Impact of sperm DNA fragmentation in couples with unexplained recurrent pregnancy loss: A cross-sectional study.

OBJECTIVE: Recurrent pregnancy loss (RPL) has a multifactorial etiology, with a majority of cases remaining unexplained. To account for these unexplained cases, possible male factors are being explored. Conventional semen analysis lacks a qualitative assessment of sperms and information regarding sperm DNA integrity. Sperm DNA fragmentation (SDF) has diagnostic value in unexplained RPL, and it may account for a number of unexplained cases. Hence, we planned a study to explore and evaluate the impact of sperm DNA fragmentation in couples with unexplained recurrent pregnancy losses. STUDY DESIGN: Analytical cross-sectional study was conducted at a tertiary-level referral facility in India between August 2021 and July 2023. Participants (n = 70) were divided into two groups-male partners of couples with unexplained RPL (following spontaneous conceptions) (n = 35) and men with at least one previous live birth (spontaneous or following fertility treatments for female factor infertility such as ovulation induction or intrauterine insemination) as controls (n = 35). Neither of the two groups of couples recruited for this study had undergone ART as fertility treatment. Primary outcome assessed was mean DNA fragmentation index (DFI). Secondary outcomes included differences in semen parameters such as sperm concentration, progressive sperm motility and morphology, proportion of men with high (≥30%) and low DFI in the two groups, and the association between various semen parameters and DFI. RESULTS: Univariate logistic regression revealed that sperm DNA fragmentation was higher in men with unexplained RPL (30.0; IQR (interquartile range) 19.0, 46.0) as compared to controls (22.0; IQR 14.0, 30.0) although it was not statistically significant (OR, odds ratio, 1.02; 95% CI 1.0-1.1, p = 0.08). A higher proportion of men with unexplained RPL had DFI ≥30% compared to controls (54.2% vs. 25.7%; OR 3.43 (95% CI 1.2-9.4); p = 0.02). No statistically significant differences were observed in semen volume, sperm concentration, progressive motility, and morphology between the two groups. Sperm DNA fragmentation index also showed a weak but significant inverse relationship with sperm morphology (r = -0.336, p = 0.004). CONCLUSION: The current study did not show any significant difference in the mean sperm DNA fragmentation levels in male partners of couples with unexplained RPL compared to controls. However, a higher proportion of men with DFI ≥30% were observed in unexplained RPL population when compared to controls.

A novel investigations on medical and non-medical mask performance with influence of marine waste microplastics (polypropylene).

The entire human race is struggling with the spread of COVID-19. Worldwide, the wearing of face masks is indispensable to prevent such spread. Despite numerous studies reporting on the fabrication of face masks and surgical masks to reduce spread and thus human deaths, this novel work is considered the marine waste of microplastics, namely Polypropylene (PP) polymer, used to fabricate non-woven fabric masks through the melt-blown process. This experimental work aims to maximize the mask's quality and minimize its fabrication cost by optimizing the melt-blown process parameters and using microplastics. The melt-blown process was used to make masks. Parameters such as extruder temperature, hot air temperature, melt flow rate, and die-to-collector distance (DCD) were investigated as independent variables. The quality of the mask was investigated in terms of bacterial filtration efficiency (BFE), particle filtration efficiency (PFE), and differential pressure. The Taguchi L16 orthogonal array and Taguchi analysis were employed for experimental design and statistical optimization, respectively. The results reveal that the higher BFE and PFE are recorded at 96.7 % and 98.6 %, respectively. The surface morphological investigation on different layers ensured the fine and uniform porosity of the layers and exhibited minimum breath resistance (a low differential pressure of 0.00152 kPa/cm2). Hence the chemically treated marine waste microplastics improved the masks' performance.

Adhesion and proliferation properties of type I collagen-derived peptide for possible use in skin tissue engineering application.

