Intrauterine platelet rich plasma versus injection G-CSF for treatment of thin endometrium in infertility

Background: For success in IVF treatment, it is essential that the patient has a responsive endometrium together with many other factors. Inspite of numerous treatments available today for growth of endometrium, there is lack of any ideal drug or protocol for increasing endometrial thickness. The study is an attempt to evaluate the role of two drugs for increasing endometrial growth before embryos transfers.Methods: This study is a retrospective cohort study including 50 patients with previously diagnosed as thin endometrium patients who may or may not have failed previous cycles of IVF. Patients were randomly divided into two groups. First group-Group A (n=25) are patients randomly selected to undergo intrauterine PRP instillation for increase in endometrial thickness before embryo transfer. Second group-Group B (n=25) are randomly selected from a retrospective cohort of thin endometrium to take injection GCSF  as intrauterine infusion (total dose 300mcg) on day of trigger or day 11 of cycle followed by 60 units subcutaneously after embryo transfer. The difference in endometrial thickness during transfer and the pregnancy outcomes were compared.Results: Injection GCSF was found to be more effective than intrauterine PRP in improving endometrial thickness in patients with thin endometrium with a p-value of <0.0001.  It was found that the chemical and clinical pregnancy rates were comparable as the p values were 0.77 and 0.37 respectively and hence statistically not significant. Although patients given injection GCSF had a slightly higher clinical pregnancy rate (44%) as compared to patients given intrauterine PRP which was 28%. All other variables were comparable.Conclusions: In the study it was proven that injection GCSF, is more effective for the treatment of thin endometrium patients as compared to intrauterine PRP infusion. Though the clinical and chemical pregnancy rates were comparable, a higher percentage of women were clinically pregnant in the group given injection GCSF.  Intrauterine PRP can also be a good alternative for thin endometrium.  More studies and RCTS are needed for comparison to prove the effectiveness of these drugs for treatment of thin endometrium

Unusual clinical presentation of rare case of vaginal leiomyoma: a case report

Primary vaginal leiomyoma are rare and usually arise from anterior vaginal wall, approximately 330 cases of vaginal fibroid reported in world literature. Vaginal myoma usually presented as discharge per vaginum, abnormal bleeding, pain lower abdomen, dyspareunia etc. We report a case of primary vaginal leiomyoma arising from lateral vaginal wall which is presented clinically as pain in hip joint and radiating to ipsilateral leg which is unusual clinical presentation creating diagnostic dilemma and because of rarity of the case

Fresh versus frozen embryo transfer: a retrospective cohort study

Background: Elective frozen embryo transfer (FET), has recently increased significantly with improvements in cryopreservation techniques. Observational studies and randomized controlled trials suggested that the endometrium in stimulated cycles is not optimally prepared for implantation; risk of ovarian hyperstimulation syndrome reduced and pregnancy rates increased following FET and perinatal outcomes are less affected after FET. However, the evidence is not unequivocal and recent randomised control trials challenge the use of elective FET for the general IVF population. Pregnancy rates were analysed in a cohort of patients undergoing embryo transfers.Methods: This was a retrospective cohort study of patients who underwent embryo transfers from April 2018 to March 2019 at study centre in Surat.175 cycles of embryo transfers (119 fresh and 56 frozen) were included in the study. Outcomes measured were positive pregnancy, clinical pregnancy and ongoing clinical pregnancy rates achieved in the IVF-ET cycles.Results: There were no statistically significant differences between positive pregnancy rate (54.6% versus 60.7%, Odds ratio (OR) 0.78; 95% Confidence Interval (CI) 0.41-1.49), clinical pregnancy rate (48.73% versus 57.14%, OR 0.52; 95% CI 0.1- 2.64) and ongoing clinical pregnancy rate  (45.38% versus 51.78% OR 1.4; 95% CI 0.29 - 6.67) in fresh ET and FET cycles, respectively, p < 0.05 was considered statistically significant for all measures.Conclusions: Despite the observed higher rates of positive biochemical, clinical and ongoing clinical pregnancy per transfer in the FET cohort, these did not reach statistical significance. Thus, both transfer strategies are reasonable options, although there is a trend favouring the freeze-all strategy

Geometry of good sets in n-fold Cartesian product

We propose here a multidimensional generalisation of the notion of link introduced in our previous papers and we discuss some consequences for simplicial measures and sums of function algebras.Comment: 17 pages, no figures, no table

Poor ovarian reserve and male infertility in a rural in vitro fertilization setup: a case report

Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35. In the female, the number of oocytes decreases with age until the menopause. Oocyte quality also diminishes, due in part to increased aneuploidy because of factors such as changes in spindle integrity. Although older male age affects the likelihood of conception, abnormalities in sperm chromosomes and in some components of the semen analysis are less important than the frequency of intercourse. Age is as accurate as any other predictor of conception with assisted reproductive technology

Where is the best site for embryo transfer? A study of relation of embryo-fundal distance with pregnancy rate in ICSI-ET cycle

