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.

Care seeking behaviour of infertile couples attending a government infertility clinic in Delhi

Background: Childbearing is the reproductive right of every infertile couple. Infertility brings with it, multi-dimensional implications like social, economic and psychological. Care seeking by infertile couples is poorly understood as infertility services are deficient at grass-root level. We aimed to examine treatment seeking behaviour among infertile couples.Methods: A descriptive study was carried from 15 October 2019 to 15 March 2020. Primary data was collected by interviewing 196 married couples seeking care from an infertility clinic in Delhi. Data was tabulated and analyzed using statistical package for the social sciences (SPSS) version 23.Results: Majority of the couples had primary infertility (73%). In 47% of the couples, care seeking was advised by the household members. Most of the couples (82%) took decision to seek care themselves. Treatment was initiated within 3 years of marriage in 45% of couples. For first consultation, infertility treatment was sought from private sector (73%), public sector (16%) and informal sector (11%). Among public sector consultations, Government Medical College was preferred by 44% of couples while in private sector, 80% of them preferred private clinics. Infertility care was sought in 79% of couples from allopathic specialists. Mean duration of treatment and visits per consultation was 5 months and 10 visits respectively. Main source of information for treatment were friends and close relatives. Females (98%) faced more pressure from family to seek treatment than the males (72%).Conclusions: Main source of infertility care was from private sector. Females faced more pressure to seek treatment. Services in the public sector needs to be developed and strengthened to make infertility care accessible, equitable and affordable.

Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization

We carried out a retrospective analysis of infertile couple data using several methodologies and data analysis techniques, including the application of a novel data mining approach for analyzing varicocele treatment outcomes. The aim of this work was to characterize embolized varicocele patients by ascertaining the improvement of some of their clinical features, predicting the success of treatment via pregnancy outcomes, and identifying data patterns that can contribute to both ongoing varicocele research and the more effective management of patients treated for varicocele. We retrospectively surveyed the data of 293 consenting couples undergoing infertility treatment with male varicocele embolization over a 10-year period, and sperm samples were collected before and at 3, 6, and 12 months after varicocele embolization treatment and analyzed with World Health Organization parameters—varicocele severity grades were assessed with medical assessment and scrotal ultrasound, patient personal information (e.g., age, lifestyle, and embolization complications) was collected with clinical inquiries, and varicocele embolization success was measured through pregnancy outcomes. Varicocele embolization significantly improved sperm concentration, motility, and morphology mean values, as well as sperm chromatin integrity. Following this study, we can predict that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance of conceiving after embolization treatment if his partners’ age is between 24 and 33 with an accuracy of 70.59%. Furthermore, male patients successful in achieving pregnancy following embolization are mostly characterized by having a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, and not working in a putatively hazardous environment.

A Successful ART Treatment of Advanced Maternal Age Pregnancy with HRT Along with Donor Oocytes: A Case Study at Wardha Test Tube Baby Centre

Introduction: This case report refers to 54 years old infertile woman who visit ACHARYA VINOBABHAVE RURAL HOSPITAL for her ARTHRITIS PROBLEM with her husband (age 61-year-old). During her treatment, she got to know about IVF/ART procedures. As she belongs to a rural area and is not so educated, she was not aware of this and start investigating it and found it interesting. After knowing about all these procedures, a new ray of hope was awakened in her that, she can also give birth to her baby after so much waiting and facing so much criticism by society as a barren woman. In the 36th week of gestation, one healthy baby girl has been delivered by Cesarean section. In this way, the faith between patient and doctor was built-up and inevitably, we can appreciate this case of postmenopausal gestation (Geriatric Pregnancy) As A Therapeutic Victory For Wardha Test Tube Baby Centre and for the patient as well. This infertile couple was not that financially strong and even this all procedure is too much unaffordable to them still after all these, their urge to having a baby is so high that, they invest financially as well as emotionally and also mother put her health in peril while going through IVF/ART procedure. Being an infertile woman, she has to face a lot, and in such conditions, women go through psychological torture, and from this depressive phase, many health issues arise. Main Symptoms and/or Important Clinical Findings: Menopausal woman, qualitative analysis of AMH show 0 ng/ml, means diminished ovarian reserve (DOR). The Main Diagnoses, Therapeutic Interventions, and Outcomes: The woman is pinpointed with primary infertility for 26 years. The couple suggested going for IVF/ICSI treatment with donor oocytes(frozen) and self-sperm sample, ICSI is performed and sequential embryo transfer is done and gets conceived in the first cycle of ART. As being a menopausal woman, the dose of oral intake of estrogen hormone tablets doubles as an HRT treatment. Conclusion: Intake of the double dose of estrogen orally (hormone replacement therapy, HRT) than the normal women whose age is not much and who is not menopausal, increases the endometrium thickness and its receptivity which helps the woman to conceive in the first cycle through ART.

The Gender Gap in the Diagnostic-Therapeutic Journey of the Infertile Couple

Medical procreation impairs both the biological and psychological lives of couples. However, male and female attitudes to infertility are different and require a different approach during the IVF journey. Thus, the gender impact assessment (GIA) method was used to analyse original studies present in the literature. We found some gender-related differences and, subsequently, possible outcomes of intervention to improve healthy reproduction management and prevent infertility. In particular, it became apparent that there was the need for an in-depth male infertility assessment and a gender-specific follow-up.

