ABSTRACT
Background: Infertility is defined as failure to conceive a clinical pregnancy after 12 months or more of regular unprotected intercourse. The birth of Louis Brown opened door to whole new world. Science of reproduction unfolded with better understanding of physiology and pharmacology of gonadotropins. Improved stimulation protocol, and lab facilities are available for IVF and intracytoplasmic sperm injection (ICSI). The objective of this study was to study relation between uterine scoring system for reproduction (USSR) scoring and pregnancy rate in patients undergoing ICSI and embryo transferred.Methods: A prospective observational study was conducted. Study comprised 48 women visiting with infertility for ICSI and embryo transfer. Baseline scan done on day2 of menses. Patients started on estradiol valerate for endometrial preparation. Transvaginal sonography done on 10th day of menstrual cycle for USSR scoring. USSR scoring includes parameters such as endometrial thickness, endometrial layering, myometrial contractions, myometrialechogenecity, uterine artery Doppler flow, endometrial blood flow, myometrial blood flow.Results: Out of total 48 infertility patients for embryo transfer 22 conceived, which gives 45.83% pregnancy rate. No patients had a perfect score of 20. Patients with score of 17-19 had pregnancy rate of 66%. Endometrial thickness of 10-14mm gave optimum result of 52%. Pulsatality index <2.19 was associated with pregnancy rate of 66%.Conclusions: USSR scoring is highly indicative of good pregnancy outcome in patients undergoing ICSI and embryo transfer. Endometrial morphology and thickness was strongly correlated with successful pregnancy outcome.
ABSTRACT
Background: An unresolved assisted reproductive technique problem is the unresponsive, thin endometrium. Approximately 0.6%-0.8% of patients do not reach the minimum thickness. Using endometrial co culture, G-CSF>130pg/mL was associated with significantly improved pregnancy rate in ART cycles. This is a retrospective study that included all unexplained infertility cycles with controlled ovulation stimulation –IUI protocols. Aim was to note the effects of G-CSF on thin endometrium and pregnancy rate in G-CSF administered COS-IUI cycles.Methods: This study was done in the IVF department of Dr D Y Patil University, Navi Mumbai, India. Thin endometrium was defined as ET<7mm on transvaginal ultrasound. Clomiphene citrate was used for ovulation induction in strengths of 100mg or 50mg on day 2 of their cycle based on the antral follicle count. Trigger used was injection 10,000µg urinary hCG. On the same day when the trigger injection was given, 300 units G-CSF was instilled into the uterus. Post 36 hours IUI was done under aseptic precautions .After 16 days β-hCG levels were done to determine whether there is a pregnancy.Results: In present study,200 COS-IUI cycles were analysed.50 cycles showed a thin endometrium and in them G-CSF was used. The chemical pregnancy rates was 32%, the intrauterine pregnancy rate was 28%, ectopic pregnancy rate was 4%.Conclusions: Present study concluded that G-CSF increases ET significantly in COS-IUI cycles in the event of thin endometrium. In view of small cohort size further larger randomized controlled trials may be required to substantiate the above conclusions.
ABSTRACT
Background: Globally, the prevalence of infertility is around 10% of the total population. 30% of these have male factor infertility. Azoospermia is found in 1% of men, in 20% of which, the etiology is a bilateral obstruction of the male genital tract while others have non obstructive azoospermia. In azoospermic men sperms are microsurgically retrieved from epididymis and testes by TESA and PESA respectively. The aim of this study was to evaluate the outcomes of intracytoplasmic sperm injection ICSI using surgically retrieved sperm of azoospermic men either obstructive or nonobstructive and to compare it with ejaculated sperms in men having severe oligospermia.Methods: This was retrospective cohort study conducted based on the data collected from our reproductive endocrinology and infertility unit, 126 ICSI cycles performed during the period of 5 years were taken and divided into two groups, one with patients having ejaculated sperms with oligospermia and other group with patients who had surgically retrieved normal sperms due to azoospermia. Outcome of these ICSI cycles included fertilization, cleavage, biochemical and clinical pregnancy was assessed.Results: In present study it was found that ICSI outcome was comparable in both the groups with ejaculated sperm and surgically retrieved sperm as fertilization rate (72% vs 65%), Implantation Rate (58 vs 51%), clinical pregnancy rate (CPR) (51% vs 44.82%) observed with ejaculated or retrieved sperm group respectively showed no statistical difference.Conclusions: Present study shows that minimally invasive techniques of PESA and TESA can be successfully performed to retrieve sperm for ICSI in the treatment of azoospermic men which gives them the chance to father their biological child. The result of this study indicates that treatment outcomes of PESA/TESA-ICSI cycles compare favourably with that of ICSI using ejaculated sperm.