Expectantly managed previable preterm PROM in an IVF conceived DCDA twin pregnancy: first case of longest extended latency in India

Previable preterm premature rupture of membranes (PPROM) between 14 and 24 weeks of gestation complicates < 1% of pregnancies. Previable PPROM in dichorionic diamniotic (DCDA) twin pregnancies are even rarer, and there is no consensus in the literature on outcomes and management due to scarcity of reports. With the recent advances in obstetrics and neonatal care, expectant management is a ray of hope for such precious pregnancies. We presented a case report of a 27 years old lady with previous two abortions with an IVF conceived DCDA twin pregnancy. We were able to extend the latency period by 95 days with our expectant management with favourable outcomes both mother and the baby. To the best of our knowledge, this is the longest case of successful expectant management of IVF conceived twins with PV-PPROM reported in India.

Prevalence and clinical utility of sperm DNA fragmentation index in couples with unexplained infertility

Background: Worldwide increased burden of infertility has built up stress in reproductive age group couples. Female factor evaluation and semen analysis are carried out routinely in infertility work up. As per the recent observations, males with normal semen analysis may have abnormal sperm DNA fragmentation index (DFI). Thus, rendering semen analysis with poor diagnostic value in unexplained infertility cases. There is lack of adequate literature on prevalence of abnormal DFI in unexplained infertility. This study is directed to contribute to the literature by assessing prevalence of couples with ‘unexplained infertility’ having DFI>15% in male partners. Methods: After getting approval from institutional ethical and scientific research committee, 200 couples with unexplained infertility were recruited for the study and sperm DFI using sperm chromatin dispersion (SCD) test (Halo test) was done. Results: Out of 200 subjects, 54% were having low DFI, 32% were having moderate DFI and 14% were having high DFI.Conclusions: Many couples diagnosed as unexplained infertility according to traditional diagnostic methods has remarkably high degrees of fragmented sperm DNA. Identification of such couples provide vital information and better therapeutic options can be offered to them to achieve best reproductive outcomes

A rare case of primary infertility with bilateral agenesis of medial part of fimbrial end with hypoplasia of fimbria and absence of fimbria ovarica with septate uterus with bilateral normal ovaries

Patients with infertility frequently present with associated congenital genital anomalies affecting around 5-6% of patients. Most of these patients have anomalies associated with uterus, cervix and vagina which have been extensively studied through time. The exact association of abnormalities of fallopian tube to infertility is still unknown due to the limited data available. The true incidence of congenital fallopian tube anomalies is unknown because abnormalities may be subtle and are often overlooked or thought to be due to acquired or iatrogenic causes. While reviewing the literature, we observed that partial or complete agenesis of the fallopian tube is rarely reported. They are usually incidental diagnosis on laparoscopy done for some other purposes. Due to rarity of such cases, their effect on fertility and its management is still a challenge. Here, we present a case report of septate uterus with bilateral fimbrial agenesis and normal ovaries in a patient of primary infertility. 

Role of hysterolaparoscopy in unexplained infertility

Background: Infertility, as defined by World Health Organization (WHO), is failure to achieve pregnancy during 1 year of regular unprotected intercourse. The objective of this study was to determine the incidence of unsuspected pathology at hysterolaparoscopy in presumed unexplained infertility, the incidence of intervention done for correcting pathology and its outcome and the importance of hysterolaparoscopy in the evaluation and treatment of infertile couples.Methods: This prospective observational study was carried out at IVF and Endoscopy centre, Department of obstetrics and gynecology at the Ruby Hall clinic, Pune from 1st November 2014 to 30th July 2016, after obtaining institutional ethical clearance and who met the inclusion and exclusion criteria. A detailed clinical history and physical examination and bimanual pelvic examination were done, following which all the patients were subjected to baseline blood investigation, 3D pelvis (TVS) and semen analysis. Day care hysterolaparoscopy was performed and systematic analysis were done.Results: The mean duration of infertility was 2 to 4 years. In our study out of 75 women 62 (82.67%) showed normal hysteroscopic findings, remaining 13 women (17.67%) showed abnormal hysteroscopic findings like cornaul blockage, intrauterine adhesions and tuberculosis endometrium. Abnormal laparoscopic findings were reported in 29.33% of which the most common pathology was endomertiosis (21.33%).Conclusions: Diagnostic Hysterolaproscopy is a safe, effective, minimally invasive, cost effective, daycare comprehensive procedure in evaluation of unexplained infertility. Apart from routine diagnostic protocol missed pathologies can be detected and this tool can be used for diagnostic as well as therapeutic intervention

Congenital malformations and assisted reproductive technique: Where is assisted reproductive technique taking us?

