Journal of Human Reproductive Sciences最新文献

Background: Use of indigenous and alternative medicines for illnesses is common in India. Studies on the use of complementary and alternative medicines (CAMs) in Western countries have shown that a significant percentage of men and women with infertility use alternative therapies. Unfortunately, there is no such data specific to the Indian population.

Aim: The aim of this study was to assess the prevalence and use of CAM treatments and supplements in couples with infertility.

Settings and design: The study was a prospective cross-sectional survey study conducted in an urban assisted reproductive centre attached to a private hospital.

Materials and methods: All patients presenting with infertility of 1 year or more who consented to participate in the study were interviewed to collect anonymised data on their use of CAM for infertility treatment, including duration of use, treatment costs, adverse effects and information about the prescriber.

Statistical analysis used: Data were analysed using SPSS v26. Descriptive statistics summarised demographics and use of CAM. Associations were tested using Fisher's Exact Test and Mann-Whitney U-test, with P < 0.05 considered statistically significant.

Results: 271 couples consented to the study. Most were well-educated, and dealing with primary infertility. CAM use was more common among women (10%) than men (5.5%), with Ayurveda being the most frequently used, followed by homeopathy. Herbal medicine use was rare. CAM usage was associated with longer durations of infertility in both genders, and with longer duration of marriage in men (P < 0.05). Most treatments were prescribed by doctors, with minimal use of unlicensed practitioners. No major adverse effects were reported.

Conclusion: CAM use for infertility was less common than expected, and linked to longer infertility duration.

We report a case of a 35-year-old nulliparous woman diagnosed with a uterine smooth muscle tumour of uncertain malignant potential (STUMP) following abdominal myomectomy. Histopathology revealed diffuse atypia, a low mitotic index and no tumour cell necrosis. Immunohistochemistry supported a low-risk profile. The patient wished to preserve fertility and, following multidisciplinary input, opted for conservative management of the uterus with structured imaging surveillance and underwent oocyte cryopreservation. This case underscores the importance of individualised fertility-sparing strategies in low-risk STUMP and the critical need for long-term follow-up.

Background: Hypothalamic pituitary gonadal axis plays a pivotal role in reproductive physiology, and gonadotropin-releasing hormone 1 (GNRH1) is considered to be the candidate gene in the regulation of the hypothalamic-pituitary-gonadal axis. GNRH1 encodes the pre-proprotein that is processed proteolytically to form the peptide GnRH1. Its polymorphisms may involve in the disruption of the luteinising hormone/follicle-stimulating hormone (LH/FSH) ratio and cause polycystic ovary syndrome (PCOS).

Aim: The current study investigated the genetic association of rs6185 with PCOS. In addition, in silico analysis and meta-analysis were also performed to clearly understand the role of rs6185 in relation to PCOS.

Settings and design: A total of 362 PCOS women and 328 healthy controls were analysed in a case control design.

Materials and methods: GNRH1 polymorphism rs6185 was genotyped using the ARMS-PCR method. Lipid and hormonal profiles were measured to analyse the correlation between genotype and phenotype.

Statistical analysis used: The Chi-square test compared genotypic and allelic frequencies between cases and controls, and the effect was estimated by calculating the Odds ratios at a 95% confidence interval. For meta-analysis, Review Manager 5.4.1 software was used.

Results: In the present study, body mass index, waist-to-hip ratio, cholesterol, triglycerides, low-density lipoprotein (LDL), very LDL, LH and LH/FSH ratio were found to be higher in PCOS women. The significant difference in the distribution of the homozygous mutant genotype (GG) and mutant allele (G) of rs6185 was found between PCOS cases and controls (P = 0.047 and 0.037, respectively). The meta-analysis revealed a significant association of the recessive model of rs6185 with PCOS, and in silico predictions confirmed that the rs6185 polymorphism alters the mRNA secondary structure and slightly decreases the stability of protein.

Conclusion: The present study demonstrates that there is a significant association of GNRH1 polymorphism rs6185 with PCOS.

