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Sperm quality plays an important role in determining embryo development and intracytoplasmic sperm injection (ICSI) outcome. Selection of competent sperm based on its ability to bind to hyaluronic acid (HA) has been suggested as one of the methods to assess sperm quality. The aim of the present study was to examine whether injection of HA bound sperm helps in improving outcome in patients undergoing ICSI with unexplained infertility having normal semen parameters.Patients with unexplained infertility having normal semen parameters in accordance with WHO 2010 criterion, undergoing their first IVF-ICSI cycle were enrolled during the course of the study.156 patients were prospectively randomized after oocyte retrieval and were assigned to either the ICSI group, where sperm selection for injection was based on visual assessment, or the PICSI group, where sperm were selected based on their ability to bind to HA. Only fresh embryo transfers were included in the analysis.There was no difference in the fertilization rates, number of top quality embryos and clinical pregnancy rates between the ICSI and PICSI groups (65.7 % vs 64.7 %; 45.8 % vs 43.6 % and 35 % vs 35.2 % respectively). However, a higher pregnancy loss rate was observed in the ICSI group (25 % vs 12 %; P = 0.227) as compared to the PICSI group, but the difference was not statistically significant. Implantation rates were 22.03 % and 18.84 % in the PICSI and ICSI groups respectively. There were 22 (31 %) live births in the PICSI group and 21(26.3 %) live births in the ICSI group.Patients with unexplained infertility having normal semen parameters may constitute a patient group which does not benefit from this sperm selection method. A larger study may be necessary to establish a relationship between PICSI and pregnancy loss rate in patients undergoing IVF with unexplained infertility.

Follicular oocytes were retrieved from goat ovaries, collected from a local slaughter house. These oocytes were cultured in TCM-199 with 20% heat inactivated goat estrous serum for 6, 12, 18, 24, 30, 31, 32 and 36 h at 39 °C; 5% CO 2 in air and 95% humidity. A total of 1465 good cumulus-enclosed oocytes were matured and fixed at different time intervals to establish the chronology of meiotic events occurring in goat oocytes during in vitro maturation. Results revealed that at 0 h, 78.3% of oocytes were in the GV stage. A total of 57.4% of the oocytes were found in diakinesis stage at 6 h culture. Peak (51.1%) metaphase-I (M-I) was noted at 12 h. M-II was first observed after 18 h of culture, but at 32 h the maximum (71.6%) oocytes were in M-II stage. The percentage of oocytes reaching M-II was comparatively less at 30, 31 and 36 h (50.3, 55.8 and 59.7%), thus indicating that 32 h of culture is the most suitable time for goat oocyte maturation in vitro.

Objectives: To evaluate the potential benefit, in terms of pain relief, of the paracervical block with 2% lignocaine in women undergoing hysterosalpingography (HSG). Study Design: This study was a prospective randomized controlled study. Settings: This study was conducted in infertility clinic of a tertiary care center. Materials and Methods: Four hundred and six patients undergoing HSG as a part of infertility evaluation were included in the study. These women were randomized into two groups: Group I received paracervical block with 2% lignocaine at the time of HSG (n = 53) and Group II (n = 53) served as control. Hyoscine (10 mg) oral tablet was given to all the patients 30 min before the procedure. Pain perception during the procedure was analyzed by the patient between 0 and 10 on a numeric rating scale, immediately after HSG. Results: The baseline demographic characteristics of participants in two groups were similar. Mean pain score immediately after HSG in the study group and control group was 4.84 ± 2.56 and 5.21 ± 1.89, respectively (P = 0.21). Conclusions : There is no benefit of paracervical block with 2% lignocaine, in terms of pain relief, in women undergoing HSG.

