Journal of Human Reproductive Science
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   2014| January-March  | Volume 7 | Issue 1  
    Online since April 19, 2014

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Genital tuberculosis: Comparative study of the diagnostic modalities
Gunjan Shrivastava, T Bajpai, GS Bhatambare, KB Patel
January-March 2014, 7(1):30-33
DOI:10.4103/0974-1208.130817  PMID:24829528
Background: Genital tuberculosis (GTB) is one of the major causes for severe tubal disease leading to infertility. Unlike pulmonary tuberculosis (TB), the clinical diagnosis of GTB is difficult because in the majority of cases the disease is either asymptomatic or has varied clinical presentation. Routine laboratory tests are of little value in the diagnosis. The objective of this study was to compare the modalities of polymerase chain reaction (PCR) technique, acid fast bacilli (AFB) culture and AFB staining. Materials And Methods: The women visiting in vitro fertility center during December 2012 and May 2013 were included in this study. A total of 227 aseptically collected endometrial tissue samples were processed. AFB staining, AFB culture and PCR were carried out using standard procedures. Result: Out of 227 patients suspected of GTB, 133 were found to be positive either by AFB smear microscopy, culture or PCR. Out of 133 samples, two samples (1.5%) were found to be positive by all three methods, i.e. microscopy, culture and PCR, 11 (4.8%) were found to be positive by both PCR and culture, whereas 126 (86%) samples were found to be positive only by PCR. The PCR has failed to detect seven cases that were positive by conventional culture method. Conclusion: Our study showed that the conventional methods of diagnosis like microscopy and culture are less sensitive when compared with PCR. PCR also helped in early diagnosis of infection. However simultaneously, false negative results were an important limitation of this method. PCR negative samples were found to be positive by culture methods. Deoxyribose nucleic acid PCR is not reliable for TB due to false positive or negative result. Thus, we suggest both culture and PCR as important diagnostic methods for detection of GTB.
  9 3,182 264
Antioxidant profile changes in reproductive tissues of rats treated with nicotine
IP Oyeyipo, Y Raji, AF Bolarinwa
January-March 2014, 7(1):41-46
DOI:10.4103/0974-1208.130823  PMID:24829530
Objectives: Nicotine intake has been associated with reduced fertility, although the mechanisms responsible are still unclear. However, oxidative stress has been repeatedly implicated as the leading cause of male infertility. This study was therefore designed to investigate the effects of nicotine administration on testicular oxidant and antioxidant system in male albino rats. Materials and Methods: Forty male rats weighing between 150 and 180 g were divided into five groups and treated orally for 30 days. Group I, which served as the control received 0.2 ml/kg normal saline, Groups II and III received 0.5 mg/kg and 1.0 mg/kg body weight (BW) of nicotine respectively. The fourth and fifth groups were administered with 0.5 mg/kg and 1.0 mg/kg BW of nicotine, but were left untreated for another 30 days. Homogenate of testis and epididymis were assayed for lipid peroxidation and anti-oxidant enzyme. Results: The results show a significant decrease (P < 0.05) in testicular glutathione peroxidase, glutathione reductase, catalase and superoxide dismutase while a significant increase (P < 0.05) was observed in testicular lipid peroxidation and nitric oxide level in both groups when compared with the control. Conclusion: This experiment established that nicotine administration is associated with decreased testicular antioxidant and increase testicular lipid peroxidation, which might be a mechanism by which nicotine induce infertility.
  9 3,494 245
Obstetric complications in women with IVF conceived pregnancies and polycystic ovarian syndrome
Sunita R Tandulwadkar, Pooja A Lodha, Nirzari T Mangeshikar
January-March 2014, 7(1):13-18
DOI:10.4103/0974-1208.130802  PMID:24829525
Polycystic ovarian syndrome (PCOS) is often accompanied by infertility that necessitates ovulation induction using clomiphene citrate, gonadotropins or even in vitro fertilization (IVF). These treatment methods are known to increase the incidence of multiple pregnancies as well as some negative consequences, including a rise in the risk for gestational diabetes mellitus, pre-eclampsia, etc., Furthermore, pregnancies established after IVF carry an increased risk for maternal complications. However, the increased risk of developing adverse obstetric complications has been suggested to occur independently of obesity as well as in populations without assisted reproductive techniques. Many studies have been performed to study the effect of PCOS on pregnancy and the effect of pregnancy on PCOS. The hormonal milieu that is exaggerated in PCOS women is quite well understood at the biochemical and genetic levels. The maternal and neonatal outcomes of PCOS women who have undergone in vitro fertilization-embryo transfer (IVF-ET) have not been widely studied till date. This review aims to evaluate the current evidence regarding adverse obstetric outcomes of PCOS women undergoing IVF-ET. The rationale of this review is to study whether the adverse obstetric outcomes are increased in PCOS women in general, or particularly in those PCOS women who are undergoing IVF-ET. It is also important to analyze via a literature review whether the increased adverse outcomes are due to infertility in general or PCOS per se. An attempt has been made to give evidence regarding preventive strategies for obstetric complications in PCOS women who have undergone IVF-ET.
