Journal of Human Reproductive Science
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   2014| October-December  | Volume 7 | Issue 4  
    Online since December 22, 2014

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Scheduling cycles with gonadotropin-releasing hormone antagonist protocol in in vitro fertilization: Is there a scope in batch in vitro fertilization?
Rohit Gutgutia, Sameer Rao, Juan Garcia-Velasco, Susmita Basu
October-December 2014, 7(4):230-235
DOI:10.4103/0974-1208.147489  PMID:25624658
In India, a practice of "Batch in vitro fertilization (IVF)" has evolved in many infertility centers in an effort to align infertility management with logistics. A "Batch IVF" is an approach where the menstrual cycles of multiple women are programmed, such that they can undergo all the processes; from stimulation until embryo transfer about the same time. In "Batch IVF", the day for initiating stimulation is calculated retrospectively from the day the visiting embryologist is available at the clinic (day of ovum pick-up). Aligning the cycles of multiple women with steroids followed by down regulation with long gonadotropin-releasing hormone agonist (GnRH-A) is one of the currently employed methods for batching. There is sufficient evidence on scheduling cycles with steroids in GnRH-An protocol without compromising on the outcome. The objective of this paper is to provide evidence-based clinical concept on scheduling cycles in "Batch IVF" setup with GnRH-An protocol through literature review.
  4,429 310 -
Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates
Pratap Kumar, Shweta Arora
October-December 2014, 7(4):255-261
DOI:10.4103/0974-1208.147492  PMID:25624661
Background: The effects of exercise, metformin, and orlistat on anthropometric parameters, lipid profile, endocrine parameters, and ovulation in polycystic ovarian syndrome (PCOS) women were compared. AIM: The aim was to study the efficacy of orlistat compared with metformin and exercise in PCOS. DESIGN: Randomized control trial. Methods: A total of 90 eligible PCOS women were randomly assigned to receive either of the two drugs (orlistat or metformin) in combination with lifestyle interventions or as controls where they received lifestyle interventions alone. Anthropometric parameters were assessed at baseline and 4 weekly intervals for 3 months. Androgen levels, insulin resistance, ovulation and conception rates and lipid profile were also assessed at the end of study. Statistical Analysis: Statistical analysis was performed using the SPSS version 17.0. Results: The levels of fasting blood sugar, fasting insulin and homeostatic model assessment insulin resistance were comparable in three treatment groups. Mean total testosterone, serum hormone binding globulin, free androgen index, dehydroepiandrosterone sulfate in all arms were comparable and statistically nonsignificant. However, orlistat and metformin were more effective in reducing weight, body mass index, waist circumference and waist-hip ratio. However, side-effects were less with orlistat. Ovulation rate was 33.3%, 23.35% with orlistat and metformin group respectively, but were not statistically significant. In orlistat group, significant improvement was observed in lipid profile at the end of 3 months. Conception rates were 40% and 16.7% and 3.3% in orlistat, metformin group and control group respectively (P - 0.003). Weight loss was found to be the best predictor of ovulation with sensitivity with good sensitivity. Conclusion: Orlistat is as effective as metformin in reducing weight and achieves similar ovulation rates in obese PCOS patients. However, orlistat has minimal side-effects and is better tolerated compared with metformin.
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Gonadotrophins: The future
Madhuri Patil
October-December 2014, 7(4):236-248
DOI:10.4103/0974-1208.147490  PMID:25624659
The role of the IVF clinician is to make the ART treatment safe, patient-friendly, cost effective and at the same time offer good and high quality treatment. IVF protocols are a burden for women and are one of the potential reasons why women don't return for subsequent cycles. Frequent injections may increase stress and also result in high error rates. Simple short treatment regimen with optimal recovery of good quality oocytes results in development of good quality embryos followed by SET in treatment and cryopreservation cycles are a less burden and result in related lesser discontinuation, side effects, treatment cycles in time and are more cost-effective. Development of FSH analogues with longer terminal t1/2 and slower absorption to peak serum levels will increase the efficiency, decrease the side effects and also is easy to administer. This makes it convenient for the patients increasing the compliance. A certain minimum LH concentration is necessary for adequate thecal cell function and subsequent oestradiol synthesis in the granulosa cells. Adjuvant r-HLH gives clinician's precise control over the dose of LH bioactivity administered to target the therapeutic window. New parenteral, transdermal, inhaled and oral fertility drugs and regimens are currently under research and development with the objective to further simplify treatment for ART.