The surface properties of three-dimensional scaffolds are improved by coating or covalently linking certain adhesion-promoting proteins or peptides. In the present study, the effect of type I collagen-derived peptide (GKNGDDGEA) on adhesion and proliferation of HaCaT keratinocytes and NIH3T3 murine fibroblast cell lines was studied to assess its suitability for possible skin tissue engineering applications. Cell adhesion and proliferation of HaCaT and NIH3T3 were found to be enhanced by peptide coating. The optimum peptide coating densities to obtain the best cell adhesion and proliferation were found to be 0.827 µmoles/cm2 and 0.62 µmoles/cm2 for HaCaT and NIH3T3, respectively. Cell adhesion, in the presence of anti-integrin α1 antibody, inhibited attachment of NIH3T3 cells indicating the involvement of integrin α1 receptor. However, the attachment of HaCaT cells was not affected by anti-integrin treatment. The higher expression of paxillin confirmed the effect of the peptide in mediating focal adhesion kinases (FAKs) in cell adhesion and proliferation. Gene expression analysis was performed on cell migration proteins like Rho, Rac, Cdc42, integrin receptor α1, and ß1, and the extracellular matrix modulating proteins like MMP2, TIMP, and COL1A1 to validate their role on the peptide-mediated cell proliferation. Immunofluorescence analysis showed the distribution and localisation of phospho-FAK on cells cultured on the peptide-coated surfaces. Results support the role of peptides in enhancing cell adhesion and proliferation properties.

Simultaneous bioelectricity generation and water desalination using Oscillatoria sp. as biocatalyst in photosynthetic microbial desalination cell.

Globally, the scarcity of drinking water has triggered the researchers towards the development of desalination techniques to turn up saline water into potable. Microbial Desalination Cell (MDC) is a novel green technology that shows potential approach for desalination along with electricity generation and wastewater treatment. However, the expensive catholyte/catalyst in the cathode side has limited the MDC for real time application. Hence, the main objective of this work was to investigate the electricity generation during dairy wastewater treatment and desalination efficiency using biocathode (Oscillatoria sp.) in the MDC. The results showed that the maximum open circuit voltage of 652 ± 10 mV, COD removal efficiency of 80.2 ± 0.5% and desalination efficiency of 65.8 ± 0.5%, were achieved respectively. The effect of saline water concentration was investigated and the performance of MDC was compared with real (sea) water. This study demonstrated that Oscillatoria sp. could be used as a potential biocatalyst in the cathode chamber for enhancing salinity removal along with electricity generation and wastewater treatment in the MDC.

Bioelectricity production from kitchen wastewater using microbial fuel cell with photosynthetic algal cathode.

In this study, the treatment of kitchen wastewater was demonstrated using microbial fuel cell (MFC) consisting photosynthetic microorganism as cathode catalyst. The power density and biomass generation were investigated using two photosynthetic microorganisms namely Synechococcus sp. and Chlorococcum sp., respectively. Cyclic Voltammogram analysis was performed to study the exoelectrogenic activity of mixed culture microorganisms present in the wastewater. The MFC experimental results showed that both species influenced the power production and COD removal efficiency. The MFC observed the higher power density of 41.5 ±â€¯1.2 mW/m2 with Synechococcus sp. as compared to Chlorococcum sp. (30.2 ±â€¯0.8 mW/m2). The effect of CO2 supply, light intensity and wastewater COD concentration on MFC performance were investigated. This study demonstrated the possibility of bioelectricity generation, CO2 sequestration and biomass production with the algae biocatholyte during the treatment of kitchen wastewater in the MFC.

Selective recovery of vanadium as AMV from calcium vanadate sludge by direct AS leaching process: An industrial approach.

Generation of calcium vanadate waste sludge their management and treatment.is one of the major problem of metal processing industry. In this paper, we have proposed a simple process for the selective recovery of vanadium as ammonium metavanadate (AMV) from the calcium vanadate sludge using ammonium sulphate (AS) as a leaching agent. Under the optimum leaching condition (pH-7.5, temperature-80 °C, time-1 h, AS reagent-0.5 M) it is possible to leach out 82% of V values from the calcium vanadate sludge. The overall recovery of V is 81% with 98.5% AMV product purity. The AMV product quality from AS leach process has been compared with conventional H2SO4 leach process. The proposed process has major advantages such as, better economic benefits, less chemical consumption, minimum effluent recycling and less waste generation.

A potential bioactive peptide candidate for biomaterial and tissue engineering applications.

The surface modification of biomaterials with matrikines for tissue engineering application is one of the recent approaches to improve their biocompatibility. In an earlier study, a peptide containing 21 amino acid isolated from bovine tendon collagen was shown to promote good cell adhesion in HeLa cell, and a smaller region in the peptide was identified using bioinformatics tool to mediate cell-peptide interaction. Hence, the present study was undertaken to validate the cell adhesion property of the smaller region of the peptide and elucidate probable peptide-cell interaction pathway. Cell adhesion and proliferation properties of the peptide were studied on cells cultured on surfaces coated with varying concentrations of peptide. Expression of focal adhesion related proteins like paxillin and pFAK Tyr397 was confirmed by immunoblotting and immunofluorescence microscopy respectively. The anti-pFAK Tyr 397 stained confocal micrographs and mRNA transcription levels of Cdc42 and Rho further confirmed peptide mediated cell spreading. The change in the expression levels of integrin α1 and ß1 indicates an integrin mediated cell-peptide interaction for cell survival and proliferation. Integrin mediated adhesion was further confirmed by anti-integrin blocking assay. The modulation of ECM components by the peptide was assessed by expression of COL1A1, TIMP mRNA levels and gelatin zymography for MMPs. The results of the study confirm the role of the small region of the larger collagen peptide in cell adhesion and proliferation and hint at the possible use of such small peptides as biocompatible surface modifiers for tissue scaffolds.

