Factors affecting success of intrauterine insemination: a 3 year prospective study

Background: Intrauterine insemination (IUI) is the therapeutic process of placing washed spermatozoa transcervically into the uterine cavity for the treatment of infertility. The aim of this study is to analyze the variables that contribute to the success of stimulated IUI cycles. A prospective study was done to identify the most important parameters with regard to IUI success that would provide important data for predicting the success of therapy and further help in planning sub fertility treatment for couples.Methods: This prospective analytical study was done at KJK Fertility Research and Gynaec Centre, Thiruvananthapuram, Kerala over a period of 3 years from June 2012 to June 2015 in 3851 stimulated IUI cycles.Results: The overall pregnancy rate was 15.2%. Among the predictive factors evaluated, the infertility diagnosis (PCO and male factor, p value <0.001), the post wash semen count (5-10 million, p value <0.001), type of IUI (double IUI over single IUI, p value <0.001) and the endometrial thickness on the day of trigger (9-10mm, χ2 =551.59 df =5 p<0.001) significantly influenced the pregnancy rate.Conclusions: IUI is a successful contemporary treatment for appropriately selected cases of PCO and male factor infertility, especially when female age is <35 years

Comparison of antral follicle count, antimullerian hormone and day 2 follicle stimulating hormone as predictor of ovarian response and clinical pregnancy rate in patient with an abnormal ovarian reserve test

Background: Patients having abnormal ovarian reserve test are likely to have poor response to controlled ovarian stimulation (COS) in artificial reproduction technique, where large number of follicles is desirable. Although direct measurement of the primordial follicle pool is impossible, it has been shown that the number of antral follicles in the ovaries is proportionally related to the size of primordial follicle stock from which they were recruited. Therefore, the antral follicle count (AFC) is believed to represent the quantitative aspect of ovarian aging. The aim of the study was to To compare the  day two Antral follicle count, antimullerian hormone and  Follicle stimulating hormone levels as a predictor of ovarian response among the patients undergoing controlled ovarian stimulation using GnRH antagonist and its implications in clinical pregnancy rate.Methods: A prospective study was conducted in KJK Hospital Trivandrum on 119 patients having abnormal ovarian reserve test undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol from January 2010- December 2015. Patients AFC, AMH and FSH levels were measured and their association in predicting the ovarian reserve in terms of oocyte maturation, fertilization and embryo cleavage and their pregnancy rate.Results: AFC had the highest accuracy for predicting ovarian response in patient with abnormal ovarian reserve test and was statistically significant (number of oocyte aspirated p value <0.001) than AMH (p value 0.06) and FSH (p value 0.212) in predicting ovarian response. For prediction of poor ovarian response a model including AFC+AMH was found to be almost similar to that of (p value 0.001) using AFC alone. However AFC (p value 0.458), AMH (p value 0.267) and FSH (p value 0.486) did not predict pregnancy rate in patient with abnormal ovarian reserve test and it was statistically not significant.Conclusions: This study indicates that AFC is the most useful marker in predicting the ovarian response. Doing AFC assessment alone would be more cost effective for predicting the ovarian response in patients undergoing controlled ovarian stimulation with GnRH antagonist

Skill development and youth aspirations in India

This doctoral thesis features two kinds of skill-training programmes implemented in Tamil Nadu (India) drawing on 18 months of fieldwork. The first explores how Nokia recruits and trains semi-skilled youth to work as Operators, in the Nokia SEZ, in Sriperumbudur. I contrast this with the case of Project SEAM: a state-funded skill-training programme, implemented by a private firm through a public-private partnership (PPP). SEAM trains rural, below-poverty-line youth, to work as sewing machine operators in India’s burgeoning garment clusters. I argue that contemporary India’s development trajectory is characterised by the confluence between an increasingly pluralised network state and rapidly proliferating network enterprises, which work together to establish new workplaces and design and implement skill-training programmes for India’s rural poor. Skill-training is used as a lens to examine the complex, symbiotic relationship between these two actors, who drive these new initiatives. Skill development programmes are predicated on the idea that aspiration is a positive, transformative force – a view that is echoed by social scientists like Appadurai (2004; 2013). I demonstrate how the network state and network enterprise, shape and mould youth aspirations, across the skill-training cycle: transforming (within mere weeks) unemployed, unskilled rural youth – into semi skilled workers, ready to work in the manufacturing sector. Youth aspirations are consciously heightened as a marketing strategy, to maximize enrollments into skill-training programmes. Aspiration is also actively taught as a valuable soft-skill, that young people must possess, to become a part of India’s new workplaces. Through an exploration of how young people encounter such initiatives, I question the idea that aspirations are positively transformational. I highlight the tension in youth experience - between aspirations elevated by the training program, and factory work’s harder realities - to illustrate the dark side of aspiration: characterized by disillusionment, disappointment and personal failure

