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Background & Objective: The data regarding the effectiveness of various protocols used for controlled ovarian stimulation (COS) in assisted reproductive techniques (ART) in our own population is scant. This study compares recombinant follicular stimulating hormone (rFSH) and human menopausal gonadotrophins (HMG) in terms of follicular numbers and oocytes retrieved in Pakistani women undergoing ART. Methods: A total of 300 patients were selected out of 1,950 patients who visited the hospital for in vitro fertilization/intra cytoplasmic sperm insemination (IVF/ICSI) from June 2018 to December 2020. These patients were further divided into two categories: first category (1) was given long protocol and the second category (2) was given short antagonist protocol. Each category was further sub-divided into two groups; group A who received HMG, and group B who received rFSH for COS. Results: There was a significantly higher number of follicles and oocytes retrieved in category 1, with rFSH (20.01 ± 4.91, 15.19 ± 9.18) versus. HMG (16.07 ± 5.67, 11.10 ± 5.07) with a p-value (0.00, 0.004). On the other hand, in category 2, the number of follicles was insignificant (p-value = 0.319) in both groups. Contrary to that the number of oocytes retrieved was significantly higher with a p-value of ≤ 0.05 in both groups. Conclusion: In COS in ART, long protocol with rFSH has much better results both in terms of follicular numbers and retrieved oocytes. While for the short protocol with the antagonist, rFSH has been demonstrated to be superior to HMG but that is limited to the number of oocytes.

Background Despite the strictness in attendance policies, absenteeism is an important current issue among medical and health sciences that affects the performance of undergraduate students worldwide. Attending lectures is the key to reaping the rewards of academic achievements in undergraduate medical students. As attendance pattern and performance go hand in hand- the physical engagement of students in the classroom and practical teaching approach have a synergistic impact on the output of lower-performing students to do their best. Methods A total of 404 full-time undergraduate MBBS male and female students of Rashid Latif Medical College (RLMC) of age 18 or above were included in this study. The principal outcome variable, such as class grades or performance, is the dependent variable, while absenteeism is a unique independent variable. Results Our results capture the positive and significant impact of attendance coefficient in all proxy variables of regression models but exhibit significant decline from OLS3 to OLS4 when proxy variables for ability, effort, and motivation were included. However, we found the effect disappears, when we incorporate panel data fixed effect estimators to minimize the time-invariant student-specific unobservable traits on performance. Conclusion Attendance of the student is only the mandatory variable that must be monitored and regulated by corrective actions to achieve the better academic performance of the students.

This retrospective case control study was executed to compare the efficacy of short and long acting Gonadotropin releasing hormone agonist (GnRH-a) on pregnancy outcome. A total of 540 cycles with a history of male factor were identified from 2013 to 2016. The patients were separated into two groups: long acting protocol (LAP) group consisting of 310 cycles which were induced by a combination of GnRH-a incorporated with Follicular stimulating hormone (FSH) and Human menopausal gonadotropin (hMG), while short acting protocol (SAP) group or flare up regimen comprises of 230 cycles introduced by a combination of GnRH-a along with FSH and hMG. Patients are divided into subsequent age groups ≤ 30, 31–35, 36–40 and > 40 years. In comparison with the SAP group, the duration of ovarian stimulation, calculated dose of GnRH-a, number of retrieved mature oocytes, good quality embryos for implantation and persistent pregnancies were all significantly found to be high (p P = 0.001) than in the SAP group (28.23%). The findings of our study revealed that irrespective of patient’s age, the long acting protocol was more reliable and fertile with reference to number of mature oocytes retrieved, time period for stimulation, total dose of GnRH-a during controlled ovarian hyperstimulation, high quality embryos, fertilization and cleavage rate as well as pregnancy outcome.

