MOTHER Study: A Multicenter Observational, Retrospective Study to Determine Coorelation Between Physical CHaracteristics and Ovarian REserve Markers in Sub-feRtile Women.

BACKGROUND: The physical characteristics which are known to affect the ovarian reserve are age, body mass index (BMI), occupational exposures, age at menarche and menstrual cycle length. A correlation between different physical characteristics and the ovarian reserve will help to identify areas which need to be tackled to increase the chances of fertility of women in India. METHODS: In this retrospective, observational study, namely the MOTHER Study, data of women between 18 and 45 years of age, attending the selected fertility centers across different states in India were taken for evaluation. Demographic information along with information on factors potentially related to fertility like age of menarche, menstrual cycle length and occupational factors were collected by review of medical records at screening visit. Most recent AMH assay and antral follicle count (AFC) where the subject has not taken any contraceptives 12 months prior to the test were collected. RESULTS: Age of woman, years of marriage, years of infertility and smoking have shown effect on ovarian reserve testing like AMH and AFC. The other physical characteristics which were evaluated and considered to affect the ovarian reserve like body mass index BMI, occupational exposures, age at menarche and menstrual cycle length have not shown statistically significant correlation. CONCLUSION: Age of woman and years of infertility are inversely proportional to ovarian reserve markers, namely AMH and AFC. Addictions like smoking and alcohol affect ovarian reserve.

Reproductive Outcome of Patients with Asherman's Syndrome: A SAIMS Experience.

BACKGROUND: The purpose of the study was to evaluate menstrual and reproductive outcome in patients diagnosed with Asherman's syndrome on hysteroscopy and to assess the role of hysteroscopic adhesiolysis. METHODS: A prospective study was performed for patients having intrauterine adhesion at a tertiary care teaching hospital, Indore, India for a period of 2 years. Findings at hysteroscopy, details of adhesiolysis, changes in menstrual pattern following adhesiolysis, need for repeat procedure and fertility outcome were prospectively collected. Data was analysed using SPSS software. A p-value of <0.05 was considered significant. RESULTS: A total of 60 patients with a mean age of 30.1±5.5 years with Asherman's syndrome were included. In 53.3% of them, no factors like post-partum curettage, uterine surgery or history of tuberculosis could be found in which the present intrauterine adhesions could be attributed to. Hypomenorrhoea was the most common (53.3%) menstrual pattern in patients diagnosed with Asherman's syndrome. Thirty eight out of 60 (63.33%) required second look hysteroscopy. There was a significant change in endometrial lining and echo pattern after adhesiolysis (p<0.05). 45% of patients started having normal menstrual flow after adhesiolysis which was statistically significant. A total of 16 conceptions and 10 live births were reported in the present cohort. Pregnancy rate was higher in patients having mild Asherman's syndrome (53.3%) as compared to moderate (26.9%) or severe type (9.5%), (p=0.0049). It was also higher in patients having normal endometrial pattern after adhesiolysis (p=0.0005). CONCLUSION: Women who underwent hysteroscopic adhesiolysis showed significant improvement in the menstrual pattern. Pregnancy rates were improved after hysteroscopic adhesiolysis.

Carrier Screening for ß Thalassemia in Pregnant Indian Women: Experience at a Single Center in Madhya Pradesh.

To study the prevalence of ß thalassemia trait in pregnancy in urban population screening for ß thalassemia in pregnant women at a single center in Indore (MP) has been conducted for a period of 2 year. Blood samples were tested for complete blood count and hemoglobin electrophoresis. During the 2 year period a total of 1,006 women were screened; 28 women who carried abnormal pattern were detected. The mean gestational age for screening was 13 ± 4 weeks. The prevalence of carriers was 2.78 %. As much as 99 % of pregnant women undergoing screening were willing for prenatal diagnosis if required. The economic burden to the society for treating thalassemic patients is huge. The institution of prevention programs like carrier screening has proven costeffective in populations with a high frequency of carriers. Screening of pregnant women early in pregnancy followed by prenatal diagnosis is acceptable and effective strategy for control of thalassemia in developing countries like India.

Successful expectant management of tubal heterotopic pregnancy.

Expectant management for tubal heterotopic pregnancy could be considered as a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. We report the obstetric outcome after expectant management for a right tubal heterotopic pregnancy. Heterotopic pregnancy was first recognized at 6 weeks gestation in a 32-year-old salpingectomized woman with an 8-year history of subfertility who conceived after in utero transfer of three embryos obtained by in vitro fertilization. Expectant management and close ultrasonographic and clinical monitoring were done. The intrauterine pregnancy proceeded unremarkably. A cesarean section was performed for breech presentation, and it allowed the delivery of a healthy 2260-g male infant. The examination of the adnexa showed a pre-rupture of the right fallopian tube.

Birth after intracytoplasmic sperm injection with use of testicular sperm from men with Kartagener or immotile cilia syndrome.

OBJECTIVE: To describe a case of intracytoplasmic sperm injection (ICSI) with testicular sperm in men with immotile cilia syndrome and to discuss the role of micromanipulation in the treatment of these patients. DESIGN: Case report. SETTING: Private infertility clinic and assisted reproduction unit. PATIENT(S): Couple with male factor infertility due to Kartagener's/immotile cilia syndrome. INTERVENTION(S): The patient's partner underwent ICSI with testicular sperm. MAIN OUTCOME MEASURE(S): Semen characteristics, sperm viability, fertilization and cleavage rate, pregnancy, and birth after ICSI. RESULT(S): With testicular sperm, the two pronuclear fertilization rates were 53%. ICSI was successful in the first cycle. The uncomplicated pregnancy resulted in the birth of two healthy children, male/female twins. CONCLUSION(S): With testicular sperm, successful oocyte fertilization after ICSI in couples with male Kartagener or immotile cilia syndrome is possible with nonprogressive motile sperm resulting in clinically healthy offsprings.