Context:Elevated sperm DNA fragmentation index (DFI) is found to affect normal embryonic development, implantation and fetal development after intrauterine insemination (IUI), in vitro fertilization and intracytoplasmic sperm injection (ICSI). Estimation of DFI by terminal deoxynucleotidyl transferase-mediated fluorescent deoxy uridine nucleotide nick end labeling (TUNEL) assay was found to have a high predictive value for pregnancy after fertility treatments.Aim:This study aims to find the effect of increased sperm DNA fragmentation by TUNEL assay on reproductive outcome after IUI and ICSI.Primary Objective:To find the association of DFI and pregnancy rate in IUI and ICSI.Secondary Objectives:To find the association of DFI with fertilization and implantation in ICSI. To find the association of DFI with miscarriage rate.Settings and Design:A prospective observational study performed at a tertiary care university teaching hospital.Subjects and Methods:105 male partners of infertile couple planned for IUI and ICSI underwent estimation of sperm-DFI by TUNEL assay. The treatment outcomes were compared between the DFI-positive (≥20%) and DFI-negative (<20%) groups.Statistical Analysis Used:Statistical analysis was performed by SPSS version 17, Software. P < 0.05 was considered statistically significant.Results:The men with abnormal semen analysis were significantly higher in the DFI-positive group (77.15% vs. 22.85%). There was no significant difference in the pregnancy rate in IUI cycles (17.6% vs. 11.8%); but in the ICSI, the pregnancy rate was significantly reduced in the DFI-positive group (16.7% vs. 47.4%).Conclusions:Elevated DFI significantly affects the pregnancy rate in ICSI cycles.
Background: Adenomyosis is known to cause reduced clinical pregnancies and increased miscarriage rates in ART (Assisted Reproductive Technology) cycles. The detrimental effect was found to be enhanced if these women would undergo fresh embryo transfer without optimal suppression by GnRH agonist treatment. Several mechanisms were proposed as causative factors such as increased myometrial contractions, decreased implantation and altered endometrial receptivity. But the conclusions from previous studies were mutually conflicting. To ensure adequate regression of the disease prior to embryo transfer, these women would commonly undergo freeze-all and subsequent frozen embryo transfer. On contrary to this, fresh embryo transfer may be necessary in certain justifiable clinical situations. The present study was designed as a retrospective case-control study to compare the ICSI-fresh embryo transfer outcomes of women with adenomyosis to those with tubal factor infertility. This study is aimed to find the extent to which adenomyosis compromises the outcomes of fresh embryo transfer in ICSI cycles. Methods: The data of the eligible patients as per the study criteria, was obtained from the hospital medical records of a tertiary care University teaching hospital, in Chennai, South India. The study groups (Group A: women with adenomyosis, GroupB; women with tubal factor infertility) were compared for the fresh embryo transfer outcomes such as pregnancy rate, clinical pregnancy rate, miscarriage and live birth rates. SPSS version 17 software was used and and P<0.05 was considered statistically significant.Results: The data of 89 women included in the study (Group A: 47, and Group B: 42) were analysed. The data analysis showed significantly reduced pregnancy, clinical pregnancy, implantation and live birth rates in Group A compared to Group B (25.7 vs. 52.4%; 23.4 vs. 52.4%; 7.6% vs. 26.2%; 17.0 vs. 47.6%, respectively).Conclusions: We found that adenomyosis is associated with a less favourable outcome in ICSI -fresh embryo transfer. Though these results are justifiable if performed with appropriate indications, the cost-effectiveness and indications of such an approach needs to be evaluated on a larger prospective data.
OBJECTIVE To ascertain the threshold value for anti‐Müllerian hormone (AMH) in the diagnosis of polycystic ovarian syndrome (PCOS) in an Indian population. METHODS A retrospective observational study was carried out on infertile women at the Department of Reproductive Medicine and Surgery at a tertiary hospital from January 2017 to November 2019. Serum AMH was analyzed with Access AMH chemiluminescent immunoassay. Receiver operating characteristic curves were used to calculate the diagnostic threshold value of serum AMH in two age groups: 20–29 and 30–39 years. RESULTS Of 688 women, 200 (29.1%) were diagnosed with PCOS by the Rotterdam criteria: 98/282 (34.8%) aged 20–29 years and 102/406 (25.4%) aged 30–39 years. Mean serum AMH was 5.07 ± 3.97 and 4.330 ± 7.15 ng/ml in women aged 20–29 and 30–39 years, respectively. A threshold value of serum AMH above 3.75 ng/ml was predictive of PCOS by Youden's J statistics in the entire cohort, whereas it was 5.46 and 3.46 ng/ml in women aged 20–29 and 30–39 years, respectively. CONCLUSION Serum AMH of 5.46 and 3.46 ng/ml in women aged 20–29 and 30–39 years, respectively, can be used to diagnose PCOS when there is a diagnostic dilemma in the Rotterdam criteria.
Background: Prevalence of Metabolic syndrome is increasing rapidly among the infertile women over the last few years Objective: to evaluate the prevalence of metabolic syndrome (MBS) among the infertile women. Methods: A prospective cross-sectional study was conducted of all infertile women in a tertiary care centre in southern India. These women underwent screening for MBS according to the modified AHA/NHLBI (ATP III 2005) definition. These women were categorized as PCOS and Non PCOS based on Rotterdam criteria (2003). Results: Among 1030 infertile women. The prevalence of MBS among the infertile women was 35.3% and among PCOS and Non PCOS women were 44.7% and 28.9% respectively. Conclusions: The prevalence of MBS among infertile women was 35.3%. It is showing an upward trend among infertile PCOS and Non PCOS women. So early screening for MBS can reduce the long term sequale.
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