Effectiveness of Anti-Mullerian Hormone-tailored Protocol Compared to Conventional Protocol in Women Undergoing In vitro Fertilization: A Randomized Controlled Trial.

BACKGROUND: Assessment of ovarian reserve before an in vitro fertilization cycle (IVF) is one among the many factors that predicts a successful cycle. Individualized protocol based on ovarian reserve is designed to optimize the pregnancy outcome without compromising the patient safety. Although authors have shown that anti-Mullerian hormone-tailored (AMH) protocols have reduced the treatment burden and improved pregnancy rates, a few others have questioned its efficacy. AIMS: The aim of this study was to decide whether the AMH-tailored protocol or the conventional protocol better decides IVF outcomes. SETTING AND DESIGN: Prospective randomized controlled trial conducted at a tertiary level university hospital. MATERIALS AND METHODS: Patients undergoing theirfirst IVF cycle who fulfilled the inclusion criteria were recruited and randomized to each group. Serum follicle-stimulating hormone was done for the patients on day 2 or 3 of a prior menstrual cycle, and serum AMH was done in the preceding cycle. STATISTICAL ANALYSIS: Analysis was performed using SPSS software version 16. RESULTS AND CONCLUSION: There were 100 patients in each group. A total of 83 patients underwent embryo transfer in the conventional group and 78 patients in the AMH group. The clinical pregnancy rates per initiated cycle (36.4% vs. 33.3%) and per embryo transfer (45.1% vs. 41.3%) were similar in both the groups. There was no statistical difference in the number of cycles cancelled due to poor response or the risk of ovarian hyperstimulation syndrome in both the groups. Hence, this study showed the similar effectiveness of AMH-tailored protocol and conventional protocol in women undergoing IVF.

Appendix B: Solid Surface Vitrification.

Solid surface vitrification method involves direct contact of carrier loaded with droplet containing gametes or embryos with precooled metal surface. Over the years, following certain modifications, solid surface vitrification has emerged as an efficient method for vitrifying human gametes and embryos. Here, we describe the principle and methodology of solid surface vitrification.

Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: A retrospective study.

OBJECTIVES: The overwhelming numbers of twins following assisted reproductive technology (ART) are dichorionic twins, but monochorionic twins account for around 0.9% of post ART pregnancies. The data for post ART-monochorionic pregnancy outcomes are scarce due to the rarity of this condition. Hence, we evaluated the obstetric outcomes of monochorionic and dichorionic pregnancies conceived on ART. SETTINGS: University teaching hospital. STUDY DESIGN: A case-control study of monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) pregnancies conceived following ART treatment. Charts of all women who conceived following ART from 2008 to 2013 were screened. Among them, the monochorionic twins diagnosed in the first trimester were included and their obstetric outcome was followed-up. For comparison, an equal number of dichorionic twin pregnancies from age and body mass index matched mothers was selected. RESULTS: The baseline clinical characteristics were similar between the two groups. MCDA group had a higher miscarriage rate (50%) than the DCDA group (10%), with three seconds trimester miscarriages in the MCDA group. The live birth rates were lower in the MCDA versus DCDA group (40% vs. 90%). Among triplet pregnancies with a monochorionic component, the live birth rate was only 25%. CONCLUSIONS: Monochorionic pregnancies following ART have poorer obstetric outcomes when compared to dichorionic pregnancies. For monochorionic pregnancies following ART, intensive antenatal surveillance at a tertiary level obstetric and neonatal center may help optimize the outcome.

A population based case control study on breast cancer and the associated risk factors in a rural setting in kerala, southern India.