Development of ART has great benefit for millions of couples all over the world and with falling fertility rate there are a growing numbers of children born with the help of ART, it is important to investigate potential risks to these children. IVF-ICSI pregnancies are associated with higher risk for multiple gestation, preterm labor and low birth weight. It is an area of great conflict and interest that whether ART is associated with increased congenital malformations or not. So, this article reviews the data and evidences linking ART to congenital malformations

Obstetric complications in women with IVF conceived pregnancies and polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is often accompanied by infertility that necessitates ovulation induction using clomiphene citrate, gonadotropins or even in vitro fertilization (IVF). These treatment methods are known to increase the incidence of multiple pregnancies as well as some negative consequences, including a rise in the risk for gestational diabetes mellitus, pre-eclampsia, etc., Furthermore, pregnancies established after IVF carry an increased risk for maternal complications. However, the increased risk of developing adverse obstetric complications has been suggested to occur independently of obesity as well as in populations without assisted reproductive techniques. Many studies have been performed to study the effect of PCOS on pregnancy and the effect of pregnancy on PCOS. The hormonal milieu that is exaggerated in PCOS women is quite well understood at the biochemical and genetic levels. The maternal and neonatal outcomes of PCOS women who have undergone in vitro fertilization-embryo transfer (IVF-ET) have not been widely studied till date. This review aims to evaluate the current evidence regarding adverse obstetric outcomes of PCOS women undergoing IVF-ET. The rationale of this review is to study whether the adverse obstetric outcomes are increased in PCOS women in general, or particularly in those PCOS women who are undergoing IVF-ET. It is also important to analyze via a literature review whether the increased adverse outcomes are due to infertility in general or PCOS per se. An attempt has been made to give evidence regarding preventive strategies for obstetric complications in PCOS women who have undergone IVF-ET

Association of in-vitro fertilization twin pregnancy with maternal and perinatal complications

Names of the authors are incorrectly given as surnames in Scopus database: Adele G., Katrina P.-L., Dmitrijs R., Inara M., Dace R.Objective: To analyze maternal and perinatal complication rates in in-vitro fertilization (IVF) twins and spontaneous twin pregnancies. Methods: The information on obstetric and perinatal outcomes and complications covering 95 IVF twins and 165 spontaneous twin pregnancies was collected from the medical records of Riga Maternity Hospital. Statistical analysis and adjustment for confounders was performed using the SPSS v24.0 software. The continuous data were compared using the t-test and Mann-Whitney U test for parametrical and non-parametrical data accordingly. The nominal data were analyzed using Pearson's Chi-square test and Fisher's exact test. Results: The preterm labor risk, intrauterine growth restriction, fetus weight between IVF and spontaneous twins were not statistically significant (P>0.005). At the same time our study revealed a statistically significant association of gestational diabetes and pregnancy induced hypertension with IVF twin pregnancies (P=0.025 and P=0.003, respectively). Moreover, IVF twins had higher odds to be delivered by cesarean section (P=0.001). Conclusions: IVF twin pregnancies are associated with a higher risk of development of gestational diabetes and gestational hypertension than spontaneous twin pregnancies.publishersversionPeer reviewe

Autologous intrauterine platelet-rich plasma instillation for suboptimal endometrium in frozen embryo transfer cycles: A pilot study

Introduction: This pilot study was to evaluate the effectiveness of intrauterine infusion of autologous platelet-rich plasma (PRP) in infertile women undergoing frozen embryo transfer cycles with suboptimal endometrium. Material and Methods: Intrauterine instillation of autologous PRP was done in 68 women between 22 and 40 years, over 8 months, with suboptimal endometrial growth, and patients with repeated cycle cancellations, in addition to Estradiol valerate. Frozen embryo transfer was performed when the endometrium reached an optimal pattern in terms of thickness, appearance, and vascularity. Results: The mean pre-PRP endometrial thickness (ET) was 5 mm which significantly increased to 7.22 mm post-PRP. There was a significant increase in vascularity, seen by the number of vascular signals seen on Power Doppler, reaching the zones 3 and 4 of the endometrium. The positive beta Human Chorionic Gonadotropin (hCG) rate was 60.93% and the clinical pregnancy rate was 45.31%. A total of 13 women are in the second trimester, 13 are in the first trimester with a healthy intrauterine pregnancy, one patient had an ectopic gestation, three had blighted ova, two had missed abortions, and two biochemical pregnancies. Conclusion: This study suggests that the use of autologous PRP holds promise in the treatment of women with suboptimal ET and vascularity for embryo transfer. It would help to reduce the incidence of cycle cancellations and thus even help reduce the financial and psychological burden of repeated cancelled cycles