low and high groups according to median (50 th centile) values of measurement. Main outcome measure was oocyte viability, which included morphological assessment of oocyte quality, fertilization rate, clinical pregnancy, and implantation rates. Statistical Analysis: Graph-pad Prism 5 statistical package. Results: Low FF AMH group shows significantly higher percentage of top-quality oocytes (65.08 ± 24.88 vs. 50.18 ± 25.01%, P =0.0126), fertilization (83.65 ± 18.38 vs. 75.78 ± 21.02%, P =0.0171), clinical pregnancy (57.57 vs. 16.67%, P <0.0001), and embryo implantation rates (29.79 vs. 7.69%, P <0.0001) compared to high FF AMH group. FF AMH shares an inverse correlation with FF E2 (Pearson r = −0.43, r 2 = 0.18) and clinical pregnancy (Pearson r = −0.46, r 2 = 0.21). Threshold value of FF AMH for pregnancy is <1.750 ng/mg protein. Conclusion: FF AMH is a plausible biochemical indicator of functional viability of oocyte in conventional IVF cycles.
  5 3,793 156
Efficacy of two sperm preparation techniques in reducing non-specific bacterial species from human semen
Prabath K Abeysundara, DMAB Dissanayake, Prasantha S Wijesinghe, RRDP Perera, AAN Nishad
April-June 2013, 6(2):152-157
DOI:10.4103/0974-1208.117169  PMID:24082658
Context: Artificial reproductive techniques using seminal preparations with bacteria may cause pelvic inflammatory disease and its sequalae. Aims: To assess efficacy of two sperm preparation techniques to clear bacteria and the effect of bacteriospermia on sperm recovery rates. Settings and Design: A descriptive cross-sectional study was carried out among males of subfertile couples. Subjects and Methods: Semen samples were randomly allocated into swim-up method (group S, n = 68) and density gradient method (group D, n = 50) for sperm preparation. Seminal fluid analysis and bacterial cultures were performed in each sample before and after sperm preparation. Statistical Analysis: McNemar's chi-squared test and independent samples t-test in SPSS version 16.0 were used. Results: Organisms were found in 86 (72.88%) out of 118 samples, before sperm preparation; Streptococcus species (n = 40, 46.51% of which 14 were Group D Streptococcus species), Coagulase negative Staphylococcus species (n = 17, 19.76%), Staphylococcus aureus (n = 13, 15.11%), Coliform species (n = 11, 12.79% of which 09 were Escherichia coli) and Corynebacterium species (n = 5, 5.81%). There was a statistically significant reduction of culture positive samples in raw vs. processed samples; in group S, 49 (72.05%) vs. 16 (23.52%) and in group D, 37 (74%) vs. 18 (36%). In group S and D, mean (SD) recovery rates of culture positive vs. culture negative samples were 39.44% (SD-14.02) vs. 44.22% (SD-22.38), P = 0.39 and 52.50% (SD-37.16) vs. 49.58% (SD-40.32), P = 0.82 respectively. Conclusions: Both sperm preparation methods significantly reduced bacteria in semen, but total clearance was not achieved. Sperm recovery rate was not affected by bacteriospermia.
  5 3,123 137
Male reproductive health under threat: Short term exposure to radiofrequency radiations emitted by common mobile jammers
SMJ Mortazavi, ME Parsanezhad, M Kazempour, P Ghahramani, AR Mortazavi, M Davari
April-June 2013, 6(2):124-128
DOI:10.4103/0974-1208.117178  PMID:24082653
Background: Modern life prompted man to increasingly generate, transmit and use electricity that leads to exposure to different levels of electromagnetic fields (EMFs). Substantial evidence indicates that exposure to common sources of EMF such as mobile phones, laptops or wireless internet-connected laptops decreases human semen quality. In some countries, mobile jammers are occasionally used in offices, shrines, conference rooms and cinemas to block the signal. Aims: To the best of our knowledge, this is the first study to investigate the effect of short term exposure of human sperm samples to radiofrequency (RF) radiations emitted by common mobile jammers. Subjects and Methods: Fresh semen samples were collected by masturbation from 30 healthy donors who had referred to Infertility Treatment Center at the Mother and Child Hospital with their wives. Female problem was diagnosed as the reason for infertility in these couples. Statistical Analysis: T-test and analysis of variance were used to show statistical significance. Results: The motility of sperm samples exposed to jammer RF radiation for 2 or 4 h were significantly lower than those of sham-exposed samples. These findings lead us to the conclusion that mobile jammers may significantly decrease sperm motility and the couples' chances of conception. Conclusion: Based on these results, it can be suggested that in countries that have not banned mobile jammer use, legislations should be urgently passed to restrict the use of these signal blocking devices in public or private places.