  6 4,795 346
Imaging techniques for assessment of tubal status
Sonal Panchal, Chaitanya Nagori
January-March 2014, 7(1):2-12
DOI:10.4103/0974-1208.130797  PMID:24829524
Fallopian tubes make a vital portal for transfer of gametes and embryo. Tubal factor is responsible for infertility in 25-35% of cases. Hysterosalpingography (HSG) has been used to evaluate the uterine cavity and the tubal status since decades. It uses iodinated contrast and X-rays and is painful and inconvenient for patient. Laparoscopy is considered to be the gold standard for tubal evaluation, but is an operative procedure and needs anesthesia. Though ultrasound is a modality of choice for assessment of uterus and ovaries, it does not allow assessment of the fallopian tube unless there is any fluid surrounding it or inside the lumen. This fluid interface can be created artificially by introducing saline in the uterine cavity and fallopian tubes and scanning simultaneously. The procedure is named Saline infusion HSG. Saline infusion sonohysterosalpingography (SIS) can be done with B mode US and Doppler. SIS can demonstrate a patent tube but if blocked, the site of block cannot be demonstrated. Ultrasound contrast agents can be used for tubal assessment using contrast mode on the scanners. This procedure is known as hystero-contrast sonography (HyCoSy). This actually shows the passage of hyperechoic contrast agent through tubal lumen and delineates it and locates the site of block. Using the volume ultrasound may even make the demonstration of tubal status and fimbriae better. Results of HyCoSy have been found to correlate well with laparoscopic findings, which are a gold standard. It is recommended by National Institute for Health and Clinical Excellence as a primary investigation for tubal assessment in patients without any positive history of tubal damage and also can replace a second look laparoscopy.
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Laparoscopic detorsion for bilateral ovarian torsion in a singleton pregnancy with spontaneous ovarian hyperstimulation syndrome
Sujal Munshi, Azadeh Patel, Manish Banker, Pravin Patel
January-March 2014, 7(1):66-68
DOI:10.4103/0974-1208.130870  PMID:24829535
A 26-year-old primigravida with a singleton pregnancy of 9 weeks gestation presented with severe lower abdominal pain, following spontaneous hyperstimulation of the ovaries in a natural conception. Emergency laparoscopy was done and bilateral ovarian torsion with retained vascularity was noted. Bilateral detorsion with ovarian puncture and ovariopexy was performed. A review of international literature suggests that this is the first case reported with bilateral ovarian torsion following spontaneous ovarian hyperstimulation syndrome in a singleton pregnancy.
  3 3,302 151
Antibiotics supplemented culture media can eliminate non-specific bacteria from human semen during sperm preparation for intra uterine insemination
D. M. A. B. Dissanayake, KA Amaranath, R. R. D. P. Perera, PS Wijesinghe
January-March 2014, 7(1):58-62
DOI:10.4103/0974-1208.130859  PMID:24829533
Rationale: Bacterial flora can be isolated from many semen samples of subfertile males. Bacteriospermia can compromise the outcome of intra uterine insemination (IUI) by contaminating the post-processed sperm sample. Objectives: The objective of the present study is to determine the efficacy of penicillin and streptomycin in eliminating the bacteria from semen samples in the sperm processing procedure, and to assess the effects of antibiotics on sperm motility, survivability, and pregnancy rates. Design and Settings: A prospectively controlled study was carried out using couples undergoing IUI with their informed consent. Intervention: Sperm processing using the swim-up technique in penicillin and streptomycin supplemented culture medium. Subjects And Methods: Couples were consecutively allocated in two groups for sperm processing (a) Group AB+ (antibiotics supplemented culture medium, n = 33) and (b) Group AB− (antibiotic free culture medium, n = 33). Semen culture was performed before and after sperm processing. Sperm motility was assessed immediately after processing and after 24 h of incubation. Results: Bacterial isolates were found in 20 (60.6%) and 22 (66.1%) of samples before processing in Groups AB+ and AB− respectively. Addition of antibiotics resulted in completely eliminating non-specific bacteria from semen samples without affecting sperm motility. In vitro survival rate of sperm enhanced in AB+ group compared with AB− group (motile sperm after 24 h), 62.21% (standard deviation [SD]: 37.27) versus 41.36% (SD: 30.78), P = 0.012. Pregnancy rate, was comparable between two groups (9% in Group AB+ vs. 6% in Group AB−, P = 0.45). Conclusion: Penicillin streptomycin combination could completely eliminate non-specific bacteria from semen samples during sperm processing in this population. The types of antibiotics and dosage used did not seem to have any harmful effects on human sperm.