Background MicroRNAs (miRNAs) are small RNA molecules that modulate post-transcriptional gene regulation. They are often used as promising non-invasive biomarkers for the early diagnosis of cancer. However, their roles in assisted reproduction are still unknown. Methods This prospective study was designed to evaluate the expression profiles of seven extracellular miRNAs (miR-7-5p, miR-202-5p, miR-378-3p, miR-224, miR-320a, miR-212-3p, and miR-21-5p) in human follicular fluid (FF) to explore the outcomes of in vitro fertilization (IVF). Of 255 women, 145 were without polycystic ovary syndrome (PCOS), and their ovarian assets were normal (NOR), while 110 were with normo-androgenic PCOS. Results The combination of six FF miRNAs expression profile discriminated between PCOS and NOR women with a sensitivity of 79.2% and a specificity of 87.32% (AUC = 0.881 [0.61; 0.92], p = 0.001). MiR-202-5p significantly had a lower abundance level, and miR-378-3p had a high abundance level in pooled FF samples from patients treated with human menopausal gonadotropin (hMG) than those treated with recombinant follicle-stimulating hormone (rFSH) (p < 0.001). Our results showed that miRNA-320a was significantly different in top-quality embryos versus non-top-quality embryos on day 3 in NOR patients with a sensitivity of 80% and specificity of 71%, (AUC = [0.753 (0.651; 0.855)], p = 0.001). For clinical pregnancy outcome prediction, FF miRNA-21 exhibited high sensitivity (74.8%) and specificity (83.7%) with the AUC value of 0.774 (0.682; 0.865). Conclusion Conclusively, our results provide evidence that miR-7-5p, miR-378-3p, miR-224, miR-212-3p were a differentially high expression in normo-androgenic PCOS patients than NOR patients. While miRNA-320a was significantly different in top-quality embryos versus non-top-quality embryos on day 3 (p = 0.001). The expression level of FF miR-212-3p was significantly related to the probability of embryos to develop into a high-quality blastocyst in patients with normal ovarian reserve., Lahore institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan, Lahore institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan.

Additional file 1 : Table S1. Fold change in the FF miRNAs at oocyte retravel day between women with normo-androgenic PCOS (n = 110) versus NOR women (n = 145). Table S2. Univariate analysis exhibiting association of specific FF miRNAs with blastocyst formation and pregnancy outcome.

BackgroundIntrafollicular melatonin maintains the DNA integrity of granulosa cells and protects them against apoptosis. This ubiquitous indoleamine compound serves as a potent free radical scavenger. It reduces oxidative stress and modulates DNA damage response, which improves oocyte's quality with a higher fertilization rate.Methods:This prospective study was designed to investigate the antioxidant property of intrafollicular melatonin and its impact on IVF outcome parameters by exploring the relative expression of five microRNAs (miR-663b, miR-320a, miR-766-3p, miR-132-3p, and miR-16-5p) and levels of cfDNA by real-time PCR in unexplained infertile patients. We collected 425 follicular fluid (ff) samples containing mature oocytes from 295 patients undergoing IVF. Results:Patients were sub-grouped based on intrafollicular melatonin concentration (Group A; ≤ 30 pg/mL, Group B; >70 to ≤110 pg/mL), Group C; >111 to ≤ 385 pg/mL). Our results showed that patients with ≤ 30 pg/mL intrafollicular melatonin levels have a significantly higher cfDNA levels and lower relative expression of miR-663b, miR-320a, miR-766-3p, miR-132-3p, and miR-16-5p compared to other subgroups (pConclusion:Conclusively, our study provided evidence that melatonin's antioxidant capability significantly impacts cfDNA concentration and miRNAs relative expression profile in the follicular microenvironment for optimal oocyte development and embryo quality. Therefore, it may be a potent non-invasive diagnostic tool to select high-quality day 3 embryos with such promise.

Despite many advances in assisted reproductive technology (ART), the most viable embryo selection remains a challenge for infertility treatment. This study was designed to investigate whether intrafollicular circulating cell-free DNA (cfDNA) fragments and Melatonin levels predict embryo quality in patients undergoing IVF treatment. A total of eight hundred and ninety-five follicular fluid (ff) samples were collected from 325 infertile patients undergoing IVF treatment. Patients were enrolled from August 2017 to December 2018 in the infertility center of a tertiary care hospital. A clear non-hematic follicular fluid was aspirated after the removal of eggs from the dominant follicles (>18 mm) of each patient. Melatonin and E-2 levels in each follicular sample were estimated by immune-chemiluminescence using commercially available kits. ALU-qPCR evaluated cfDNA levels in individual follicular fluid samples. Our study presented a significant and negative relationship between intra-follicular cfDNA and melatonin concentration (-0.541: P = 25%) than embryos with low fragmentation rate (, Lahore institute of Fertility and Endocrinology, Hammed Latif Hospital, Lahore institute of Fertility and Endocrinology, Hammed Latif Hospital.

