Evidence of sexual transfer of mycobacteria from male to female partners reporting to an IVF clinic.

Female genital tuberculosis (GTB) contributes significantly to infertility in low- and middle-income countries. Dissemination of infection from pulmonary and extrapulmonary sites is the major reason for causation of GTB. Additionally, sexual transmission of GTB from male partners has been reported. We selected 81 couples desiring babies from an in vitro fertilization clinic. We used multiplex-PCR for mycobacterial detection in semen of males, in the endometrium of their female counterparts and in the products of conception (POC) from miscarriage. Data interpretation shows that these pregnancies failed owing to sexual transmission of mycobacteria. We noticed by multiplex PCR that mycobacterial infestation in the female can take place in either endometrium or POC from asymptomatic males harbouring mycobacteria in their semen. Therefore, we propose sexual transfer of mycobacteria to be a probable cause of miscarriage. Thus, we suggest multiplex PCR based screening of semen for all males of the couples attempting successful childbirth.

Role of latent female genital tuberculosis in recurrent early pregnancy loss: A retrospective analysis.

BACKGROUND: Latent Female Genital tuberculosis (FGTB) or tubercular infestation is prevalent in Southeast Asia and even the presence of tubercular bacilli in the genital tract is becoming an important factor for reproductive failure. An immature endometrium becomes non-receptive, preventing implantation or rejection of implanted embryo in early months, resulting in recurrent pregnancy loss (RPL) in association with other factors. OBJECTIVE: To detect the underlying causes of RPL in addition to the proven causes like uterine cavity defects, thrombophilia, chromosomal abnormalities, etc. MATERIALS AND METHODS: 317 women with RPL, enrolled over a period of 60 months (January 2014 to December 2018) conducted at Calcutta Fertility Mission in the present study. They were grouped in A, B, and C and undergone routine tests for the same along with the PCR test with an endometrial aspirate. RESULTS: Patients with only latent FGTB (Group A), patients with FGTB and associated factors (Group B), and patients with other causes of RPL (other than latent FGTB) (Group C) were34.4%, 42.3%, and 23.3% respectively. About 29.36%, 47.01%, and 21.62%of the patients had achieved pregnancy in Group A, B, and C, respectively. The rate of miscarriage was high in both Groups A and B, affected with latent FGTB, and live-birth was higher (75%) in Group C that did not have tubercular involvement of the genital tract. CONCLUSION: The tubercular infestation or latent FGTB as per our study appears to be a very important cause of RPL in patients with recurrent "unexplained" miscarriage. It should be treated adequately at an early stage to prevent permanent damage to pelvic organs and restore reproductive health in women.

Frozen embryo transfer: the present practice and beyond.

BACKGROUND: With the success of oocyte donation in vitro fertilization (IVF) in postmenopausal women, the importance of endometrial preparation became obvious. This appears also very crucial for achieving pregnancy after frozen embryo transfer (FET) after failed fresh IVF cycles and FET in subsequent natural cycles. Although there are different methods of preparing endometrium, in this study, another method of preparing the implantation bed using letrozole was scrutinized for its usefulness. METHODS: Two hundred and seventy patients between 28 and 40 years of age undergoing IVF due to bilateral tubal blocks were chosen for FET. They had a previous unsuccessful single IVF attempt or had postponed embryo transfer due to the threat of ovarian hyperstimulation syndrome or poor endometrial development. Informed consents were obtained from the participants. One hundred patients had endometrial preparation by gonadotrophin-releasing hormone agonist down-regulation and with hormone replacement therapy, 55 had natural cycle FET, and the remaining 115 patients had letrozole-induced ovulation induction (OI) for endometrial preparation. RESULTS: The clinical and biochemical pregnancy rate or live birth rate was higher in the letrozole OI group than in the other two groups. CONCLUSIONS: OI by letrozole and subsequent endometrial preparation as a result of it may be utilized for FET, and this will be cheap and easy to administer, giving better success rates in FET cycles.

Pregnancy outcome in pre-operative danazol treatment followed by laparoscopic correction in infertility associated with endometriosis.

Probably, more has been written and less has been agreed upon, regarding the pathogenesis of the enigmatic disorder--endometriosis, which is the leading cause of disability in women of reproductive age group, resulting in infertility and pelvic pain. It is an accepted fact that the medical treatment of endometriosis does not help in infertility management, except certain situations like pain, limiting the attempt of pregnancy, or endometriosis presenting with cornual block, due to endosalpingiosis. The usual treatment of infertility being either surgical correction, or assisted reproductive technology procedures. In our patient population, the acceptance of In-vitro fertilisation or embryo transfer is much less, because of its high cost and social taboo. In this series, the improved pregnancy outcome is observed with medical treatment of endometriosis with danazol before and after the laparoscopic correction of the tubo-ovarian relation due to endometriosis or in certain cases of minimal to mild endometriosis, not requiring correction. Out of 722 suspected cases of endometriosis, 576 cases were subjected to prelaparoscopic treatment with danazol, and the result was compared with 424 cases of only laparoscopic treatment, and 216 cases of postlaparoscopic danazol treatment, during the years 2004 to 2008. A total of 1216 cases were included in the study. The initiation of medical treatment in the pre-operative period gives better pregnancy outcome, as compared to only surgical or postsurgical medical treatment. The experience proves that the adjuvant medical treatment with danazol, initiated before laparoscopy in suspected endometriosis cases is useful treatment procedure, to increase the pregnancy rate.

Postcoital intra-uterine aspirate--a unique criterion for selecting patients for natural or assisted conception.

The success of any infertility management programme is reflected in its efficacy to achieve a pregnancy either spontaneously or through assistance. For this purpose some routine investigations are carried out to pinpoint the nature of problem(s) which an infertile couple is troubled with. As the basic requisite for conception to occur is the accumulation of motile spermatozoa around the egg at the site of fertilisation, proper assessment of sperm transit from the vagina to the tubal ampulla becomes a very important criterion to predict the possibility of spontaneous pregnancy. Till date postcoital test was the sole investigative tool available to serve this purpose but unfortunately it fails to furnish any information about the concentration and nature of quality of spermatozoa beyond the cervix. This results in the disparity between postcoital test results and pregnancy outcome. In the present study intra-uterine fluid was examined along with cervical mucus 4-6 hours postcoitus in the pre-ovulatory period. The objective was to gather information about the fate of spermatozoa subjected to the uterine environment after being vaginally deposited during coitus. The result of this combined test has been found to be very much informative and helpful for the fertility physician to set the criteria for timed intercourse and / or intra-uterine insemination. This simple test thus appears to play a leading role in infertility management in near feature.

Medical management of male infertility.

Management of male infertility is always a difficult task. In recent years booming of artificial reproductive technologies (ART) has put infertologists and andrologists in front of a million dollar question whether to treat the person or the gametes. A basic andrology laboratory at present has become part and parcel of an infertility clinic. Hence treatment of male infertility has become institutional and collective for clinicians and basic scientists. The basic approach towards management of male infertility includes confirmation of diagnosis and to find out the cause for which pathological, endocrinological and biochemical tests are essential. In this series specific defects causing seminopathy has been found in 18% cases where treatment is straightforward and towards the cause. The main bulk of idiopathic seminal defects (82%) really poses challenge to the infertologists so far management is concerned. In this study commonest seminal defect has been found to be oligoasthenozoospermia which amounts to 63% cases. For medical management purpose drugs commonly used are clomiphene, gonadotrophins, bromocriptine, L-thyroxine, vitamin E, B12, etc. When they fail the main approach remains to be intra-uterine insemination (IUI) and ART eg, in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).