Chorionic villous sampling through transvaginal ultrasound approach: A retrospective analysis of 1138 cases.

AIM: The aim of this study was to evaluate the effectiveness and safety of a transvaginal approach for chorionic villous sampling (CVS). METHODS: We carried out a retrospective data analysis of all the transvaginal CVS procedures performed for the purpose of prenatal diagnosis in a university-level referral center between January 2000 and December 2014. Women underwent the prenatal testing between 10 and 17 weeks of gestation mainly for hematological disorders involving single gene defects. The main outcomes were successful sampling rate, maternal contamination rate, post-procedure complications rates, and immediate fetal loss rate (<14 days post-procedure). RESULTS: A total of 1138 transvaginal CVS were performed during the study period and were available for analysis. The sampling success rate after the first attempt was 98.5% (1121/1138) and the overall success rate was 99.6% (1133/1138). The maternal contamination rate was 0.4% (5/1138). While two patients had vaginal bleeding (0.2%), fresh retroplacental collection was noted in four patients (0.4%) post-procedure. None of the patients developed ascending uterine infection following CVS. The immediate fetal loss rate was 0.2% (2/1138). CONCLUSION: Transvaginal approach is associated with high sampling success, along with low rates of maternal contamination and post-procedure complications; hence, it can be offered as an effective alternative method of CVS.

Effectiveness of GnRH Agonist Short Protocol Versus GnRH Antagonist Protocol in POSEIDON Groups 3 and 4: a Retrospective Cohort Study.

The aim of this study is to compare the ART (assisted reproductive technology) outcomes and cancellation rates between GnRH antagonist protocol and GnRH agonist short protocol in POSEIDON (Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number) groups 3 and 4. It is a retrospective cohort study conducted in the Department of Reproductive Medicine and Surgery of a tertiary-level hospital. Women who underwent ART treatment with either GnRH antagonist or GnRH agonist short protocol with fresh embryo transfer, between January 2012 and December 2019 belonging to POSEIDON 3 and 4 groups, were included. Among the 295 women who belonged to the POSEIDON groups 3 or 4, 138 women received GnRH antagonist and 157 women received GnRH agonist short protocol. The median total dose of gonadotropin in the GnRH antagonist protocol was not significantly different from GnRH agonist short protocol [3000, IQR (2481-3675) vs. 3175, IQR (2643-3993), p = 0.370]. There was a significant difference in the duration of stimulation between the GnRH antagonist and GnRH agonist short protocol [10, IQR (9-12) vs. 10, IQR (8-11), p = 0.002]. The median number of mature oocytes retrieved was significantly different in the cohort of women receiving GnRH antagonist protocol compared to GnRH agonist short protocol [3, IQR (2-5) vs. 3, IQR (2-4), p = 0.029]. There was no significant difference in the clinical pregnancy rate (24% vs. 20%, p = 0.503) and cycle cancellation rate (29.7% vs. 36.3%, p = 0.290) between the GnRH antagonist and agonist short protocols respectively. Live birth rate was not significantly different between the GnRH antagonist protocol (16.7%) and GnRH agonist short protocol (14.0%) [OR 1.23, 95% CI (0.56-2.68), p = 0.604]. After adjusting for the significant confounding factors, the live birth rate was not significantly associated with the antagonist protocol compared with the short protocol [aOR 1.08, 95% CI (0.44-2.63), p = 0.870]. Though GnRH antagonist protocol results in higher mature oocyte yield when compared with GnRH agonist short protocol, it does not translate into an increase in live birth in POSEIDON groups 3 and 4.

Perinatal Outcomes Using Ejaculate versus Surgical Sperm Retrieval in Patients Undergoing Intracytoplasmic Sperm Injection for Male Infertility - A Retrospective Analysis of 628 Cycles.