PURPOSE: Intrafollicular fluid (IFF) melatonin plays a decisive role in maintaining granulosa cells’ DNA integrity and protects them against apoptosis. It reduces oxidative stress and improves the oocyte quality with a higher fertilization rate. METHOD: This prospective study investigated the antioxidant property of IFF melatonin and its impact on IVF outcome parameters. We also explored the relative expression of five microRNAs (miR-663b, miR-320a, miR-766-3p, miR-132-3p, miR-16-5p) and levels of cell-free DNA (cfDNA) by real-time PCR in unexplained infertile patients. We collected 425 follicular fluid (FF) samples containing mature oocytes from 295 patients undergoing IVF. RESULTS: Patients were subgrouped based on IFF melatonin concentration (group A ≤ 30 pg/mL, group B > 70 to ≤ 110 pg/mL, group C > 111 to ≤ 385 pg/mL). Our results showed that patients with ≤ 30 pg/mL IFF melatonin levels have significantly higher oxidative stress markers, cfDNA levels, and lower relative expression of miR-663b, miR-320a, miR-766-3p, miR-132-3p, and miR-16-5p compared to other subgroups (p

Premature ejaculation is one of the most common sexual disorders in men due to uncontrolled modulation of spinal reflexes controlled by cortico-limbic centers in the brain. In this study, we investigate the combinatorial effects of trinucleotide repeats of androgen receptor and allelic variants of the 5-HTTLPR gene on sex steroids, hypophyseal hormones, sexual performance, and premature ejaculation assessment parameters among evidence-based lifelong premature ejaculation subjects. A total of 271 outpatients (age 26.6 ± 1.9) consulting for evidence-based lifelong premature ejaculatory dysfunction were selected in this study. The control group consists of 155 men with normal IELT (>4 min). The study revealed that the subjects who have the highest (≥26) CAG stretches depicted a significantly higher serum oxytocin levels (102.1 pg/ml; n = 126, p

Key Clinical Message Placenta accreta (PA) is a critical condition that represents a significant source of morbidity and mortality observed in women with multiple prior cesarean sections. Precise prenatal identification of affected pregnancies permits optimal obstetric management. Antenatal diagnosis leads to less blood loss and a requirement for blood transfusion than women diagnose during cesarean section.

WOS: 000426953600003, PubMed ID: 29083935, Androgen mediating signaling is implicated in regulating the expression of reproductive related genes. Any deviation in the gene expression might be the ignitable precursor for genomic instability that inflames the genomic rearrangements and a leading cause of cancer. The main goal of this study was to determine the relationships between trinucleotide repeats of androgen receptor (AR), sex steroids, and sexual function in men presenting with reduced sperm motility. We investigated the singleton or combinatorial effects of the length of trinucleotide repeats of AR on reproductive hormones, clinical parameters, semen analyses, as well as sexual assessment function of 210 asthenospermic outpatients along with 125 normal subjects. Sexual assessment was executed using the International Index of Erectile Function (IIEF-15 score) which measures erectile function (EF), orgasmic function (OR), sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction. Our findings suggest that long (>26 CAG)n repeats have an inverse correlation with circulatory FSH and T, whereas long (>25 GGC)n repeats have moderated affiliation with reduced sperm concentration. The study revealed a novel finding by exploring the negative correlation between elongated (CAG)n repeats and the cumulative IIEF-15 score, orgasm function (OR), and erectile function (EF) in asthenospermic men. This study examines the tri-nucleotide correlation with sexual function in Punjabi men enhancing our understanding of the regulatory mechanisms of sexual performance.Abbreviations: AR: androgen receptor; IIEF-15 score: International Index of Erectile Function; EF: erectile function; OR: orgasmic function; SD: sexual desire; IS: intercourse satisfaction; FSH: follicular stimulating hormone; T: testosterone; NTD: N-terminal transactivation domain; DBD: DNA-binding domain; LBD: ligand binding domain; TNR: tri-nucleotide repeat