Study of Semen Analysis Patterns in Male Partner of Infertile Couple Attending Tertiary Level Hospital of Nepal

Aims: The aim of this study is to analyze the pattern of semen abnormality in male partner of infertile couple in Nepal. Methods: A retrospective study of semen sample of male partner of infertile couple analyzed in Department of pathology, Dhulikhel Hospital from January 2014 to December 2018. All semen samples were processed and analyzed according to methods and standards outlined by World Health Organization laboratory manual for the examination and processing of human semen 2010. Results: A total of 520 semen samples were analyzed. Our study shows 221 (44%) abnormal for different semen parameters and asthenozoospermia (39.3%) is the most common abnormality followed by azoospermia (28.8 %), Oligoasthenozoospermia (17.9 %), Oligozoospermia (8.7 %), Oligoasthenoteratozoospermia (3.5 %) and teratozoospermia (1.8 %). Conclusions: Abnormal semen parameters remain significant causes in overall infertility in our set up with asthenozoospermia and azoospermia were common abnormalities in male partner. Semen analysis is an inevitable tool for evaluation of infertility in male partner. Further study is required to find out the possible etiologies of male infertility for holistic management of infertility.

Semen Analysis and Insight into Male Infertility

Objectives: Semen analysis is the cornerstone for the valuation of the male partner in the infertile couples. This test has been standardized throughout the world through the World Health Organization (WHO) since the1970s by producing, editing, updating, and disseminating a semen analysis manual and guidelines. A retrospective study to give an insight about male infertility. Methods: This retrospective study assessed the semen findings of 1000 men evaluated at the Department of Urology, Al-Kindy Teaching Hospital in Baghdad-Iraq between January 2016 and May 2019. Semen analysis were done for them. Results: According to WHO standard for semen normality, 1000 samples that were analyzed, normospermia was shown in 835 (83.5%)males (95% CI=0.811-0.857) and 12% had oligospermia and the rest 4.5% was azospermia. The normospermic samples had significantly higher levels regarding the following parameters: count per ml (51.30±1.24) (P= 0.001), volume(3.34±2.31)(P=0.0001), pus cell (8.04±1.02)(P=0.0001), motility (22.81±5.8)(P=0.0001), abnormal motility (22.81±5.8)(P=0.0001) and normal (V)(P=0.0001)or abnormal morphology (25.86 ±12.4)(P=0.0002) when compared with oligospermia. Conclusions: Semen analysis is the keystone of infertile couple. Semen parameters like sperm concentration, motility and morphology, are indicators for male reproductive function. Sperm concentration is declining and there is a significant association between sperm concentration and sperm parameters.

High Complexity Fertilization in Cuba: Egg Donation

The decades of the 70s and 80s of the last century in our country, allowed us to glimpse that the possibilities of treatment for the infertile couple were considerably expanded. Until that moment, infertile couples had very limited options such as adoption, insemination using a donor or conforming to not having children. In Cuba, since 1979, the first steps were taken in the field of assisted reproduction in animals. Human reproduction studies have been carried out at the National Institute of Endocrinology and the Ramón González Coro Gyneco-obstetric Hospital, the first birth having occurred in 1986. Since 2006 and with the aim of guaranteeing perinatological care specialized in pregnant patients as a result of in vitro fertilization, it was decided to create a consultation at the Ramón González Coro Hospital given the high rate of twin and triple pregnancies, preterm births and complications. The number of patients treated had to proceed with high complexity in vitro fertilization and sometimes ICSI and it was not until 2014 after the approval by our constitution, the family code and medical ethics that egg donation began.

Genetic counseling and diagnostic guidelines for couples with infertility and/or recurrent miscarriage

Around 10–15 % of all couples are infertile, rendering infertility a widespread disease. Male and female causes contribute equally to infertility, and, depending on the definition, roughly 1 % to 5 % of all couples experience recurrent miscarriages. In German-speaking countries, recommendations for infertile couples and couples with recurrent miscarriages are published as consensus-based (S2k) Guidelines by the “Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften” (AWMF). This article summarizes the current recommendations with regard to genetic counseling and diagnostics. Prior to genetic counseling, the infertile couple must undergo a gynecological/andrological examination, which includes anamnesis, hormonal profiling, physical examination and genital ultrasound. Women should be examined for the presence of hyperandrogenemia. Men must further undergo a semen analysis. Based on the overall results, hyper- or hypogonadotropic hypogonadism can be diagnosed in both sexes. Female genetic diagnostics for infertility comprise karyotyping, analysis of the FMR1 premutation and a gene panel including genes associated with congenital hypogonadotropic hypogonadism (CHH) or congenital adrenal hyperplasia. Male genetic diagnostics for infertility comprise karyotyping, screening for AZF microdeletions, CFTR analysis and a gene panel including genes associated with CHH. Also, gene panels are increasingly being used to causally clarify specific phenotypes such as defective sperm morphology/motility or azoospermia. As infertile couples have an increased risk for chromosomal aberrations, a chromosomal analysis should also be offered to both partners prior to undergoing assisted reproductive technology. In couples with recurrent miscarriages, karyotyping is recommended to detect balanced structural chromosomal aberrations.