BACKGROUND: Men with azoospermia undergoing a surgical sperm retrieval are anxious about the well-being of the baby. It is therefore important to study the perinatal outcomes in this group compared to the ejaculate sample group. AIM: The aim of the study was to compare the perinatal outcomes between ejaculate and surgical sperm retrieval (SSR) groups in couples undergoing intracytoplasmic sperm injection for male factor. STUDY SETTING AND DESIGN: This was a retrospective cohort study conducted in a university-level infertility unit. MATERIALS AND METHODS: It is a retrospective cohort study analysis of 628 assisted reproductive technique (ART) cycles with male factor and combined (male and female) factor infertility over a period of 5 years (January 2011-December 2015). All women who underwent a fresh embryo ART cycle were followed up. The study population included the ejaculate and SSR groups. The perinatal outcomes of these two groups were compared. The congenital anomaly risks among the two groups were also analyzed. STATISTICAL ANALYSIS: Chi-square test, Fisher's exact test and Logistic regression. RESULTS: A total of 628 ART cycles were included in the current study, of which 478 cycles used ejaculate sperm, while SSR was done in 150 cycles. The analysis was restricted to singletons, and the risk of preterm birth was 22.9% in the ejaculate group, 5.9% in the epididymal group, and 12% in the testicular group (epididymal vs. ejaculate odds ratio [OR], 0.21; 95% confidence interval [CI]: 0.02-1.66) (testicular vs. ejaculate OR, 0.46; 95% CI: 0.12-1.65). The risk of low birth weight was 23.7% in the ejaculate group, 11.8% in the epididymal group, and 20.0% in the testicular group (epididymal vs. ejaculate OR, 0.42; 95% CI: 0.09-1.9) (testicular vs. ejaculate OR, 0.80; 95% CI: 0.27-2.3). The incidence of congenital anomalies was 7.3% in the ejaculate group, 0 in the epididymal group, and 3.5% in the testicular group (epididymal vs. ejaculate OR, 0.28; 95% CI: 0.01-5.2) (testicular vs. ejaculate OR, 0.63; 95% CI: 0.10-3.7) which was not significantly different. CONCLUSION: The current study showed no significant differences in the risk of adverse perinatal outcomes in the ejaculate group versus the surgically retrieved sperm groups.

Dietary pattern characterisation among subfertile South Asian women and the impact of vitamin B12 intake on frozen embryo transfer outcomes: a cross-sectional study.

