Background: Polycystic ovary syndrome (PCOS) is known to be associated with insulin resistance and anti-Mullerian hormone (AMH), leading to the use of insulin-sensitizing agents (ISAs) to manage PCOS. Metformin is the most widely used ISA to treat irregular menstruation; however, the gastrointestinal side effects are quite debilitating. The development of herbal medicines such as bioactive fraction DLBS3233 offers a possibly effective treatment with minimal side effects. Aim: To determine the effect of metformin and DLBS3233 on serum AMH level. Materials and Methods: This study was a double-blind, randomized, controlled trial conducted between March 2013 and June 2015 at Yasmin Clinic, RSCM Kencana, Jakarta and Hasan Sadikin Hospital, Bandung. The patients with PCOS were diagnosed using the Rotterdam criteria. All participants received daily treatment consisting of 1500 mg metformin divided into two doses or 100 mg DLBS3233 for 6 months. An evaluation of serum AMH level was conducted before and after the completion of therapy. Results: Twenty patients received metformin, whereas 18 patients received DLBS3233. The levels of AMH prior to the intervention were 9.30 ± 5.06 ng/mL and 11.27 ± 6.47 ng/mL. After 6 months of therapy, we found that the decrease in AMH level was higher in the metformin group compared to the DLBS3233 group (ΔAMH = 1.83 ng/mL, P = 0.003 and ΔAMH = 1.15 ng/mL, P = 0.077, respectively). However, more side effects were observed in the metformin group compared to the DLBS3233 group (P = 0.01). A total of seven patients (18.42%) were confirmed as pregnant during the study. Conclusion: There was a significant decrease in the serum AMH level after administration of either metformin or DLBS3233.

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Background: Although anti-mullerian hormone (AMH) level is known to predict ovarian reserve, there is conflicting evidence regarding the association between AMH and clinical pregnancy or live birth (LB). Aim: Our aim is to establish if there is any association between AMH and LB considering the effects of age and other relevant confounding factors in predicting LB. Settings and Design: 200 in-vitro fertilisation (IVF) cycles were retrospectively analysed in a tertiary fertility centre. Materials and Methods: From the database, data regarding the women’s age, AMH level, IVF/intracytoplasmic sperm injection, the factors of infertility, protocols, median AMH level and live birth rates (LBRs) were compared between the groups with and without LB in four age groups. The influences of age and AMH in predicting LB were analysed. Statistical analysis was performed using the Statistical Package for the Social Sciences version 21 software (SPSS Inc., Chicago, IL, United States). Results and Conclusion: There were no significant differences in any of the confounding factors analysed between the groups with and without LB. In the higher two age groups, median AMH levels in the group with LB were higher than that in the group without LB. The odds of having a LB was significantly higher in the younger three age groups, and when AMH level was >20 pmol/l. AMH was not found to be the IVF outcome defining factor in younger women, but was relevant in those above 35 years. Older women with significantly higher AMH level had significantly higher LBR than their peers with low AMH level. Thus AMH does have a role in counselling women when predicting live birth from IVF, although age of women plays a major role in determining success from IVF treatment.

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Publishing original research in a peer-reviewed and indexed journal is an important milestone for a scientist or a clinician. It is an important parameter to assess academic achievements. However, technical and language barriers may prevent many enthusiasts from ever publishing. This review highlights the important preparatory steps for creating a good manuscript and the most widely used IMRaD (Introduction, Materials and Methods, Results, and Discussion) method for writing a good manuscript. It also provides a brief overview of the submission and review process of a manuscript for publishing in a biomedical journal.

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Aim: The aim of this study was to investigate the relationship between the morphology, euploidy and implantation rate of cleavage stage and blastocyst stage embryos. Setting: Institution-based, tertiary care in-vitro fertilization centre. Study Design: This study included a retrospective data analysis of 306 embryos: 154 cleavage stage embryos and 152 blastocysts that underwent biopsy on day 3 and day 5/6, respectively, which were subsequently screened for aneuploidy by array comparative genomic hybridization analysis. Materials and Methods: Both cleavage stage and blastocyst stage embryos were categorized according to their morphology into the following three groups: good, average and poor. In addition, blastocysts were categorized into day 5 and day 6 embryos on the basis of their developmental rate. Results: The euploidy rate was found to be significantly higher for blastocysts with good morphology as compared to those with poor morphology, with 73.2, 50 and 40.5% euploid embryos in the good, average and poor morphology groups, respectively (P = 0.001). No significant association was found between day 3 embryo morphology and euploidy rates with 40.6, 29.3 and 25.8% euploid embryos in the three groups, respectively (P = 0.254). The implantation rates, as per morphology, for the transferred euploid cleavage stage and blastocyst stage embryos were 43.8, 37.5 and 0% (P = 0.354) and 51.7, 71.4 and 66.7% (P = 0.562) in the good, average and poor morphology groups, respectively. The euploidy rate for day 5 blastocysts was significantly higher (70% vs. 34.1%, P < 0.001) than that of day 6 blastocysts, but the implantation rate was similar in both the groups (58.8 and 50%, respectively). The miscarriage rates for the euploid cleavage stage and the blastocysts stage embryos were 18.2 and 8.3% (P = 0.575), respectively. Conclusion: Blastocyst morphology and the rate of development were found to be significantly associated with euploidy, whereas cleavage stage morphology was not. The implantation rates of the good quality, euploid cleavage stage embryos were higher than that of the poor quality embryos. The implantation rates were similar for all transferred euploid blastocysts, irrespective of their morphology or the rate of development.