Skill development and youth aspirations in India

This doctoral thesis features two kinds of skill-training programmes implemented in Tamil Nadu (India) drawing on 18 months of fieldwork. The first explores how Nokia recruits and trains semi-skilled youth to work as Operators, in the Nokia SEZ, in Sriperumbudur. I contrast this with the case of Project SEAM: a state-funded skill-training programme, implemented by a private firm through a public-private partnership (PPP). SEAM trains rural, below-poverty-line youth, to work as sewing machine operators in India’s burgeoning garment clusters. I argue that contemporary India’s development trajectory is characterised by the confluence between an increasingly pluralised network state and rapidly proliferating network enterprises, which work together to establish new workplaces and design and implement skill-training programmes for India’s rural poor. Skill-training is used as a lens to examine the complex, symbiotic relationship between these two actors, who drive these new initiatives. Skill development programmes are predicated on the idea that aspiration is a positive, transformative force – a view that is echoed by social scientists like Appadurai (2004; 2013). I demonstrate how the network state and network enterprise, shape and mould youth aspirations, across the skill-training cycle: transforming (within mere weeks) unemployed, unskilled rural youth – into semi skilled workers, ready to work in the manufacturing sector. Youth aspirations are consciously heightened as a marketing strategy, to maximize enrollments into skill-training programmes. Aspiration is also actively taught as a valuable soft-skill, that young people must possess, to become a part of India’s new workplaces. Through an exploration of how young people encounter such initiatives, I question the idea that aspirations are positively transformational. I highlight the tension in youth experience - between aspirations elevated by the training program, and factory work’s harder realities - to illustrate the dark side of aspiration: characterized by disillusionment, disappointment and personal failure.This thesis is not currently available in OR

Submucous fibroids and infertility: Effect of hysteroscopic myomectomy and factors influencing outcome

Background: Submucosal myomas are associated with infertility and may be treated by hysteroscopic resection. Objective: The aim of this retrospective study was to analyze 37 subfertile patients who unnderwent hysteroscopic myomectomy in a tertiary care center with particular regard to their postprocedure reproductive outcome. Materials and Methods: The entire patient group (n = 37) underwent the procedure between March 2004 and March 2010. The submucosal myomas were type 0 (n = 27), type 1 (n = 8), and type 2 (n = 2). The mean myoma size was 2.1 cm; mean duration of the procedure was 54 mins and mean follow-up was 26 ΁ 10 months. 22 patients had one or more associated infertility factors. Results: The complication rate was 5.4%. 11 patients (29.7%) conceived after the procedure. The pregnancy rate was better when myoma was the exclusive etiology of infertility (40%), when the myoma was completely intracavitary (33.3%), when the lesion was ≥ 30 mm in size (50%), and there were no associated intramural fibroids. Conclusion: Hysteroscopic myomectomy is a safe procedure to enhance fertility especially in cases with unexplained infertility

Factors affecting success of intrauterine insemination: a 3 year prospective study

Background: Intrauterine insemination (IUI) is the therapeutic process of placing washed spermatozoa transcervically into the uterine cavity for the treatment of infertility. The aim of this study is to analyze the variables that contribute to the success of stimulated IUI cycles. A prospective study was done to identify the most important parameters with regard to IUI success that would provide important data for predicting the success of therapy and further help in planning sub fertility treatment for couples.Methods: This prospective analytical study was done at KJK Fertility Research and Gynaec Centre, Thiruvananthapuram, Kerala over a period of 3 years from June 2012 to June 2015 in 3851 stimulated IUI cycles.Results: The overall pregnancy rate was 15.2%. Among the predictive factors evaluated, the infertility diagnosis (PCO and male factor, p value &lt;0.001), the post wash semen count (5-10 million, p value &lt;0.001), type of IUI (double IUI over single IUI, p value &lt;0.001) and the endometrial thickness on the day of trigger (9-10mm, χ2 =551.59 df =5 p&lt;0.001) significantly influenced the pregnancy rate.Conclusions: IUI is a successful contemporary treatment for appropriately selected cases of PCO and male factor infertility, especially when female age is &lt;35 years

Comparison of antral follicle count, antimullerian hormone and day 2 follicle stimulating hormone as predictor of ovarian response and clinical pregnancy rate in patient with an abnormal ovarian reserve test

Background: Patients having abnormal ovarian reserve test are likely to have poor response to controlled ovarian stimulation (COS) in artificial reproduction technique, where large number of follicles is desirable. Although direct measurement of the primordial follicle pool is impossible, it has been shown that the number of antral follicles in the ovaries is proportionally related to the size of primordial follicle stock from which they were recruited. Therefore, the antral follicle count (AFC) is believed to represent the quantitative aspect of ovarian aging. The aim of the study was to To compare the day two Antral follicle count, antimullerian hormone and Follicle stimulating hormone levels as a predictor of ovarian response among the patients undergoing controlled ovarian stimulation using GnRH antagonist and its implications in clinical pregnancy rate. Methods: A prospective study was conducted in KJK Hospital Trivandrum on 119 patients having abnormal ovarian reserve test undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol from January 2010- December 2015. Patients AFC, AMH and FSH levels were measured and their association in predicting the ovarian reserve in terms of oocyte maturation, fertilization and embryo cleavage and their pregnancy rate. Results: AFC had the highest accuracy for predicting ovarian response in patient with abnormal ovarian reserve test and was statistically significant (number of oocyte aspirated p value <0.001) than AMH (p value 0.06) and FSH (p value 0.212) in predicting ovarian response. For prediction of poor ovarian response a model including AFC+AMH was found to be almost similar to that of (p value 0.001) using AFC alone. However AFC (p value 0.458), AMH (p value 0.267) and FSH (p value 0.486) did not predict pregnancy rate in patient with abnormal ovarian reserve test and it was statistically not significant. Conclusions: This study indicates that AFC is the most useful marker in predicting the ovarian response. Doing AFC assessment alone would be more cost effective for predicting the ovarian response in patients undergoing controlled ovarian stimulation with GnRH antagonist. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000): 2762-2767