STUDY QUESTION: Is there a difference in dietary patterns among subfertile South Asian women undergoing frozen embryo transfer (FET)? SUMMARY ANSWER: Significant regional differences in dietary pattern exist among subfertile South Asian women undergoing FET. WHAT IS KNOWN ALREADY: Preconception consumption of certain food groups or adopting specific dietary patterns, such as the 'Mediterranean diet', and its level of adherence have been shown to enhance the odds of achieving a successful pregnancy in women undergoing ART. However, differences in geographic location, individual preference, cultural beliefs and local availability contribute to such dietary choices. There is also a predisposition to a vitamin B12 deficiency in those of South Asian ethnicity and a predominant pattern of vegetarian food intake. There is a paucity of studies analysing the type of dietary pattern followed by South Asian women, their vitamin B12 levels and the potential impact on ART treatment outcomes. STUDY DESIGN SIZE DURATION: This is a cross-sectional study of 159 South Asian women aged 21-37 years, belonging to the Eastern (n = 75) and Southern (n = 84) regions of India plus Bangladesh, and undergoing a FET cycle at a tertiary level infertility clinic between February 2019 and March 2020. PARTICIPANTS/MATERIALS SETTING METHODS: Women underwent dietary assessment using '24-hour dietary recall' to capture daily nutrient consumption. A 'Food Frequency Questionnaire' listing commonly consumed foods was used to record frequency of intake. The primary outcome was the characterisation of regional dietary patterns in the cohorts using principal component analysis (PCA). Secondary outcomes included association of vitamin B12 intake and serum levels with clinical and ongoing pregnancy. MAIN RESULTS AND THE ROLE OF CHANCE: Four components contributing to overall variance in dietary pattern were identified, namely: meat, poultry and seafood; green leafy vegetables and root tubers; fruits, dairy and sugar; nuts and oilseeds. PCA analysis showed a significantly higher consumption of two components in the East-meat, poultry and fish (P < 0.001); green leafy vegetables and root tubers (P < 0.001). All women reported taking preconception oral folic acid supplementation. The dietary intake of vitamin B12 and serum concentration correlated, showing a good validity of measured dietary intake (r = 0.398; P ≤ 0.001). Compared to the Southern region, participants from the East showed a higher daily median intake of vitamin B12 (1.11 versus 0.28 mcg, respectively; P < 0.001) and a higher serum vitamin B12 levels (441 versus 239 pg/ml, respectively; P < 0.001). Ongoing pregnancy showed no association with dietary vitamin B12 intake (relative risk 0.90; 95% CI, 0.68 to 1.19) or serum vitamin B12 levels (relative risk 0.99; 95% CI, 0.73 to 1.33) after adjustments for female age, body mass index (BMI) and geographic differences. Women belonging to different quartiles of serum vitamin B12 concentration had a similar likelihood of ongoing pregnancy. LIMITATIONS REASONS FOR CAUTION: Self-reported dietary assessment is prone to measurement errors owing to its subjective nature and recall bias. The study was not adequately powered to detect the impact of geographic differences in vitamin B12 intake and serum levels on FET treatment outcomes, the second objective. We adjusted for potential confounders, such as female age and BMI, but it is possible that residual confounders, such as physical activity, stress and use of dietary supplements, may have influenced the results. Extrapolation of the study findings to women undergoing ART in other populations should be made with caution. WIDER IMPLICATIONS OF THE FINDINGS: Our study findings suggest important differences in local dietary patterns within the South Asian region. Hence a personalised approach to dietary assessment and intervention when undergoing ART based on population dynamics is warranted. The geographic differences in the vitamin B12 intake or serum levels did not have an impact on the FET outcomes. There is also a need to further investigate the impact of such dietary differences on ART treatment outcomes in a large study population. STUDY FUNDING/COMPETING INTERESTS: No grant from funding agencies in the public, commercial, or not-for-profit sectors was obtained. The authors have nothing to disclose. TRIAL REGISTRATION NUMBER: N/A.

Antioxidant pretreatment for male partner before ART for male factor subfertility: a randomized controlled trial.

STUDY QUESTION: Does oral antioxidant pretreatment for the male partner improve clinical pregnancy rate in couples undergoing ART for male factor subfertility? SUMMARY ANSWER: There was no significant difference in clinical pregnancy rate following oral antioxidant pretreatment for male partner in couples undergoing ART for male factor subfertility compared to no pretreatment. WHAT IS KNOWN ALREADY: Damage to sperm mediated by reactive oxygen species (ROS) contributes significantly to male factor infertility. The ROS-related injury reduces fertilization potential and adversely affects the sperm DNA integrity. Antioxidants act as free radical scavengers to protect spermatozoa against ROS induced damage. During ART, use of sperms which have been exposed to ROS-mediated damage may affect the treatment outcome. Pretreatment with antioxidants may reduce the ROS-mediated sperm DNA damage. Currently, antioxidants are commonly prescribed to men who require ART for male factor subfertility but there is ambiguity regarding their role. STUDY DESIGN SIZE DURATION: This was an open label, randomized controlled trial conducted at a tertiary level infertility clinic between February 2013 and October 2019. The trial included 200 subfertile couples who were undergoing ART treatment for male factor subfertility. PARTICIPANTS/MATERIALS SETTING METHODS: Couples were randomized into treatment arm (n = 100) and control arm (n = 100). In the treatment arm, the male partner received oral antioxidants (Vitamin C, Vitamin E and Zinc) for 3 months just prior to the ART cycle. In the control arm, no antioxidant was given to the male partner. The primary outcome was clinical pregnancy rate, while live birth rate (LBR), miscarriage rate and changes in semen parameters were the secondary outcomes. MAIN RESULTS AND THE ROLE OF CHANCE: Out of 200 women randomized, 135 underwent embryo transfer as per protocol. Following intention to treat analysis, no significant difference was noted in clinical pregnancy (36/100, 36% vs 26/100, 26%; odds ratio (OR) 1.60, 95% CI 0.87 to 2.93) and LBR (25/100, 25% vs 22/100, 22%; OR 1.18, 95% CI 0.61 to 2.27) between antioxidant and no pretreatment arms. The clinical pregnancy rate per embryo transfer was significantly higher following antioxidant pretreatment (35/64, 54.7% vs 26/71, 36.6%; OR 2.09, 95% CI 1.05 to 4.16) compared to no pretreatment. There was no significant difference in LBR per embryo transfer (25/64, 39.1%, vs 22/71, 31.0%; OR 1.43, 95% CI 0.70 to 2.91) after antioxidant pretreatment versus no pretreatment. The semen parameters of sperm concentration (median, interquartile range, IQR) (18.2, 8.6 to 37.5 vs 20.5, 8.0 to 52.5, million/ml; P = 0.97), motility (median, IQR) (34, 20 to 45 vs 31, 18 to 45%; P = 0.38) and morphology (mean ± SD) (2.0 ± 1.4 vs 2.2 ± 1.5%; P = 0.69) did not show any significant improvement after intake of antioxidant compared to no treatment, respectively. LIMITATIONS REASONS FOR CAUTION: The objective assessment of sperm DNA damage was not carried out before and after the antioxidant pretreatment. Since the clinicians were aware of the group allotment, performance bias cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS: The current study did not show any significant difference in clinical pregnancy and LBR following antioxidant pretreatment for the male partner in couples undergoing ART for male subfertility. The findings need further validation in a larger placebo-controlled randomized trial. STUDY FUNDING/COMPETING INTERESTS: This trial has been funded by Fluid Research grant of Christian Medical College, Vellore (internal funding). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: CTRI/2013/02/003431. TRIAL REGISTRATION DATE: 26 February 2013. DATE OF FIRST PATIENT'S ENROLMENT: 11 February 2013.