  4 4,124 164
Case report on spontaneous ovarian hyperstimulation syndrome following natural conception associated with primary hypothyroidism
Smisha Sridev, Sridev Barathan
April-June 2013, 6(2):158-161
DOI:10.4103/0974-1208.117164  PMID:24082659
Spontaneous OHSS is a rare event in pregnancy following natural conception and only a few cases have been reported in the literature so far. This report is a case of spontaneously conceived pregnancy with Spontaneous OHSS and Primary hypothyroidism
  3 3,378 179
Cytogenetic evaluation of patients with clinical spectrum of Turner syndrome
Rajasekhar Moka, Kodandapani Sreelakshmi, Puthiya Mundyat Gopinath, Kapettu Satyamoorthy
April-June 2013, 6(2):129-132
DOI:10.4103/0974-1208.117177  PMID:24082654
Aim: The objective of this study was to correlate the genotype, of female patients, withshort stature and primary amenorrhea. Materials and Methods: One hundred and forty-six subjects were recruited during 2005-2012. Microscopic and automated karyotyping analyses were done by using chromosomes isolated from the lymphocytes using Giemsa banding (GTG) to identify chromosome abnormalities. Results: A total of 146 clinically suspected Turner syndrome (TS) subjects were recruited for the study, of which, 61 patients were identified to have chromosome abnormalities. The chromosomal abnormalities detected were as follows: Monosomy X (n = 19, 13.01%), triple X syndrome (n = 4, 2.7%), mosaic TS (n = 12, 8.21%), XY gonadal dysgenesis (n = 13, 8.9%), and structural abnormalities including X chromosome (n = 15, 10.27%) and one patient each with autosomal changes involving 9qh inversion and translocation of chromosomes 12 and 14. Conclusion: Karyotype abnormalities accounting for 46% in this study emphasize the need for karyotype testing in cases of short stature with primary amenorrhea.
  3 5,001 229
Correlation between serum zinc levels and successful immunotherapy in recurrent spontaneous abortion patients
Ahad Zare, Abotaleb Saremi, Marjan Hajhashemi, Gholam Ali Kardar, Seyed Mohammad Moazzeni, Zahra Pourpak, Pirouz Salehian, Maryam Naderi, Reza Safaralizadeh, Maryam Nourizadeh
April-June 2013, 6(2):147-151
DOI:10.4103/0974-1208.117170  PMID:24082657
Background: Immunotherapy with paternal lymphocytes plays an important role in preventing recurrent spontaneous abortion (RSA) and is an effective treatment for it. This kind of treatment is performed as an immunotherapy method in several centers in the world. It attributes to the production of anti-paternal cytotoxic antibodies (APCAs) in women with RSA. Production of APCA after lymphocyte immunotherapy (LIT) in RSA patients gives them a better chance for successful pregnancy. Regarding the important effect of trace elements on the function of the immune system, we tried to investigate the correlation between serum zinc level and the success of LIT in RSA. Materials and Methods: Serum zinc concentration was determined in two groups of RSA patients using atomic absorption spectrophotometer systems. Group (a) that responded to the paternal lymphocytes and their cross-match test was positive, and group (b) that had no response to the paternal lymphocytes immunizations and their cross-match test was negative. Results: Serum zinc levels in group (a) patients were 74.98 ± 11.88 μg/dl, which was significantly higher than those in group (b) with the zinc concentration of 64.22 ± 9.22 μg/dl. Conclusions: Zinc deficiency may be one of the substantial causes of negative results for LIT in RSA patients. Therefore, compensation of zinc defect before LIT can be a promising approach to improve the immune response in patients.
  3 2,958 142
Preimplantation and postimplantation therapy for the treatment of reproductive failure
Pratap Kumar, Siddharth Mahajan
April-June 2013, 6(2):88-92
DOI:10.4103/0974-1208.117165  PMID:24082648
Treatment of patients with recurrent pregnancy losses and recurrent implantation failure can be instituted only when the underlying etiology is determined. Embryo-secreted preimplantation factor (PIF) is essential for implantation and adequate trophoblastic invasion. Deficiency of PIF affects the outcome of the pregnancy leading to recurrent pregnancy losses. Synthetic PIF modulates the outcome of the pregnancy decreasing the incidence of recurrent implantation failure and recurrent pregnancy losses. In this article a thorough search is done regarding the data published for diagnoses of reproductive failure and its treatment. The effect of immunoglobulin (Ig), intralipid, heparin, aspirin, progesterone, estrogen, and granulocyte colony stimulating factor (G-CSF) is taken into consideration. Heparin, aspirin, and progesterone have successfully shown to decrease the incidence of recurrent pregnancy loses; whereas G-CSF, intralipids, estrogen, and Igs have shown success in the treatment of the recurrent implantation failure and recurrent pregnancy failure. The pregnancies treated with Igs and intralipids showed equal outcome when evaluated and compared. The place of intralipid in reducing natural killer (NK) cells has been discussed.
  3 5,326 495
From the Editor's desk
Madhuri Patil
April-June 2013, 6(2):87-87
DOI:10.4103/0974-1208.117162  PMID:24082647
  - 1,930 128
Progesterone supplementation - Beware of changes in the oral cavity
Preetinder Singh, Yash Paul Dev, Sumit Kaushal
April-June 2013, 6(2):165-165
DOI:10.4103/0974-1208.117163  PMID:24082661
  - 2,528 93
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