INTRODUCTION: The incidence of breast cancer is increasing in developing countries over three decades. Despite good health indicators breast cancer is a public health problem in Kerala with an annual incidence of 14.9/100000 population. Identifying the risk factors helps to reduce the incidence in future. METHOD: A Population based case control study was conducted among all the breast cancer cases in the Arpookara Panchayat of Kottayam district in Kerala. 20 cases of breast cancer were paired with age matched controls from the same geographic area (ratio 1:4) with a total of 100 study participants. Data were collected by interviewing the participants using a pre tested structured questionnaire. Analysis was done by the authors using SPSS version 16.0 RESULTS: Age group of participants ranged from 32-70 years with mean age of 49.7 + 10.39. Early menarche < 13 years [Odds Ratio =3.2, p= 0.03], being unmarried and single, family history of breast cancer [Odds Ratio = 3.5, p = 0.02], previous history of benign breast tumours [Odds Ratio =8.14, p= 0.04], breast feeding less than 2 years [Odds Ratio = 2.28, p = 0.01 ] were found to be the risk factors for the breast cancer and the birth of first child before 30 years [Odds Ratio =0.302, p = 0.03 ] was found to be a protective factor for breast cancer. 60% of cases belonged to lower socioeconomic status [Odds Ratio = 14.47, p = 0.03]. Despite high literacy status, significantly lower awareness about symptoms of breast cancer and self examination of the breast were noted [Odds Ratio =11.6, p= 0.03]. CONCLUSION: Awareness about symptoms of breast cancer and self examination of the breast were lacking in the study population. Health care personnel should be trained to spread the awareness of breast cancer in the community and to identify the vulnerable groups at the primary care settings itself. The policy makers can consider encouraging community participation by involving the non-governmental organizations, women self help groups and Public Private Partnerships in spreading the awareness of breast cancer.

Comparison of clinical outcomes following vitrified warmed day 5/6 blastocyst transfers using solid surface methodology with fresh blastocyst transfers.

OBJECTIVES: The literature regarding clinical outcomes following day 5/6 vitrified warmed blastocysts transfer has been conflicting. We decided to evaluate and compare the clinical outcomes following vitrified warmed day 5/6 blastocyst transfer using a solid surface vitrification protocol with fresh blastocyst transfers. SETTINGS: University teaching hospital. STUDY DESIGN: A total of 249 women were retrospectively analyzed: 146 fresh day 5 blastocyst (group 1), 57 day 5 vitrified warmed blastocyst (group 2), and 46 vitrified warmed day 6 blastocyst (group 3) transfer cycles. Vitrification was done using solid surface methodology (non immersion protocol). The main outcomes were implantation rates, clinical pregnancy, and live birth rate per embryo transfer. RESULTS: The baseline clinical characteristics were similar among all three groups. The implantation and clinical pregnancy rates following vitrified warmed day 6 blastocyst transfers (20.9% and 32.6%) were significantly lower as compared to day 5 fresh and vitrified warmed day 5 blastocyst transfers (40.3% and 56.1%, 36.3%, and 52.6%). However, there was no significant difference in the live birth rates across the three groups (group 1: 37.6%, group 2: 40.3%, and group 3: 28.2%). CONCLUSION: No statistically significant difference was observed in live birth rates between fresh day 5 blastocyst transfers and vitrified warmed day 5/6 blastocyst transfers. Vitrification of blastocysts using solid surface methodology is an efficient method of cryopreservation.

A Cross-sectional Descriptive Study was to Estimate the Prevalence of the Early Initiation of and Exclusive Breast Feeding in the Rural Health Training Centre of a Medical College in Tamilnadu, South India.

INTRODUCTION: The World Health Organization and the National guidelines on infant and young child feeding recommend the practice of exclusive breastfeeding of infants for the first 6 months after their birth. The objective of this study was to estimate the prevalence of the early initiation of and exclusive breast feeding. METHOD: A cross sectional, descriptive study was done. 79 infants and children who attended the under five clinic in the Rural Health Training Centre (RHTC), Pulipakkam Village, were chosen for the study by convenient sampling. This study was conducted by interviewing 79 mothers of the children in the ages of 0-24 months, who attended the under five clinic of RHTC, Pulipakkam. The data was collected by using a pre tested, structured questionnaire to obtain the information on the breast feeding and the hygienic feeding practices among mothers. The statistical analysis was done by the authors by using the SPSS, version 16. The significance in the differences were evaluated by using the Chi square test and the relationship between the variables were evaluated by using Kendall's tau correlation. A p value of <0.05 was considered as statistically significant. RESULTS: The prevalence of the early Initiation of breast feeding was 97.5% and the prevalence of exclusive breast feeding in the study population was 68%. Inadequate exclusive breast feeding and the lack of hygienic feeding practices among the mothers were significantly associated with an increased incidence of upper and lower respiratory tract infections and gastro intestinal infections in the infants and the children. CONCLUSION: The education of the antenatal mothers on the benefits of breast feeding and hygienic feeding practices and making all hospitals baby friendly have to be focused on, in order to achieve 80% exclusive breast feeding as per the national guidelines on infant and young child feeding. We need to strengthen the MCH services in the study area in order to achieve 100% immunization.