The effects of prolactin and corticosterone on insulin binding to rat Leydig cells.

The influence of prolactin (PRL) and corticosterone on insulin binding to purified rat Leydig cells was assessed in vitro. The lowest dose of PRL (50 ng/ml) increased (p<0.05) and the remaining PRL concentrations (100, 150, 200, 250 ng/ml) decreased (p<0.05) the insulin binding to Leydig cells. All doses of corticosterone (150, 200, 250, 300 ng/ml) except the lowest one (100 ng/ml) decreased the insulin binding. In conclusion, hyperprolactinemia or excess glucocorticoids associated with an impairment of testicular steroidogenesis may be mediated by a defective insulin binding to Leydig cells.

Comparison of Conventional Slow Freeze versus Permeable Cryoprotectant-Free Vitrification of Abnormal Semen Sample: A Randomized Controlled Trial.

BACKGROUND: The cryopreservation of semen samples by slow freezing remains as standard protocol. Recently, vitrification of spermatozoa was successfully reported with superior outcome. Till date, there is no randomized trial comparing the two different protocols. AIM: The aim of the present study is to evaluate the slow freezing with vitrification of the subfertile men spermatozoa to evaluate the progressive motility, vitality, and chromatin integrity. SETTING: The study was conducted at University teaching hospital. DESIGN: Study design involves randomized control trial. MATERIALS AND METHODS: Twenty subfertile men with semen characteristics of severe oligoasthenozoospermia (SOA) and very SOA (VSOA) randomized to undergo slow freezing and vitrification protocol and cryopreserved at 1-month and 6-month storage interval, postthawed or warmed, samples were assessed for progressive motility, vitality, and hyaluronan binding. SPSS version 14 software was used for statistical analysis. RESULTS: The SOA samples at 1 month revealed significantly higher motility (42% [22%-74%] vs. 7% [1%-13%]; P = 0.015) and vitality (57% [45%-78%] vs. 34.5% [27-42]; P < 0.001) following vitrification compared to slow-freeze method. For Very severe oligoasthenozoospermia (VSOA), the motility was significantly higher following vitrification (14.5% [2%-32%] vs. 2.5% [0%-4%]; P = 0.007). At 6 months, no statistically significant difference in motility was found between the two groups for Severe Oligoasthenozoospermia (SOA) samples (27% [13%-62%] vs. 8% [0%-11%]; P = 0.066), but motility was significantly higher following vitrification for VSOA samples (12.5% [3%-32%] vs. 2% [1%-5%]; P = 0.019). The hyaluronan-binding assay was comparable in both the groups at 6 months. CONCLUSIONS: The current study found the vitrification method involving the use of only nonpermeable cryoprotectants for cryopreservation of abnormal semen sample to be an effective alternative to the conventional slow-freeze technique.