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Background: Obesity, a known epidemic, is a leading cause of various reproductive disorders. Association of body mass index (BMI) with pregnancy outcomes, either ovarian or endometrial, is controversial and least elucidated. Aim: This study aimed to analyze the effect of BMI on in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome in women using self-oocytes, embryos prepared from donor oocytes (DE), or vitrified/frozen embryos (VE) obtained from both the SE and DE groups. Materials and Methods: A 9-month retrospective study was conducted on women undergoing IVF/ICSI. The women were grouped according to the World Health Organization classification of BMI (<18.50, 18.50–24.99, 25.00–29.99, and ≥30.00 kg/m²). They were further subcategorized as SE, DE, and VE groups. Ongoing pregnancy rate (OPR) was recorded as primary, whereas pregnancy rate (PR), clinical PR (CPR), implantation rate (IR), and clinical abortion rate (CAR) were secondary endpoints. Age, number of mature eggs, usable embryos, and embryos transferred were also measured. The data were statistically analyzed using chi-square and analysis of variance. P-value <0.05 was considered statistically significant. Results: OPR was statistically insignificant across all the groups. Secondary outcomes were statistically insignificant in all the groups except in VE, where IR (P = 0.008) and CAR (P = 0.0002) were statically significant. Other parameters were statistically insignificant among all the groups. However, in the SE and VE groups, the mean age was statistically significant (SE, P = 0.0001; VE, P = 0.0191). Conclusion: This study showed marginal/no effect of BMI on oocyte quality/endometrial receptivity and, subsequently, on the pregnancy outcome. However, well-designed, larger prospective studies are needed to clarify the role of BMI in pregnancy outcome in women undergoing IVF/ICSI.

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Primary amenorrhea is a common diagnostic challenge in the gynecology department, wherein there are numerous causes that need to be approached in a systematic manner. However, when a case with a pelvic lump or a solid pelvic mass presents to a gynecologist or a radiologist, the approach becomes difficult to justify amenorrhea and pelvic mass as a single entity. We present the case of a 36-year-old female with the complaints of primary amenorrhea with a pelvic mass. The case was approached keeping in view the diagnostic possibilities and applying the role of clinical, radiological, and laboratory analyses. The final diagnosis of Swyer syndrome with gonadoblastoma was made, and she was further subjected to operative resection and hormonal therapy. This study stresses on the approach to a case, wherein the diagnosis was based only on the clinician’s acumen and the radiologist’s expertise, providing a way to simplify the protocol in the evaluation of such types of cases.

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We report a case of ureteric injury during transvaginal oocyte retrieval (TVOR), which was identified immediately (on the operation table) and managed successfully in the same sitting. A 28-year-old woman with primary infertility underwent in-vitro fertilisation (IVF) in a private centre. Because of the policy of doing an ultrasonography post-procedure, she was diagnosed immediately with vaginal vault haematoma and ureteric injury. A double-J catheter was inserted under cystoscopic guidance. A major complication was averted by the timely diagnosis of ureteric injury and its appropriate management. To conclude, given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureteric injury. Early diagnosis of complications (by knowing and anticipating potential risks of procedure) leads to efficient management by timely intervention.