Background: Vitamin D, widely recognised for its role in bone health and immune function, has recently garnered significant interest for its potential impact on male reproductive health. Several studies have suggested that adequate Vitamin D levels may be associated with improved sperm quality and, consequently, enhanced male fertility.

Aim: The study was conducted to evaluate the effects of different concentrations of Vitamin D on sperm parameters in vitro, including motility, viability, DNA fragmentation index (DFI) and sperm DNA decondensation index.

Settings and design: This is a prospective in vitro study conducted on 100 semen samples, comprising 50 normozoospermic and 50 asthenozoospermic samples.

Materials and methods: Sperm samples were incubated with different concentrations of Vitamin D (1.625 × 10^-1 M; 1.625 × 10^-2 M; 1.625 × 10^-3 M to 1.625 × 10^-4 M) for varying durations (5, 15 and 30 min). Following incubation, sperm motility, viability, DFI and sperm DNA decondensation index were assessed using standardised laboratory protocols.

Statistical analysis used: Statistical analysis was performed using SPSS (version 27.0.1) with analysis of variance. Results were expressed as mean ± standard deviation, and P < 0.05 was considered significant.

Results: A significant improvement in sperm motility was observed at a concentration of 1.625 × 10^-3 M in both normozoospermic and asthenozoospermic samples. No significant changes were noted in sperm viability across all tested concentrations. DFI and DNA decondensation index showed statistically significant improvements (P < 0.001) in both groups.

Conclusion: Vitamin D supplementation in vitro demonstrated a positive effect on certain sperm quality parameters, particularly motility and DNA integrity. These findings indicate that Vitamin D could represent a promising approach for enhancing male fertility, although further studies on larger cohorts are warranted to confirm these results and establish clinical protocols.

Survival in paediatric haemoglobinopathies like sickle cell disease and thalassemia major has improved due to curative hematopoietic stem cell transplantation. However, myeloablative chemotherapy regimens are gonadotoxic, increasing the risk of premature ovarian insufficiency. Ovarian tissue cryopreservation is commonly used for fertility preservation (FP) in prepubertal girls, but minimally invasive options like controlled ovarian stimulation (COS) and oocyte vitrification remain underexplored. We report two cases of oocyte cryopreservation in premenarchal girls (ages 12 and 15) with haemoglobinopathies. COS with hMG resulted in adequate follicular response and successful retrieval of mature oocytes. One patient underwent transvaginal retrieval, while the other required a transabdominal approach. Our experience suggests that with multidisciplinary coordination and careful hormonal assessment, COS and oocyte vitrification can be viable FP strategies in selected peri-pubertal patients.

Intramyometrial pregnancy is a rare type of ectopic pregnancy that is difficult to diagnose. We report a case of intramyometrial pregnancy with uterine rupture following frozen embryo transfer (FET), highlighting both the diagnostic challenges and the necessity for prompt surgical management. A 32-year-old woman with diffuse adenomyosis who had undergone in vitro fertilisation followed by FET presented at 14 weeks of pregnancy with acute abdominal pain and signs of hemoperitoneum. Imaging showed intra-abdominal bleeding and absent foetal cardiac activity. Laparoscopy revealed a rupture in the posterior uterine wall, with the placenta deeply embedded within the myometrium. Conservative surgical repair was successfully performed without necessitating a hysterectomy, and the patient fully recovered postoperatively. Although intramural pregnancy is rare, it is a potentially fatal form of ectopic pregnancy that can result in uterine rupture if left undiagnosed. Clinicians should maintain a high level of suspicion for early pregnancies achieved through assisted reproductive technologies, especially in patients with prior uterine procedures. Prompt recognition and timely surgical intervention can be lifesaving and preserve reproductive potential.

Background: Studies have assessed the impact of culturing warmed cleavage-stage embryos to blastocyst in frozen embryo transfer (FET) cycles; there is a paucity of studies that have evaluated the impact of warming of day 3 embryos and culturing for a day before embryo transfer.

Aim: The purpose of this research was to study whether warming of day 3 embryos and subsequent transfer on day 4 versus same-day warming and transfer of day 3 embryos improves the treatment outcomes following a FET.