Comparison of Perinatal Outcomes of Singletons Following Vanishing Twin Phenomenon and Singletons with Initial Single Gestational Sac Conceived Following Assisted Reproductive Technology: A Retrospective Analysis.

AIM: The aim of the study was to compare the perinatal outcomes between singletons following vanishing twin phenomenon and singletons arising from initial single gestational sac following assisted reproductive technology (ART) treatment. SETTING AND DESIGN: This was a retrospective cohort study. MATERIALS AND METHODS: A retrospective cohort study included analysis of all singleton births following ART over a period of 7 years (January 2010 -December 2016). All women who underwent fresh or frozen embryo ART cycles were followed up. The study population included all singleton births following spontaneous reduction of one of the gestational sacs in dichorionic diamniotic twin pregnancies. The perinatal outcome of this group was compared with those of singletons arising from the initial single gestational sac. RESULTS: A total of 521 singleton births were recorded during the study period. In the study group, 72 singleton births had spontaneous reduction of one of the gestational sacs (vanishing twin group) and the remaining 449 had an initial single gestational sac. The risk for low birth weight (LBW) (14/72, 19.4% vs. 96/449, 21.6%) and preterm birth (PTB) (17/72, 23.6% vs. 134/449, 29.8%) was not significantly different between those singletons who had spontaneous reduction from two gestational sacs to single sac compared to those with initial single sac. The miscarriage rate was significantly lower in vanishing twin group compared to control group (7/84, 8.3% vs. 157/622, 25.2%; P = 0.01). The subgroup analysis based on spontaneous reduction occurring before or after the appearance of the embryonic pole also showed similar risk of PTB (11/41, 26.8.% vs. 9/31, 29.0%) and LBW (7/41, 17.1% vs. 9/31, 29.0%). CONCLUSION: Perinatal outcomes in singleton live births following vanishing twin phenomenon are similar to those pregnancies with an initial single gestational sac following ART.

Does duration of abstinence affect the live-birth rate after assisted reproductive technology? A retrospective analysis of 1,030 cycles.

OBJECTIVE: To study influence of abstinence period on the live-birth rate after assisted reproductive technology (ART). DESIGN: Retrospective cohort study. SETTING: Reproductive medicine unit, university-level hospital. PATIENT(S): A total 1,030 ART cycles evaluated from 2011 to 2015. INTERVENTION(S): Group I, abstinence period 2-7 days, and group II, abstinence period >7 days, were compared. Two subgroups Ia (2-4 days) and Ib (5-7 days) were also compared with group II. MAIN OUTCOME MEASURE(S): Primary outcome was live birth per ET. Secondary outcomes included implantation, clinical pregnancy, and miscarriage rates. RESULT(S): The live-birth rate (34.1 % vs. 24.1%; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), clinical pregnancy rate (44.4 % vs. 32.7%; OR, 1.6; 95% CI, 1.1-2.3), and implantation rate (26.4% vs. 18.2%) were significantly higher in group I compared with group II. Other secondary outcomes of fertilization rate and miscarriage rate did not differ between groups I and II. The adjusted odds ratio (aOR) for live birth (aOR, 1.6; 95% CI, 1.1-2.5) and clinical pregnancy rates (aOR, 1.7; 95% CI, 1.2-2.5) were significantly higher for group I compared with group II. The live-birth rate was significantly higher in group Ia (36.1% vs. 24.1%) compared with group II. CONCLUSION(S): An abstinence period of more than 7 days may impact ART outcomes adversely when compared with an abstinence period of 2-7 days.