Background: Embryo transfer is the ultimate and most critical step of IVF-ICSI treatment cycle. It has a significant impact on the success rate of IVF cycle. Undoubtedly, it has significant impact of the pregnancy rate and implantation rate. Along with the other factors the impact of the site of embryo transfer has also been studied by several investigators. There is lack of clear consensus about the ideal site of embryo transfer.Methods: This study includes a retrospective analysis of 200 embryo transfers done in 200 infertile couples done at our infertility clinics from January 2016 to March 2016. Transfer cycles of gamete donation, embryo donation and frozen embryos were excluded from the study. The study involved patients undergoing their first IVF- ICSI cycle with fresh embryo transfer at our IVF Unit. All patients were stimulated using Antagonist protocol starting Gonadotropins from day 2/3 of menses.Results: The clinical pregnancy rate was highest (55.2%) in group 2 when the embryo fundal distance was more than 10 mm but less than or equal to 15 mm. In group 3 when embryos were placed beyond 15 mm distance from the fundus, the clinical pregnancy rate was 34.66%. The lowest pregnancy rate - 30% was found in group 1 when embryos were places less than 10 mm from fundus. There was only a single case of ectopic pregnancy in the study group. The ectopic pregnancy was seen in group 1. There two cases of abortion each in group 2. The miscarriage rate was higher in group 3-5. 33% as compared to 1.9% in group 2. The sample size was small to determine if these results were significant enough.Conclusions: The present study demonstrates that higher pregnancy rates are obtained if the embryos are selectively placed at a distance between 10mm to 15 mm from the fundal endometrial surface. It is not possible to determine exact location of embryo placed in utero by any method. The findings of our study can be considered as a guiding force by clinicians

Successful pregnancy outcome in a case of Swyer Syndrome with hypertension and morbid obesity

To report a case of Swyer syndrome with hypertension and morbid obesity with successful pregnancy and live birth after assisted reproductive technology. 27 year old morbidly obese female with essential hypertension who had been on HRT for 10 years with well-developed secondary sexual characters with primary infertility. After adequate development of the uterus and the endometrial preparation, Patients with Swyer syndrome conceive with oocyte donation and ICSI. Caesarean section rate is high due to multiple pregnancies and other obstetric complications. Early detection of these cases would help in timely development of their secondary sexual characters and restoration of menses and gonadectomy for prevention of malignancy as its propensity is high. Multidisciplinary approach is required including counseling and management of long term health problems. Pregnancy is feasible but caesarean rate is high

Art outcome in combined group of women with premature ovarian failure and menopausal women

Background: It is to present an overview of the study of the ART cycles in combined group of women with premature ovarian failure (POF) and menopausal women in 1 year period. Purpose of the study was to know the pregnancy outcome in this combined group. Since majority of the patients who entered our tertiary hospital had already received various treatment methods such as gonadotropins, long protocols and ultra-short protocols in previous hospitals with no positive result, we had to take them directly to the ovum donation (OD) or embryo donation (ED).Methods: A simple study was performed from 1st January, 2015 to 31st December, 2015. Women with POF and menopause were enrolled and complete follow up of them was done from their first visit till stable pregnancy of 14 weeks was achieved. While doing this, we considered various parameters which can affect the ART outcome, for e.g. endometrial evaluation, hysteroscopy findings, proliferative phase preparation, leuteal support, semen analysis etc. The study outcome results included pregnancy rate and miscarriage rate.Results: In spite of good efforts, ultimately, stable pregnancy rate (beyond 14 weeks gestation) of these women was only 35% that was almost one third of the total study population that too with the help of OD and ED. Pregnancy rate was actually 42%, out of which 7% had miscarriage. With all the cost, efforts and time involved, 65% (2/3rd) of women could not achieve successful pregnancy.Conclusions: Since the possibility of pregnancy gradually declines after the age of 30 and a steep fall in fertility after the age of 35, women should be advised not to postpone marriages and should be encouraged to have children earlier

Knowing a cross-talk between embryo and endometrium can help to achieve successful pregnancy outcome in recurrent implantation failure

Recurrent implantation failure is most distressing condition to both couple as well as doctor in the field of reproductive medicine. Patients have already undergone various ART treatments with no favourable outcome and are drained emotionally as well as economically. To overcome this obstacle a comprehensive approach is needed. In this case report, we are addressing a couple who came to us with primary infertility of 15 yrs, with recurrent IVF failures (four cycles of IUI, seven cycles of ICSI both fresh and frozen and with ovum donation in last two cycle), with poor ovarian reserve and male factor infertility for surrogacy as a last option. After complete evaluation of couple, recurrent Implantation failure is thought to be due to poor endometrium and bad embryo quality, and we counselled couple to go for ovum donation and ICSI before considering surrogacy. To improve endometrial receptivity we performed local endometrial injury, oral estradiol therapy, intrauterine G-CSF instillation and IVIG etc. Simultaneously for better quality of embryo we decided to choose ovum donation due to poor ovarian reserve and advance age of the patient and ICSI was done with husband sperm after treatment of male factor infertility and ET was performed. Patient conceived in first cycle with single live intrauterine pregnancy, her antenatal course was uneventful and delivered a healthy baby at term without any complication