Optimizing intrauterine insemination: A systematic review and meta-analysis of the effectiveness and safety of clinical treatment add-ons.

INTRODUCTION: Intrauterine insemination (IUI) is one of the most widespread fertility treatments. However, IUI protocols vary significantly amongst fertility clinics. Various add-on interventions have been proposed to boost success rates. These are mostly chosen arbitrarily or empirically. The aim of this systematic review and meta-analysis is to assess the effectiveness and safety of add-on interventions to the standard IUI protocol and to provide evidence-based recommendations on techniques used to optimize the clinical outcomes of IUI treatment. MATERIAL AND METHODS: Systematic review and meta-analyses were performed in accordance with PRISMA guidelines. A computerized literature search was performed from database inception to May 2023. Randomized controlled trials (RCTs) were included reporting on couples/single women undergoing IUI with any protocol for any indication using partner's or donor sperm. A meta-analysis based on random effects was performed for each outcome and add-on. Three authors independently assessed the trials for quality and risk of bias and overall certainty of evidence. Uncertainties were resolved through consensus. Primary outcomes were ongoing pregnancy rate (OPR) or live birth rate (LBR) per cycle/per woman randomized. Registration number PROSPERO: CRD42022300857. RESULTS: Sixty-six RCTs were included in the analysis (16 305 participants across 20 countries). Vaginal progesterone as luteal phase support in stimulated cycles was found to significantly increase LBR/OPR (RR 1.37, 95% CI 1.09-1.72, I2 = 4.9%) (moderate/low certainty of the evidence). Endometrial scratch prior/during stimulated IUI cycles may increase LBR/OPR (RR 1.44, 95% CI 1.03-2.01, I2 = 1.8%), but evidence is very uncertain. Results from two studies suggest that follicular phase ovarian stimulation increases LBR/OPR (RR 1.39, 95% CI 1.00-1.94, I2 = 0%) (low certainty of evidence). No significant difference was seen for the primary outcome for the other studied interventions. CONCLUSIONS: The findings of this systematic review and meta-analysis suggest that vaginal luteal phase progesterone support probably improves LBR/OPR in stimulated IUI treatments. In view of moderate/low certainty of the evidence more research is needed for solid conclusions. Further research is also recommended for the use of endometrial scratch and ovarian stimulation. Future studies should report on results according to subfertility background as it is possible that different add-ons could benefit specific patient groups.

Should women with high body mass index be denied fertility treatments?

Obesity is an emerging global epidemic with a negative impact on fertility. Almost all guidelines and policies have a stringent limit of body mass index (BMI) to access fertility services which has promoted a debate amongst fertility practitioners globally. Proponents of placing such a limit point to the negative impact of elevated BMI on the outcome of fertility treatment, its cost effectiveness and the risk it poses to the intending mother and unborn child. Opponents of placing a restriction base their arguments on the lack of conclusive, robust evidence regarding the variables along with the ethical dilemmas of promoting discrimination and stigmatization by denying a couple their basic right of parenthood. In this review, we analyse these medical and ethical dilemmas in the light of current evidence. The focus is on female infertility.

A study of transobturator tape in stress urinary incontinence.

BACKGROUND: Stress urinary incontinence (SUI) is commonly encountered in gynecological practice. Nowadays, midurethral sling surgeries in the form of transobturator tape (TOT) surgery are recommended in its treatment. AIMS AND OBJECTIVES: To assess the outcome and patient satisfaction of TOT surgery in the treatment of SUI. MATERIALS AND METHODS: A prospective study was undertaken for patients of SUI who underwent TOT surgery by the outside in method and followed up for 5 years. The patients were assessed clinically and by the Patient Global Impression of Improvement (PGI-I) preoperatively and at postoperative day 3, discharge and 3 months follow-up. RESULTS: Successful surgical treatment with TOT was seen in all patients at the time of discharge. There was no recurrence of SUI seen up to 1 year, but at 5-year follow-up two patients had a recurrence of SUI on examination though they did not complain of SUI. Urinary retention, tape extrusion, and groin stitch infection were the commonly seen complications following surgery. On subjective assessment, 61 patients were completely satisfied at day 3, and all patients were completely satisfied at discharge and 3 months follow-up as per the PGI-I score. CONCLUSION: TOT gives an excellent outcome in the treatment of SUI.

High ambient noise levels in Vadodara City, India, affected by urbanization.

The present research was conducted to study the urbanization of Vadodara city and to monitor the ambient noise level in the industrial, commercial, residential and silence zones of the city. A settlement map created by unsupervised classification for the land use and land cover study of Vadodara city clearly shows the increasing pattern of urbanization in its central part, which may be the result of urban sprawl due to migration of people from the rural to the urban areas. The fluctuation in ambient noise level was recorded using an A-weighted sound level meter in all the four zones of Vadodara city for 3 h at regular intervals of 15 min on 3 consecutive days at the same time. The results showed the highest equivalent noise level of 93.7 dBA in the commercial zone followed by 85.5 dBA in the industrial zone, 73.2 dBA in silence zone, and 70.2 dBA in the residential zone. The values of noise level were high in all the zones of the city increasing remarkably over the prescribed limit given in the Noise Pollution (Control and Regulation) Rules, 2000. Continuous exposure to such high level of noise may lead to detrimental effect on people.

Overexpression of the immediate early gene fra-1 inhibits proliferation, induces apoptosis, and reduces tumourigenicity of c6 glioma cells.

Hexamethylene bisacetamide (HMBA)-induced growth inhibition and differentiation of the rat C6 glioma cell line were found to be accompanied by down-regulation of the constitutively expressed fra-1 gene. In order to check if the fra-1 gene down-regulation was essential for HMBA's growth inhibitory effect, C6 cells were stably transfected with vector expressing fra-1 cDNA under CMV promoter in either sense or antisense orientation. Contrary to the expectations, fra-1 overexpression was found to inhibit proliferation and induce morphological differentiation of C6 cells. Furthermore, all three differentiation inducers studied viz. dibutyryl cyclic AMP (dbcAMP), staurosporine, and HMBA have greater growth inhibitory effect on fra-1 overexpressing clones as compared to the parental C6 cells. dbcAMP and staurosporine not only inhibit proliferation but bring about complete apoptosis of fra-1 overexpressing clones. Spontaneous apoptosis is seen in fra-1 overexpressing clones especially in confluent cultures. fra-1 overexpression also results in substantial reduction in anchorage-independent growth and tumourigenicity of C6 cells. Overexpression of fra-1 leading to proliferation inhibition of C6 glioma cells is consistent with the concept that fra-1 functions as a negative regulator of AP-1 activity.