Congenital bilateral absence of vas deferens (CBAVD) is a form of male infertility in which mutations occur in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The molecular basis of CBAVD is not completely understood, especially in developing countries.We characterized the mutations/variants in the CFTR gene by single strand conformation polymorphism followed by sequencing in 35 CBAVD patients. None of the patients had systemic manifestations of cystic fibrosis. Fifty normal subjects were studied as controls.Mutations/variants in the CFTR gene were found in all CBAVD patients. Five mutations and 10 variants were detected in 35 patients. The most frequent severe mutation was F508del (34.2%) and the most common variant was IVS8-5T (54.2%). Two novel severe mutations (p.E217Gfs*11 and p.A1285V) and four novel variants (pT438A, c.4095+30insCT, c.-737GA, and c.2909-92AG) were detected.The protocol for identification of mutations in cases of CBAVD in developing countries would have to include a different set of mutations than those reported from western countries.

Window happens to be the most critical and vulnerable component in high-power gyrotrons. For the first Indian gyrotron window, a face cooled double sapphire disc structure has been decided for delivering 200 kW power at 42 GHz. Development of sapphire machining and techniques for its UHV grade joining to metals are the major achievements so far. Optimisation of electrical and thermal parameters is in progress.

The initial cycles following menarche are often anovulatory due to delay in positive feedback mechanism of the hypothalamus–pituitary–ovarian axis. The consequent estrogen secretion in such situation results in endometrial proliferation with unstable growth and incomplete shedding which presents as menorrhagia [1, 2]. Amongst the causes of adolescent menorrhagia, dysfunctional uterine bleeding accounts for the vast majority [3]. Having ruled out anovulation and any pregnant status, excessive bleeding during adolescence should raise the doubt of coagulopathy since this accounts for the other large subgroup especially in abnormal uterine bleeding at menarche [4, 5]. The bleeding secondary to blood dyscrasias is usually a heavy flow with regular, cyclic menses [6]. Anovulation and coagulopathy therefore constitute the majority of cases of adolescent menorrhagia (93–95 %). Thyroid under or over activity, severe renal or hepatic disorders can also present with menorrhagia. The remaining 5–7 % of cases are due to local causes and include lesions, tumors, infections, foreign bodies and lacerations of the vulva, vagina and cervix [7]. Sexually transmitted diseases should also be borne in mind. Neoplastic causes are highly unlikely in this age group. Though always a dilemma in adolescents a pelvic examination may be life-saving if diagnosis is unclear. The importance of doing a thorough local examination in spite of absent history of sexual activity is highlighted by the following case.

Uterine leiomyomas are by far the most common benign uterine tumours present in almost 25 % women of reproductive age. However fibroids are an infrequent cause of infertility being the sole cause in less than 3 % of infertile couples [1]. Uterine fibroids especially submucous leiomyomas may be associated with infertility as well as with subfertilty and pregnancy losses. Some researchers have speculated that the location of fibroids within the endometrial cavity may interfere with sperm transport and/or implantation [2]. One study has calculated a 10 % rate of pregnancy complications in women with fibroids [3]. Though being an infrequent cause of infertility and pregnancy complications, it is still extremely rare to have a pregnancy, that too uneventful in patients with extreme distortion of uterine cavity due to multiple intramural and submucosal fibroids. We would like to report such a case. Patient first presented in 1998 at 28 years of age with secondary infertility and failure to conceive for 1 year. She was married for 4 years and had undergone medical termination of pregnancy 2 years earlier. On investigations, she had regular ovulatory cycles; hysterosalpingogram confirmed bilateral tubal patency and the semen parameters were normal. Pelvic ultrasound showed a uterus with numerous intramural and submucous fibroids of variable size, the largest being 3 × 3 cm. There were no other factors contributing to infertility. She was subjected to six-cycles of COH with IUI, using Clomiphene for 3 cycles urinary gonadotrophins for other 3 cycles. These were unsuccessful. Pelvic ultrasound revealed increasing size and number of myomas. In view of above finding and inability to conceive, she was taken up for operative laparoscopic and hysteroscopic resection of myomas, wherein eight submucosal myomas were resected, the largest on the right lateral wall measuring 3 × 3 × 3 cm. Diagnostic laparoscopy revealed multiple subserous and intramural myomas on the posterior wall and right cornua. Both the tubes were patent. Three more cycles of controlled ovarian hyperstimulation with intrauterine insemination were attempted to no avail. Pelvic ultrasound again revealed a number of submucous myomas. Two injections of depot GnRh-agonist were administered at four weekly intervals and hysteroscopic loop resection of fourteen submucous myomas was done (Fig. 1). Due to suboptimal preovulatory endometrium, IVF was delayed till endometrium was 7 mm and carried out 8 months later. However, at the time of embryo transfer the endometrium was only 5.4 mm triple layered. She failed to conceive and discontinued any further management. She next came to us 10 months later at 35 years of age with a naturally conceived pregnancy. Despite our apprehensions and USG again confirming an extremely unhealthy milieu interior for the conceptus she continued her pregnancy uneventfully except for mild PIH. She was taken up for an elective LSCS at 37 weeks of gestation and a live female baby was delivered. The placenta was however partially adherent and removed piecemeal because the entire uterine cavity was riddled with fibroids from 0.3 to 4 cm in size, a few of which presented themselves in the surgeon’s hands. This case brings a ray of hope to those managing seemingly hopeless cases of leiomyomas. Fig. 1 View of submucous myomas at time of second hysteroscopic resection S submucous myoma, U uterine cavity

