Maternity After Orthotopic Liver Transplantation: Can the Use of Biological Fertility Indicators Help? Our Own Experience and Literature-based Recommendations

Over the last 5 decades, the fulfillment of maternity wishes in solid organ transplanted women has become a reality. Despite pregnancy contraindication in transplanted women during the early post-transplant period, such a condition can be overcome after 12 months if patients show a good clinical evolution and do not present other general pre-conceptional findings. This article presents the case report of a young female liver transplanted patient that used symptothermal method as a reliable family planning method. After her gestational contraindication was lifted, observation of biological fertility indicators and fertility-guided sexual intercourse helped her fulfill her maternity wish and conceive and carry out a healthy offspring. Based on this case and on the available bibliographic evidence, this paper reviews the potential implications of the use of this kind of approach as a safe and effective alternative to assisted reproduction technology in the management of potential infertility problems in the young female transplanted population, a population which according to literature has higher rates of unsuccessful parenthood and might also be more vulnerable to iatrogenicity of ovarian hyperstimulation process and to multiple pregnancy.

A study on outcome of controlled ovarian hyperstimulation and intrauterine insemination (husband) in a medical college in Kolkata

Background: A combination of controlled ovarian hyperstimulation and intrauterine insemination (IUI) remains an important treatment option for couple having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors. Aims and Objectives: To assess the factors affecting the success rate of IUI and to evaluate the success of ovulation Induction by different methods of controlled stimulation protocol. Materials and Methods: It is a duration-based prospective cross-sectional study where total of 67 couples were included by inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having a maximum of three cycles. Ovulation induction was done by clomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The outcomewas measured by positive urine pregnancy test. Range, percentage, confidence interval, mean with standard deviation, median, range, and P-value were calculated. P<0.05 was taken as statistically significant. Results: Out of 90 IUI cycles 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors that had a positive impact were follicle size >21 sqmm, endometrial thickness >9 mm, post wash count >15 million/ml, >2 cycles of IUI and on the number of follicles 2 or more on the day of trigger. Conclusion: The study concluded that IUI after ovulation induction can be a simple and safe cost-effective procedure in selected group of infertile couple. Clinical significance IUI following ovulation induction can be a successful approach for specific indications in a low-resource setting where options for other ART interventions are absent or limited.

Effectiveness of Cryopreservation in Patients of Young Reproductive Age with the Risk of Ovarian Hyperstimulation, "Thin" Endometrium and Previous IVF Failures

The article provides an analysis of clinical, anamnestic and laboratory parameters for patients of young reproductive age who participated in IVF programs and have cryopreserved embryos. The main reasons for embryo cryopreservation were prevention of OHSS, "thin" endometrium and "previous IVF failures." It has been found that the patients from the group of transfer cancellation due to prevention of ovarian hyperstimulation had a higher ovarian reserve, a larger number of eggs, fresh and frozen embryos, and shorter shelf life of frozen embryos. All embryos were of the best quality (corresponding to the day of cultivation); the “post-thaw cultivation” technique was applied. During stimulation, lower amounts of gonadotropins were used. Patients with thin endometrium and previous IVF failures demonstrated slow growth of follicles, which required a higher course dose of gonadotropins with the addition of LH-containing preparations. Regardless of the group, in most cases, frozen/thawed embryos were transferred at the blastocyst stage (Day 5). The pregnancy rate was high in patients at risk of OHSS and with thin endometrium (48.6%, 48.0%). Patients with IVF failures had a lower pregnancy rate; this is due to endometrial pathology in the medical history, a smaller number of antral follicles, oocytes, fresh and frozen embryos, and longer shelf life of frozen embryos.