Semen is a pale whitish fluid secreted by male during ejaculation and containsspermatozoa which are male gametes essential of fertilizing the oocytes which are femalegametes. In a quest to evaluate male’s fertility potential semen is analyzed to look into some ofits characteristics and of the sperms contained within the semen analyzed. Method of collectioninfluences the results of Semen analysis as does the technique of analysis. Spermatozoa areexamined for number (count), shape (morphology) and movement (motility) in order to assesstheir quality. Non sperm cells, volume, Fructose level, pH, liquefaction are also checked asa part of routine analysis. Objectives: To describe the pattern of semen parameters in subfertilemales. To look into frequency and distribution of abnormal semen parameters in a groupof Pakistani males in Lahore. Methods: In this Retrospective, cross sectional, observationalstudy all males undergoing for evaluation and treatment for sub-fertility at a private AssistedReproductive Technology clinic in Lahore, Pakistan were included. Approval of the IRB wassought and data collection instrument was a specially designed Performa which was validatedby the biostatistician of LIFE research cell. Data was extracted from the files of LIFE (LahoreInstitute of Fertility and Endocrinology) and entered in SPSS version 15. Sampling techniquewas non-probability, consecutive. Semen analysis was done by methods defined by the WHO(World Health Organization). Results: Of total patient (n=679) 92.2% (626) males passed sampleat LIFE (Lahore institute of fertility and endocrinology) and (7.8%) 53 brought sample fromhome. Of the males who passed sample at LIFE (78.8%) 535 collected semen by masturbation,(11.9%) 81 by coitus; the source of sample of (9.3%) 63 males was not known. As 2-6 ml semenwas consider to be normal by WHO criteria, (80.6%) 547 males were in normal range (14.1%)96 found to be less than 2-6 ml and (5.3%) 36 found to be more than normal range. Accordingto WHO criteria 15 million/ml count is said to be normal, in our research (82.0%) 557 were foundto be normal, in (2.9%) 20 count was found to be less than 15 million/ml and in (5.9%) 40 countwas less than 1 million/ml. In (9.1%) 62 counts was found to be abnormally low. In this research(66.1%) 449 had normal sperm motility, (21.8%) 148 had less than 40% and abnormally lowsperm motility was found in (12.1%) 82 males. Conclusion: The results of the single semenanalysis are of limited utility and no decision should be taken on the bases of these results interm of diagnosis and treatment strategies.

WOS: 000449716000001, PubMed ID: 29556396, Background: Despite its worldwide high occurrence, the obscurity regarding the description, epidemiology and management of premature ejaculation remains provocative. It is well established that male premature ejaculatory dysfunction is an increasing problem due to spontaneous ejaculation across a variety of general and clinical subjects. The main goal of this study was to determine the relationships between trinucleotide repeats of the androgen receptor (AR), sex steroids, and pituitary hormones with sexual function in men with type 2 diabetes mellitus (DM) and reported with acquired premature ejaculation (PE). Methods: A total of 150 normal and 250 PE + DM subjects were enrolled in this study. Each subject was invited to fill out an elaborative questionnaire to acquire precise selective information regarding BMI, duration of PE + DM, self-reported Intra-Vaginal Ejaculatory Latency Time (IELT), sexual and mental health status by using the premature ejaculation diagnostic tool (PEDT) and Beck Depression Inventory-II (BDI-II). Pearson's correlation analysis was used to analyze the relationship between clinical, hormonal, and genetic variables. Ward's minimum variance cluster analysis and principal component analysis were used for evaluation of dependence between genetic, clinical, and demographic parameters. Results: The patients who have the lowest number of (= 26) number of (CAG)n repeats (62.9 pg/ml; n = 108, 43.2%). On the other hand, patients who have the highest numbers of (CAG)n repeats (>= 26) have higher serum testosterone (6.1 ng/ml; n = 108, 43.2% of cohort) lower prolactin (3.01 ng/ml; n = 108, 43.2% of cohort) levels than the controls and patients with the lowest numbers (