Settings and design: We conducted a retrospective cohort study in the Department of Reproductive Medicine and Surgery at Christian Medical College, Vellore, India. All couples who underwent FET at our centre between January 2016 and December 2023 were screened for eligibility.

Materials and methods: The patients were divided into two groups according to the stage of the embryo that was transferred: warmed and transferred the same day as a day 3 embryo. The other group in which embryos were warmed the previous day of embryo transfer, cultured for 1 day and were transferred as day 4 embryo. The study groups were matched for age and body mass index by case-control matching. After case-control matching, 209 FET cycles were analysed in either group. The primary outcome was live birth rate (LBR).

Statistical analysis used: A parametric t-test or non-parametric Mann-Whitney test was used to find the difference between the groups. The Chi-square and Fisher's exact tests were used to find the association between categorical variables. Univariate and multivariable analysis was performed with a multiple logistic regression model to assess the potential impact of those parameters on LBR.

Results: The clinical pregnancy rate per transfer (41.1% vs. 38.2%, P = 0.548) and LBR per transfer (29.1% vs. 27.7%, P = 0.745) were comparable between day 3 versus day 4 transfer groups. Although the cycle cancellation rate was comparable in both the groups (0.8% in day 3 vs. 1.4% in day 4, P = 0.673), cryosurvival of embryos was higher in the day 3 group versus the day 4 group (86.3% vs. 81.7%), and the difference was significant (P < 0.001). Multivariate logistic regression analysis demonstrated that the likelihood of achieving live birth did not depend on day of embryo transfer (odds ratio: 1.059, 95% confidence interval: 0.688-1.628, P = 0.793).

Conclusion: Warming cleavage-stage embryos and culturing for 1 extra day did not show any significant difference in FET outcomes.

Background: Investigators have compared progestin-primed ovarian stimulation (PPOS) and conventional stimulations in multiple studies, however, with contrasting observations with respect to in vitro fertilisation (IVF) cycle outcomes. The extent of serum luteinising hormone (LH) suppression has not been studied much between the protocols.

Aim: The primary aim of this study was to compare IVF cycle outcomes in terms of oocyte yield, maturation rate, fertilisation rate, blastulation rate, implantation and cumulative pregnancy rate between gonadotropin-releasing hormone (GnRH) antagonist protocol and fixed PPOS protocol. The secondary aim was to compare the extent of pituitary suppression as reflected by serum LH before final oocyte maturation between both the protocols.

Settings and design: This was a retrospective observational cohort study.

Materials and methods: All ovarian stimulation cycles, either performed as GnRH-antagonist or as fixed PPOS, between 1^st October 2023 and 15^th July 2024, at a tertiary level IVF centre were included. Egg freezing cycles and donor egg cycles were excluded.

Statistical analysis used: Statistical tests applied were Student's t-test two-tailed for interval/ratio variables and the Chi-square test for nominal variables with a significance level of 0.05.

Results: The total number of cycles was 189, of which 87 (46.03%) cycles were in the GnRH antagonist group and 102 (53.96%) in the PPOS group. The groups were similar with respect to age, anti-Müllerian hormone, body mass index as well as total gonadotropin consumption. There was no significant difference observed for the number of oocytes (P = 0.92), maturation rate (P = 0.07), fertilisation rate (P = 0.84), blastulation rate (P = 0.52), implantation rate (P = 0.36) and cumulative pregnancy rate (P = 0.63). The serum LH values before final oocyte maturation (suppressed LH) were similar (P = 0.09) in both the protocols.

Conclusion: IVF cycle outcomes with respect to oocyte yield, maturation rate, fertilisation rate, blastulation rate, implantation rates and cumulative pregnancy were comparable between GnRH antagonist and PPOS cycles. Furthermore, the extent of pituitary suppression, reflected by the serum LH levels before final oocyte maturation, was similar between the groups as observed in our analysis. However, these findings need to be validated by prospective studies or randomised trials with equal patient division.