The aim of the present study was to compare the two oocyte maturation systems, i.e. a granulosa cell (GC) monolayer from small (4mm) or large (4mm) follicles and a granulosa co-culture for their effects on in vitro maturation (IVM), fertilization and developmental competence of caprine oocytes. A total of 1945 oocytes were used for studies on maturation, fertilization and embryo development. Monolayers were primed with maturation medium, 18-24h before the onset of maturation. Nuclear studies of 263 fertilized oocytes, 18h post-fertilization, revealed that the rate of sperm penetration was not affected by any of the maturation culture systems. Penetration rate was 66.30% versus 69.59% for the control and GC monolayers. On the other hand, progression of fertilization, i.e. sperm head decondensation (32.70% versus 9.78%) and pronucleus formation (8.76% versus 2.17%) were significantly (P0.05) enhanced in the oocytes matured over GC monolayers, compared to those with GC co-culture respectively. Cleavage rate was significantly (P0.05) higher in the oocytes matured and cultured over GC monolayers (27.59%) compared to those in oocytes matured and cultured with the GC co-culture (19.28%). Proportionately more embryos derived from oocytes matured and cultured with the GC co-culture blocked (16.53 and 25.92%) at early developmental stages (2-cell and 4-cell, respectively), compared to those derived from oocytes matured and cultured over GC monolayers (7.61% versus 10.56%; 2-cell versus 4-cell). It was concluded that GC monolayers better support cytoplasmic maturation of growing caprine oocytes, which is evident by a better maturation rate, active fertilization, an improved cleavage rate and subsequently a higher rate of morula formation. Granulosa cells from small and large follicles can be used for IVM and IVC with approximately the same efficiency after conditioning them with maturation medium and embryo development medium 18-24h before the onset of culture.

A rare case of severe menorrhagia in a young girl with polycystic ovarian syndrome (PCOS) is presented. On thorough investigations (blood tests and ultrasound) nothing substantial came up, hence ultimately pelvic examination under anesthesia was undertaken, which uncovered a cervical polyp 2.5 × 2.5 × 1.5 cm size, with a intracervical broad base, presenting at the external os but not protruding into the vagina. The growth was electrocauterized at its base, resected and a thorough curettage was done. Histopathology revealed a myomatous polyp and secretory endometrium. Though always a dilemma, in adolescent menorrhagia, a pelvic examination may be lifesaving in certain cases, if diagnosis is unclear. The importance of doing a thorough local examination in spite of absent history of sexual activity is highlighted by the following case.

A case of post-in-vitro fertilization (IVF) cervical and intrauterine heterotropic pregnancy with cardiac activity in both embryos is presented. It was diagnosed in the 7(th) week of gestation by ultrasonography and cervical pregnancy was treated conservatively with intrathoracic administration of potassium chloride under transvaginal ultrasound guidance with regression of trophoblastic tissue. The intrauterine pregnancy continued and cesarean section was performed in the 31(st) week due to absent end diastolic umbilical artery fetal blood flow. A live male baby was delivered.