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Background: There is significant evidence among the general population regarding the impact of physical activity in improving the quality of life; however, evidence regarding the effect of physical activity in improving fertility and the quality of life in infertile women is inadequate. Existing medical literature shows that moderately regular physical activity positively influences ovarian reserve and assisted reproductive technology (ART) outcomes in overweight and obese women. It is not known whether moderate physical activity influences ovarian reserve in normal weight reproductive age women, and whether age has any influence on the physical activity related changes in ovarian reserve. Objectives: The objectives of the study were (1) to study the impact of moderate physical activity on ovarian reserve markers in normal weight reproductive age women and (2) to understand whether age influences the effect of physical activity on ovarian reserve markers in reproductive age women. Methods: This observational, cross-sectional study included 162 married women in the age group of 19–42 years, who were evaluated for ovarian reserve markers antimullerian hormone (AMH), follicular stimulating hormone (FSH), and antral follicle count (AFC) on the days 3–6 of the menstrual cycle. The study participants were divided into two age groups (above and below 30 years) and physically active and inactive groups. Ovarian reserve markers were compared among both the age groups and the physically active and inactive participants by analysis of variance. Results: When the study participants in both the age groups were compared for the effect of moderate exercise on ovarian reserve profile, better ovarian reserve profile was observed in the physically active participants in both the age groups. Significant differences were not seen with respect to FSH level (P = 0.371) and AFC (P = 0.483) in both the age groups, but significant difference was observed with respect to AMH level in the below 30 years age group compared to the above 30 years age group (P ≤ 0.001). Conclusion: This study demonstrated that moderate physical activity is associated with improved age-specific levels of ovarian reserve markers.

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A 31-year-old woman presented with secondary amenorrhoea and inability to conceive, which was of 3 years duration. She had Raynaud’s phenomenon for 16 years, primary hypothyroidism for 5 years, digital ulcers for 4 years and skin tightening for 2 years. She had an expressionless face, with loss of wrinkles and restriction of the mouth opening along with flexion contractures of the hands and the terminal digit resorptions. Investigations showed Antinuclear antibodies (ANA) and anti-Scl 70 positivity confirming the presence of systemic sclerosis (SSc). The Follicle Stimulating Hormone (FSH) level was elevated, the ovarian follicles were absent, and the endometrial thickness was reduced confirming premature ovarian failure (POF). POF causing infertility and secondary amenorrhoea in SSc is an unusual manifestation; moreover, POF occured without the involvement of other internal organs.

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Aim: To evaluate the role of uterine natural killer (uNK) CD56^dim and CD16⁺ cells in patients with refractory antiphospholipid, antibody-mediated, recurrent, pregnancy loss. Settings and Design: A case–control study was conducted between 2012 and 2015 at a university hospital. Patients and Methods: A group of 118 women with a history of antiphospholipid antibody syndrome experiencing fetal loss in spite of low dose aspirin (LDA) and low molecular weight heparin (LMWH) treatment in the current pregnancy were included in this study. A group of 32 patients undergoing an elective termination of viable pregnancies before 20 weeks were taken as controls. Suction evacuation was performed to collect abortus specimens, and uterine wall curettage was performed to collect decidua specimens, which were then stained using monoclonal antibodies specific to CD56 and CD16. Statistics: Statistical analyses were performed using the Statistical Package for the Social Sciences version 18 software. Chi-square and Fisher exact tests were used for making comparison between the groups. Results: Abnormal fetal karyotype was found in nine (9/97) cases of the study group, which means that abnormal karyotype accounts for only 9.3% of the causes of failure of treatment. Abnormal karyotype was found in four cases of the control group. Only cases with normal karyotyping were subjected to decidual uNK cells analysis. We found that CD56^dim and CD16⁺ were found in the decidua of 79 cases (79/97), which means that aberrant natural killer cells expression might account for 81.4% of the cases of refractory antiphospholipid antibody (APA)-mediated recurrent pregnancy loss. Conclusion: CD56^dim and CD16⁺uNK cells might be correlated with refractory APA-mediated recurrent pregnancy loss.

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Context: Antiphospholipid antibodies (aPL) are related with a high risk of pregnancy morbidity (PM) and also of vascular thrombosis. On the basis of recent studies, we expect that in women with PM associated with antiphospholipid syndrome (APS), further factors may be deregulated and involved in pathophysiology of the disease. Such factors may have the potential to become novel biomarkers for APS and its stages. Settings and Design: Descriptive study from a recurrent pregnancy loss program. Aims: To study the protein expression in sera from women with PM with or without aPL. Materials and Methods: Protein profiles were determined by surface enhanced laser desorption and ionization − time of flight mass spectrometry (SELDI-TOF MS) in the serum samples from women with PM, 10 of them with aPL and 12 without aPL. On the basis of the mass-to-charge ratio (m/z) of the protein, signals differentially expressed between the two groups were compared with data banks to approach candidate proteins. Statistical Analysis Used: To determine the differential expression of each protein, a no paired t-test was performed using Ciphergen Express Client 3.1 software. Results: SELDI-TOF analysis makes it possible to discriminate between several proteins in women with PM with and without aPL, although it does not allow protein identification. Nine proteins were found in significantly higher levels in aPL-positive women. Conclusion: The results underline that further factors beyond autoantibodies are involved in PM associated with APS and might lead to the development of new biomarkers.

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