  3,472 346 1
Survey of reasons for discontinuation from in vitro fertilization treatment among couples attending infertility clinic
Grishma Kulkarni, Nimain C Mohanty, Ipseeta Ray Mohanty, Pradeep Jadhav, BG Boricha
October-December 2014, 7(4):249-254
DOI:10.4103/0974-1208.147491  PMID:25624660
Background: With the increase in infertility burden, more and more couples are opting for in vitro fertilization (IVF). Despite the availability of various treatment options, the major concern that needs to be addressed is the reasons why such couples, initially motivated so strongly, drop out in fairly high numbers from IVF cycles. With this point of view the study was designed. AIM: The objective of this study was to explore the reasons why couples discontinue fertility treatment. Settings and Design: This retrospective study was carried out among couples in the age group of 20-40 years who opted for IVF at Tertiary care hospital and a private infertility center. Materials and Methods: Medical records for 3 years (2009-2012) were taken out and included in the study for analysis. Socio-demographic details along with indication for IVF and reasons for drop-separate IVF therapy were recorded on case record form and were analyzed. Results: Twenty-one percent of the patients had tubal pathology, thus making it the commonest female related factor for indication of IVF. Oligoasthenospermia (13%) was the commonest cause of male related infertility factor. Financial burden was the primary cause for terminating treatment in majority of the IVF cases. Conclusions: Financial burden (62.5%) was the commonest reason for drop out among couples from IVF cycle.
  3,306 147 4
Successful pregnancy outcome in an untreated case of concomitant transverse complete vaginal septum with unicornuate uterus
Naina Kumar, Surekha Tayade
October-December 2014, 7(4):276-278
DOI:10.4103/0974-1208.147497  PMID:25624665
Transverse vaginal septum is a result of faulty canalization of embryonic vagina. Septum may be complete but usually has laterally placed tiny hole giving an impression of vaginal vault without cervix. We described a case of untreated transverse vaginal septum with small central aperture diagnosed during labor and unicornuate uterus diagnosed intraoperatively, with successful pregnancy outcome.
  3,207 88 -
Custom fabricated acrylic vaginal stent as an adjunct to surgical creation of neovagina for a young female with isolated vaginal agenesis
Manu Rathee, Priyanka Boora, Renu Kundu
October-December 2014, 7(4):272-275
DOI:10.4103/0974-1208.147496  PMID:25624664
Vaginal agenesis is one of the major congenital anomalies of the female genital tract. It may present either as an isolated developmental defect or within a complex of more extensive anomalies. Most commonly it is associated with Mayer-Rokitansky-Kόster-Hauser (MRKH) syndrome. The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. After reconstruction of space for vagina surgically, a long-term vaginal stent use is required to maintain vaginal width and depth and to prevent contraction. In this article is presented a case of nonsyndromic agenesis of vagina in a 14-year-old girl and its surgical management using custom fabricated acrylic vaginal stent.
  3,178 111 4
Primary umbilical endometriosis: A rarity
Sumit Ranjan Pramanik, Saumen Mondal, Sayanti Paul, D Joycerani
October-December 2014, 7(4):269-271
DOI:10.4103/0974-1208.147495  PMID:25624663
Endometriosis is a functional endometrial tissue found outside the normal uterine cavity. Primary umbilical endometriosis is defined as the presence of ectopic endometrial glands and stroma within umbilicus, without prior history of pelvic endometriosis. It is a rare presentation in all cases of endometriosis, especially in Asians. Here, a case of primary umbilical endometriosis has been reported in a 33-year-old nulliparous female who presented with the history of cyclical bleeding and pain in an umbilical mass during menstrual cycle. Athough the disease is rare, umbilical endometriosis should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. The disease pathogenesis, its symptoms, and treatment modality have been discussed.
  3,116 121 1
Double and multiple chromosomal aneuploidies in spontaneous abortions: A single institutional experience
Shivakumar Subramaniyam, Venkat R Pulijaal, Susan Mathew
October-December 2014, 7(4):262-268
DOI:10.4103/0974-1208.147494  PMID:25624662
Objective: To characterize double and multiple aneuploidies in spontaneous abortions (SAB). Materials and Methods: Retrospective analysis of cytogenetics data obtained by culturing/harvesting products of the conception material at our center from 2006 to 2009 was performed. The abnormal cytogenetic results, maternal age, gestational age, and previous pregnancy history were recorded and compared. Results: Double and multiple aneuploidies are rare, however, a high percentage of double (4.6%) and multiple (0.4%) chromosomal aneuploidies were observed in our study of 1502 cases of SAB. Of 1502 cases of SAB evaluated, 70 cases (4.6%) showed double aneuploidy, whereas 6 cases (0.4%) had multiple aneuploidies. The chromosomes most frequently involved in double aneuploidy in the decreasing order were 21, 16, ± X, 22, 18, 13, and 15. The most frequent chromosome combinations observed were: Loss of X/21 (8.5%), 21/22 (4.4%), 16/21 (4.4%), and 7/16 (4.4%). The chromosome combinations in multiple aneuploidy included trisomy of chromosomes X/5/8, 8/20/22, 16/20/22, 14/21/22, and loss of X with 21/21 and 7/21. These abnormalities were significantly observed in women between the age group 40-44 years (59.2%). A high success rate (94%) of obtaining metaphase cells was observed in this study mainly due to the use of direct and long-term cultures. Conclusions: We observed a high percentage of double (4.6%) and multiple (0.4%) aneuploidies, frequently involving the acrocentic chromosomes 13, 15, 21, and 22 and nonacrocentric chromosomes X, 16, and 18.
  2,807 136 10
From the Editor's desk
Madhuri Patil
October-December 2014, 7(4):229-229
DOI:10.4103/0974-1208.147488  PMID:25624657
  2,122 158 -
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