Affordable ART: a different perspective.

BACKGROUND: Although ≈ 10% of the population is affected by infertility, the treatment option of in-vitro fertilisation (IVF) remains unaffordable for the majority of infertile couples. We have initiated a lowcost programme incorporating an uncommonly used, but recognized, ovarian stimulation protocol, together with certain costlimiting initiatives in an established assisted reproductive technology (ART) set up. METHODS: The medical records of women who underwent the lowcost programme were analysed. Clomiphene citrate 50 mg daily was administered from Day 2 of the cycle and continued till the day of hCG trigger, thus preventing the LH surge. Intermittent doses of human menopausal gonadotrophin 150 IU were administered on alternate days from the 5th day onwards. Oocyte retrieval was carried out once at least two follicles of >18 mm were identified. The cycle was monitored by ultrasound only, with embryo transfer being carried out on Day 3. Clinical outcomes were recorded together with an estimation of the direct costs per cycle. Direct cost calculations did not include professional charges or facility costs. RESULTS: Of 143 women evaluated, 104 women underwent embryo transfer. The live birth rate and clinical pregnancy rate per embryo transfer were 19 and 22%. The live birth rate per initiated cycle was 14% (20/143). The multiple pregnancy rate was 26% with no case of ovarian hyperstimulation syndrome being recorded. The average direct cost per cycle was US$ 675 for IVF and US$ 725 for an ICSI treatment cycle. CONCLUSIONS: Using this protocol, together with several costcutting measures, we achieved an acceptable live birth rate per transfer of 19% at a reasonable cost. This approach could be used by established ART centres to provide treatment to couples who cannot afford conventional ART.

Blastocyst cryopreservation using solid surface vitrification: A preliminary study.

OBJECTIVE: The objective was to evaluate the effectiveness of a blastocyst cryopreservation program using solid surface vitrification. SETTING: This study took place in a university teaching hospital. STUDY DESIGN: Retrospective observational study. MATERIALS AND METHODS: Women undergoing frozen embryo transfer cycles over a 4-year period between 2006 and 2010 were studied. The cryopreservation policy followed was a vitrification protocol performed at the blastocyst stage, using a solid surface (nonimmersion) method. The post-thaw survival rate, implantation rate, clinical pregnancy rate, live birth rate, and neonatal outcome were recorded. RESULTS: Eighty-one women underwent 86 frozen embryo transfer cycles. Of the 240 blastocysts warmed, 204 survived giving a cryosurvival rate of 85% (204/240). The clinical pregnancy, implantation, miscarriage, ongoing pregnancy, and live birth rates per transfer were 47%, 29%, 12%, 16%, and 23% respectively. Of the 20 live births, there were 16 singletons and 4 twins. Eleven boys and 13 girls were delivered with no major or minor abnormality detected. CONCLUSION(S): The blastocyst vitrification protocol using the solid surface method is effective with results comparable to fresh blastocyst transfers. While retaining the rapid cooling effect, the nonimmersion technique eliminates the risk of contamination and disease transmission. Larger studies with long-term follow-up data would further confirm the efficacy and safety of this method of vitrification.

Symptomatic unilateral pleural effusion: A rare presentation of ovarian hyperstimulation syndrome.

Isolated pleural effusion is a rare presentation of ovarian hyperstimulation syndrome. The pathogenesis of this disorder has not been fully elucidated. It supports the role of systemic factors rather than transudation of fluid from the surface of enlarged ovaries. This article describes a rare case of isolated pleural effusion following controlled ovarian hyperstimulation during an in-vitro fertilization cycle.

The role of ellipticity on the preferential binding site of Ce and La in C78-D3h--a density functional theory study.

