Search

Better diagnostic and treatment modalities for malignancies occurring in childhood and young age have increased the overall survival of the affected young girls and boys, but this has come at a cost of developing premature ovarian failure in girls and azoospermia in boys because of the gonadotoxicity of chemotherapy and radiotherapy. Thus, young girls and women of reproductive age who are at risk of ovarian failure due to cancer treatment must be mandatorily offered fertility preservation in any form such as cryopreservation of mature metaphase II oocytes after ovarian stimulation with gonadotropins and oocyte recovery and cryopreservation of embryos if the young female has a partner. However, these modalities may require the postponement of chemotherapy. Thus, in such instances, cryopreservation of ovarian tissue remains the only option. Herein, we report a case of a nulligravid young female patient who had stage IV Hodgkin's lymphoma and had to be taken up for immediate fertility preservation owing to the advanced stage of the disease. Therefore, cryopreservation of ovarian tissue was performed. The uniqueness of the case is that after remission of the disease was achieved with chemotherapy, transplantation of the ovarian tissue was carried out which was not successful, but the desire for motherhood prompted to carry out an ovulation induction in the remnant native ovary with a severely compromised ovarian reserve, and she conceived. [ABSTRACT FROM AUTHOR]

Background Cryopreservation of spermatozoa is a widely used technique to preserve the fertility of males. It can also benefit the armed forces personnel who are to be sent for long recruitments, while leaving their families behind. This study, apart from studying the effects of freezing and thawing, reveals the effect of the post thaw interval on the motility of the human spermatozoa and thus widens the insemination window period. Methods A detailed semen analysis was carried out as per the WHO guidelines for 25 samples. The samples were then washed, analysed and frozen in liquid nitrogen. The semen samples were subsequently thawed and similarly analysed after 20 min and 40 min of thawing. This was then followed by statistical analysis of the comparative motilities. Results Motility of sperms is found to decrease after cryopreservation. However, the study revealed that after thawing a significant increase in the motility of the sperms was noted with the progression of time ( p < 0.05). Conclusion By simulating conditions similar to the in vivo conditions for the post thaw semen samples, we can safely wait, confirm the parameters like motility and count, and then inseminate the samples instead of blindly inseminating them immediately after thawing. [ABSTRACT FROM AUTHOR]

Abstract: Ovarian Hyperstimulation Syndrome (OHSS) an iatrogenic and potentially life-threatening complication resulting from an exaggerated response to ovulation induction with gonadotropins during assisted reproductive technologies, is a self-limiting disorder with a broad spectrum of clinical manifestations related to increased capillary permeability and fluid retention brought about by many biochemical mediators especially vascular endothelium growth factor (VEGF), playing a pivotal role in its pathophysiology. Although various strategies had been proposed and tried to prevent this serious complication none was found to be completely effective. With the current knowledge and understanding of the causative molecule i.e. VEGF in the pathogenesis of OHSS, pharmacologic tools targeting this member of the family of heparin binding proteins, seems promising. Antagonizing and blocking VEGF action by dopamine agonists especially Cabergoline has shown to be a valid alternative to overcome the changes induced by the gonadotropins. Delaying embryo transfer with embryo cryopreservation definitely reduces the incidence of OHSS but not the early OHSS. In-vitro maturation of oocytes a major breakthrough in the field of ART although totally eliminates the risk of OHSS is highly labor intensive and cannot routinely carried in all cycles. Thus the newer drugs, mainly the dopamine agonists in the light of the new pathogenic and pharmacological evidence, should definitely be considered for prevention of both early and late OHSS. [Copyright &y& Elsevier]

Abstract: Background: Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is a common and cost-effective alternative to surgery. Early diagnosis and timely institution of methotrexate has resulted in a dramatic decline in the morbidity, mortality and financial burden associated with ectopic pregnancy. The objective of our study was to evaluate the efficacy of medical management in a series of patients with unruptured ectopic pregnancy meeting the strict inclusion criteria. Methods: Multiple dose methotrexate regimen was utilized for the management of the cases. Parenteral methotrexate 1 mg/kg was administered on Day 1, Day 3, Day 5 and Day 7 whereas rescue dose of injection leucovorin 0.1 mg/kg was given on Day 2, Day 4, Day 6 and Day 8. Monitoring for the resolution of the ectopic was carried out with β-hCG, done on Day 1, Day 3, Day 5, and Day 7. Any value showing a decline of >15% of the baseline value led to the termination of treatment and only surveillance was carried out. If the decrease was <15%, treatment was continued. Results: Total 43 patients with ectopic pregnancy were diagnosed over a period of 1 year, conceived during infertility evaluation and treatment. 11 cases went directly for surgery whereas 32 were subjected to medical treatment. 75% of the patients got successfully treated and rest 25% required surgery following failed medical management. Conclusions: Methotrexate therapy is a safe and effective alternative for the management of unruptured ectopic pregnancies with minimal or no side-effects and associated advantage of avoiding invasive surgery. [Copyright &y& Elsevier]

Abstract: Background: Although every step in the in vitro fertilisation (IVF) procedure is important, the impact of embryo transfer (ET) on pregnancy rate (PR) is significant. Of all the crucial aspects of ET the type of catheter used and the technique of transfer on the PR has drawn the maximum attention and controversy. We aimed to compare the outcome of two different ET catheters on the PR. Method: A prospective analysis comparing the classical Frydman (Laboratoire CCD, France) and the soft Cook (Cook Medical, Indiana, USA) ET catheters was performed. Primary end-point was clinical pregnancy rate (CPR); secondary end-points were rates of difficult transfer. A total of 1,446 ETs were performed in women undergoing IVF treatment, of which 723 cycles were randomised to the Cook catheter and 723 to the Frydman catheter. Results: It was observed that, although the Cook catheter was related to a slightly higher PR, the overall comparison failed to indicate a significant difference in CPR. It was also seen that the ease of transfer did not significantly affect the PRs. Conclusion: Individual variables during ET may not contribute significantly to the success of an IVF programme; however, a holistic approach encompassing all the factors is quintessential to improve the PR. [Copyright &y& Elsevier]

Abstract: Background: The transvaginal ultrasound-guided embryo reduction technique is a feasible option for the prevention and management of the medical and obstetric risks associated with high-order multiple pregnancy resulting from assisted reproductive treatment. Method: Multifoetal pregnancy reduction was carried out in 51 in vitro fertilisation pregnancies (IVF) and one intrauterine quintuplet pregnancy resulting from intrauterine insemination (IUI) using transvaginal approach under ultrasonographic guidance. Results: Of the 52 embryo reduction procedures, 48 (92%) were performed between the seventh and eighth weeks of gestation, three between eighth and ninth weeks and one in the 10th week of gestation. Forty-nine patients (94%) underwent reduction from triplets to twins, two from quadruplet to twins, and one from quintuplet to twin pregnancy. The average time required for the embryo reduction was 5.0±0.5 minutes per sac in early gestation (6th-9th weeks), increasing to 8.5 minutes per sac for later procedures, due to technical difficulties brought about by increased embryo size and mobility. All embryo reduction procedures were successfully performed in a single session. Conclusion: Transvaginal ultrasound guided embryo reduction technique performed between seventh and eighth-weeks of gestation is an effective and safe procedure for embryo reduction. [Copyright &y& Elsevier]