  3 3,898 251
Comparison of gonadotropin-releasing hormone agonist with GnRH antagonist in polycystic ovary syndrome patients undergoing in vitro fertilization cycle: Retrospective analysis from a tertiary center and review of literature
Neeta Singh, Moumita Naha, Neena Malhotra, Kusum Lata, P Vanamail, Abnish Tiwari
January-March 2014, 7(1):52-57
DOI:10.4103/0974-1208.130852  PMID:24829532
Introduction: Polycystic ovary syndrome (PCOS) is one of the most common infertility factor for which women are enrolled in in vitro fertilization (IVF) technique. In the recent years, gonadotropin releasing hormone antagonist protocol has emerged as the protocol of choice for controlled ovarian hyperstimulation in these patients. Objectives: The objective of the present study is to compare conventional long agonist protocol with fixed antagonist protocol in PCOS patients undergoing IVF cycle. Materials and Methods: Retrospective analysis of 4 years data of a single center from northern India. Totally 81 patients who had long agonist protocol were compared with 36 patients with similar baseline characteristics who had antagonist protocol. Result: Total dose of gonadotropin required was significantly lower (P - 0.004) in the antagonist group. There was no significant difference in pregnancy rate or incidence of ovarian hyperstimulation syndrome between two groups. Cycle cancellation due to arrest of follicular growth was significantly higher in the antagonist group (P - 0.027). Conclusion: More randomized control trials and meta-analysis are required before replacing conventional long agonist protocol with antagonist protocol in patients with polycystic ovary syndrome.
  1 4,010 278
Role of perifollicular Doppler blood flow in predicting cycle response in infertile women with genital tuberculosis undergoing in vitro fertilization/intracytoplasmic sperm injection
Neena Malhotra, Anupama Bahadur, Neeta Singh, Mani Kalaivani, Suneeta Mittal
January-March 2014, 7(1):19-24
DOI:10.4103/0974-1208.130809  PMID:24829526
Objective: This study was evaluated the role of perifollicular Doppler blood flow in predicting cycle response in women with and without genital tuberculosis (TB) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Materials and Methods: This prospective observational study was performed on 254 women undergoing IVF for tubal factor infertility in the assisted reproductive unit. Perifollicular Doppler blood flows were assessed in dominant follicles >16 mm before oocyte recovery in patients with and without genital TB. Results: A positive correlation was found between estradiol on the day of human chorionic gonadotropin (r = 0.15, P = 0.05), number of oocytes retrieved (r = 0.25, P = 0.001), MII (r = 0.24, P = 0.001), day 1 2PN (r = 0.16, P = 0.04), number of embryos (r = 0.16, P = 0.04) and blood flow in patients without genital TB. A trend of having poor ovarian blood flow was observed in patients with genital TB when compared with those without the disease (P > 0.001). Conclusion: In our study, the perifollicular blood flow (PFBF) provided a favorable prediction on the quantity of oocytes retrieved, MII, day 1 2PN and number of embryos but did not show any significant statistical difference in other outcome variables including fertilization or cleavage rate in women with or without genital TB undergoing IVF/ICSI cycles. Hence PFBF has the potential to be used as a simple and non-invasive surrogate marker of capillary blood flow around recruitable follicles to predict response to ovarian stimulation and cycle outcome.
  1 4,255 213
Prevalence of dental attrition in in vitro fertilization children of West Bengal
Sudipta Kar, Subrata Sarkar, Ananya Mukherjee
January-March 2014, 7(1):34-40
DOI:10.4103/0974-1208.130820  PMID:24829529
Context: Dental attrition is one of the problems affecting the tooth structure. It may affect both in vitro fertilization (IVF) and spontaneously conceived children. Aims: This study was aimed to evaluate and to compare the prevalence of dental attrition in deciduous dentition of IVF and spontaneously conceived children. Settings and Design: In a cross-sectional case control study dental attrition status of 3-5 years old children were assessed. The case group consisted of term, singleton babies who were the outcome of IVF in the studied area in 2009. Subjects and Methods: The control group consisted of term, first child, singleton and spontaneously conceived 3-5 years old children who were also resident of the studied area. A sample of 153 IVF and 153 spontaneously conceived children was examined according to Hansson and Nilner classification. Statistical Analysis Used: Statistical analysis was carried out using Chi-square tests (χ2 ) or Z test. Results: No statistically significant difference found in studied (IVF children) and control group (spontaneously conceived children). Conclusions: IVF children are considered same as spontaneously conceived children when studied in relation to dental attrition status.