Endohedral metallofullerenes that encapsulate one or several atoms, or a cluster of atoms have molecular properties making them useful both in technology and in bio-medical applications. Some fullerenes are found to have two metal atoms incarcerated and it has been recently found that two Ce atoms are incorporated into the C(78)-D(3h) (78 : 5) cage. In this study, we report calculations on the structural and electronic properties of Ce(2)@C(78) using density functional theory (DFT). While Ce(2)@C(80)-I(h) (D(3d)) and La(2)@C(80)-I(h) (D(2h)) have different ground state structures, we have found that Ce(2)@C(78) has a D(3h) ground state structure just as La(2)@C(78). The encapsulated Ce atoms bind strongly to the C(78)-D(3h) cage with a binding energy (BE) of 5.925 eV but not as strong as in Ce@C(82)-C(2v) nor in Ce(2)@C(80)-I(h). The elliptical nature of the cage plays a crucial role and accommodates the two Ce atoms at opposite ends of the C(3) axis with a maximized inter atomic distance (4.078 A). This means that the effect of the additional f-electron repulsion in M(2)@C(78) with M = Ce compared to M = La, is less pronounced than in Ce(2)@C(80) compared to La(2)@C(80). We compare the results to the elliptical M(2)@C(72) (#10611) (M = La, Ce), and with a range of additional Ce and La endohedral fullerenes and explain the role ellipticity has in the preferential binding site of Ce and shed light on the formation mechanism of these nanostructures.

A rare case report: ovarian heterotopic pregnancy after in vitro fertilization.

OBJECTIVE: To report a case of ovarian heterotopic pregnancy after an IVF cycle. DESIGN: Case report. SETTING: Reproductive medicine unit, Christian Medical College Hospital, Vellore, India. PATIENT(S): A woman with an ovarian heterotopic pregnancy. INTERVENTION(S): Laparoscopic removal of ovarian ectopic pregnancy. MAIN OUTCOME MEASURE(S): Early detection and successful treatment of heterotopic pregnancy. RESULT(S): Successful laparoscopic management of ovarian pregnancy resulting in a single viable ongoing intrauterine pregnancy. CONCLUSION(S): Clinicians need to be aware of such rare and potentially fatal presentations after IVF, because early diagnosis and management in these cases can yield a favorable outcome.

Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome.

OBJECTIVE: To determine the predictive factors for pregnancy after controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI). DESIGN: Prospective observational study. SETTING: University-level tertiary care center. PATIENTS AND METHODS: 366 patients undergoing 480 stimulated IUI cycles between November 2007 and December 2008. INTERVENTIONS: Ovarian stimulation with gonadotrophins was initiated and a single IUI was performed 36 h after triggering ovulation. MAIN OUTCOME MEASURES: The primary outcome measures were clinical pregnancy and live birth rates. Predictive factors evaluated were female age, duration of infertility, indication for IUI, number of preovulatory follicles, luteinizing hormone level on day of trigger and postwash total motile fraction (TMF). RESULTS: The overall clinical pregnancy rate and live birth rate were 8.75% and 5.83%, respectively. Among the predictive factors evaluated, the duration of infertility (5.36 vs. 6.71 years, P = 0.032) and the TMF (between 10 and 20 million, P = 0.002) significantly influenced the clinical pregnancy rate. CONCLUSION: Our results indicate that COH/IUI is not an effective option in couples with infertility due to a male factor. Prolonged duration of infertility is also associated with decreased success, and should be considered when planning treatment.

Blastocyst stage transfer vs cleavage stage embryo transfer.

OBJECTIVE: To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage embryo in a similar cohort of women. DESIGN: Retrospective analysis. SETTING: University teaching hospital. MATERIALS AND METHODS: Women aged 35 or less undergoing in vitro fertilization/intracytoplasmic sperm injection between January 2005 and December 2006 were included in the study. When four or more grade 1 embryos were observed on day 3, extended culture till day 5 was undertaken. This policy was compared with a cohort of women who had at least three grade 1 embryos on day 3 and who had undergone a cleavage stage embryo transfer during the time period of January 2002-December 2004. Primary outcome evaluated was implantation rate and clinical pregnancy rate. RESULTS: Group 1 consisted of 50 women who underwent extended culture and blastocyst transfer. Group 2 comprised of 85 women who had cleavage transfer. The implantation rate for embryos transferred in group 1 was significantly higher than that for embryos transferred on day 3 (40.16% vs 11.43%). The clinical pregnancy rate was also significantly better with blastocyst transfer as compared with cleavage stage transfer (62% vs 29.76%). Significantly fewer embryos were required for transfer at the blastocyst stage compared with day 3 transfer (2.54 vs 3.45). CONCLUSION: In selected cases, blastocyst transfer with fewer embryos can be performed with high implantation and clinical pregnancy rates. This policy could lead to a reduction in the incidence of higher-order pregnancies.