Background:It is essential to determine the cut-off value of serum anti-Mullerian hormone (AMH) to predict the hyper response in assisted reproductive technology (ART). There are few studies mentioning the cut-off value for the hyper response in infertile women but not specifically for polycystic ovary syndrome (PCOS) and non-PCOS groups. With this in background, this study was conducted.Aim:To determine the cut-off value of serum AMH to predict the hyper response in women with PCOS and non-PCOS undergoing a controlled ovarian stimulation (COS) in ART.Objective:To compare the outcome of stimulation in PCOS and non-PCOS groups.Materials and Methods:All 246 women enrolled for Intra Cytoplasmic Sperm Injection (ICSI) fulfilling the selection criteria were recruited. On the day 3 of the cycle, the serum AMH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol and antral follicle count (AFC) were measured. They underwent COS as per the unit protocol. They were divided into PCOS and non-PCOS groups as per the Rotterdam’s criteria. The mean age, duration of infertility, Body Mass Index (BMI), Ovarian reserve markers and outcome of stimulation were compared. Using the Statistical Package for the Social Sciences version 16.0 software, the significant difference was measured by multivariate analysis, as well as a one-way analysis of variance with Tukey’s post-hoc test was used.Results:Among 246 women, 31.3% were in PCOS group, and 68.7% were in non-PCOS group. Comparison of PCOS and non-PCOS groups showed a significant difference in the age with the mean age being 29.2 and 31.5 years, respectively. The mean AMH and AFC were 2-fold higher in PCOS group. The mean number of follicles, oocytes retrieved, MII and oocytes fertilised were significantly higher in PCOS group. The pregnancy rate was 52.6% in PCOS and 30.9% in non-PCOS group. In the PCOS group, 22.1% had ovarian hyper stimulation syndrome (OHSS), and only 4.7% had OHSS in non-PCOS group (P = 0.0005). Receiving Operator Curve (ROC) curve was plotted to predict the hyper response, which showed a cut-off value of 6.85 ng/ml with a sensitivity of 66.7% and a specificity of 68.7% for PCOS group and 4.85 ng/ml with a sensitivity of 85.7% and a specificity of 89.7% in non-PCOS group.Conclusion:The cut-off value of serum AMH to predict the hyper response in PCOS group is 6.85 ng/ml and in non-PCOS group is 4.85 ng/ml.

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:Serum estradiol (E2) levels are measured in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), to assess the ovarian response and to predict ovarian hyperstimulation syndrome. The impact of peak E2 levels on IVF-ICSI outcome was found to be inconsistent in the previous studies.AIM:To evaluate the impact of the serum E2 levels on the day of ovulation trigger with the reproductive outcome of ICSI.SETTINGS AND DESIGN:Retrospective observational study. ART Center, at a Tertiary Care University Teaching Hospital.SUBJECTS AND METHODS:Eighty-nine infertile women, who underwent ICSI with fresh embryo transfer over a period of 3 years, were included in the study. The study subjects were grouped based on the serum E2 level on the day of ovulation trigger:- Group I - <1000 pg/ml, Group II - 1000–2000 pg/ml, Group III – 2000.1-3000 pg/ml, Group IV – 3000.1–4000 pg/ml, and Group V >4000 pg/ml. The baseline characteristics and controlled ovarian hyperstimulation (COH) outcome were compared among the study groups.STATISTICAL ANALYSIS USED:Chi-square test, Student's t-test, ANOVA, and logistic regression analysis.RESULTS:The study groups were comparable with regard to age, body mass index, ovarian reserve. Group V had significantly higher number of oocytes retrieved than I and II (18.90 vs. 11.36 and 11.33; P = 0.009). Group IV showed significantly higher fertilization rate than I, III, and V; (92.23 vs. 77.43, 75.52, 75.73; P = 0.028). There were no significant differences in the implantation rates (P = 0.368) and pregnancy rates (P = 0.368).CONCLUSION:Higher E2 levels on the day of ovulation trigger would predict increased oocyte yield after COH. E2 levels in the range of 3000–4000 pg/ml would probably predict increased fertilization and pregnancies in ICSI cycles.

Aim and objective To study the prevalence of metabolic syndrome (MBS) in different body mass index (BMI) group infertile women in both polycystic ovarian syndrome (PCOS) and non-PCOS subgroups. Materials and methods A prospective cross-sectional study of all infertile women attending the outpatient in the department of reproductive medicine and surgery in a tertiary care center catering patients from South India was conducted. These women were categorized based on BMI into groups as ≤23 kg/m2, 23.1–25 kg/m2, 25.1–27 kg/m2, 27.1–30 kg/m2, and >30 kg/m2. They were further subdivided as PCOS and non-PCOS based on Rotterdam criteria (2003). These women underwent screening for MBS according to the modified American Heart Association/National Heart Lung Blood Institute AHA/NHLBI (ATP III 2005) definition. The results were analyzed for significance by the unpaired t test and the Chi-square test. Results A total of 1,030 infertile women were analyzed. The mean age was 28.8 ± 4.5 years; mean BMI was 26.9 ± 3.7 kg/m2. More than 90% of women had waist circumference >80 cm. The prevalence of MBS among the infertile women was 35.3% and among PCOS and non-PCOS women was 44.7 and 28.9%, respectively. Even though there was statistically no significant difference in the metabolic parameters among PCOS and non-PCOS subgroups in different BMI cutoff levels, there was an increase in abnormal metabolic parameters with increase in BMI. The prevalence of MBS in the BMI groups among PCOS women was 11.1, 28.1, 29.7, 51.8, and 73.6%, respectively (p = 0.0005) and among non-PCOS women was 4.9, 20.4, 24.6, 41.6, and 66.7%, respectively (p = 0.0005). Conclusion The BMI is an independent risk factor for MBS in both PCOS and non-PCOS infertile women. Clinical significance Screening for MBS in infertile women helps in early identification and primary prevention by lifestyle modification helps in delaying long-term consequences of type 2 diabetes mellitus and cardiovascular diseases. How to cite this article Vembu R, Nandini Devi M, Nellepalli SR, et al. Impact of Body Mass Index on the Prevalence of Metabolic Syndrome among Infertile South Indian Women. Int J Infertil Fetal Med 2019;10(3):42–45.

of >10 mIU/mL. Of those 8 became pregnant (27.6%) compared to 10 pregnancies (32.3%) in the 31 patients with no LH rise (P ¼0.693). Twelve patients (20%) had a rise of plasma progesterone (¼>1.5 ng/mL) and 8 patients (13.3%) had a rise of ¼>3 ng/mL and none of these patients became pregnant, compared to 18 pregnancies in the 48 patients (37.5%) with plasma progesterone <1.5 ng/mL (P < 0.02). The serum LH and plasma progesterone levels were 10.8 mIU/mL and 0.9 ng/mL, respectively in the patient who miscarried.CONCLUSIONS: Contrary to accepted convention, the premature rise of serum LH on the day of HCG administration does not seem to affect the clinical outcome in anovulatory patients treated with gonadotropins. However, the rise of progesterone >1.5 ng/mL is detrimental to the clinical outcome in those patients. Converting the cycle to IVF in those patients and freezing all the embryos for transfer in subsequent cycle(s) is suggested.SUPPORT: None.