  1 2,745 142
Absent endometrium due to balanced translocation [t(4;20)] presenting as primary amenorrhea
Aruna Nigam, Ayesha Ahmad, Swaraj Batra
January-March 2014, 7(1):63-65
DOI:10.4103/0974-1208.130867  PMID:24829534
Primary amenorrhea is defined as the absence of menarche by 16-18 years of age in the presence of well-developed secondary sexual characters. An incidence of 1-3% has been reported in women of reproductive age group. The etiology varies with anatomical, genetic and hormonal factors implicated in the causation of primary amenorrhea. We present a case of absent endometrium due to balanced reciprocal translocation (RCPTR), 46 XX t (4;20)(q12;q13.1) as primary amenorrhea.
  - 2,834 161
From the Editors desk
Madhuri Patil
January-March 2014, 7(1):1-1
DOI:10.4103/0974-1208.130791  PMID:24829523
  - 2,680 170
Attitudes of Iranian infertile couples toward surrogacy
Ensiyeh Mohebbi Kian, Hedieh Riazi, Saeid Bashirian
January-March 2014, 7(1):47-51
DOI:10.4103/0974-1208.130847  PMID:24829531
Background: Surrogacy arrangements are multifaceted in nature, involving multiple controversial aspects and engaging ethical, moral, psychological and social issues. Successful treatment in reproductive medicine is strongly based on the mutual agreement of both partners, especially in Iran where men often make the final decision for health-related problems of this nature. AIM: The aim of the following study is to assess the attitudes of Iranian infertile couples toward surrogacy. Setting and Design: This descriptive study was conducted at the infertility clinic of Hamadan university of medical sciences, Iran. Materials and Methods: The study sample consisted of 150 infertile couples selected using a systematic randomized method. Data collection was based on responses to a questionnaire consisting of 22 questions. Statistical Analysis: P <0.05 were considered to be statistically significant. Results: While 33.3% of men and 43.3% of women surveyed insisted on not using surrogacy, the overall attitudes toward surrogacy were positive (53.3% of women and 54.6% of men surveyed). Conclusion: Although, there was not a significant difference between the overall positive attitudes of infertile women and men toward surrogacy, the general attitude toward using this method is not strongly positive. Therefore, further efforts are required to increase the acceptability of surrogacy among infertile couples.
  - 3,247 174
Pre-implantation genetic screening using fluorescence in situ hybridization in couples of Indian ethnicity: Is there a scope?
Shailaja Gada Saxena, Kundanbala Desai, Lata Shewale, Prabhat Ranjan
January-March 2014, 7(1):25-29
DOI:10.4103/0974-1208.130812  PMID:24829527
Context: There is a high incidence of numerical chromosomal aberration in couples with repeated in vitro fertilization (IVF) failure, advanced maternal age, repeated unexplained abortions, severe male factor infertility and unexplained infertility. Pre-implantation genetic screening (PGS), a variant of pre-implantation genetic diagnosis, screens numerical chromosomal aberrations in couples with normal karyotype, experiencing poor reproductive outcome. The present study includes the results of the initial pilot study on 9 couples who underwent 10 PGS cycles. Aim: The aim of the present study was to evaluate the beneficial effects of PGS in couples with poor reproductive outcome. Settings and Design: Data of initial 9 couples who underwent 10 PGS for various indications was evaluated. Subjects and Methods: Blastomere biopsy was performed on cleavage stage embryos and subjected to two round fluorescence in situ hybridization (FISH) testing for chromosomes 13, 18, 21, X and Y as a two-step procedure. Results: Six of the 9 couples (10 PGS cycles) conceived, including a twin pregnancy in a couple with male factor infertility, singleton pregnancies in a couple with secondary infertility, in three couples with adverse obstetric outcome in earlier pregnancies and in one couple with repeated IVF failure. Conclusion: In the absence of availability of array-comparative genomic hybridization in diagnostic clinical scenario for PGS and promising results with FISH based PGS as evident from the current pilot study, it is imperative to offer the best available services in the present scenario for better pregnancy outcome for patients.
  - 3,516 186
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