ABSTRACT
BACKGROUND: The physical characteristics which are known to affect the ovarian reserve are age, body mass index (BMI), occupational exposures, age at menarche and menstrual cycle length. A correlation between different physical characteristics and the ovarian reserve will help to identify areas which need to be tackled to increase the chances of fertility of women in India. METHODS: In this retrospective, observational study, namely the MOTHER Study, data of women between 18 and 45 years of age, attending the selected fertility centers across different states in India were taken for evaluation. Demographic information along with information on factors potentially related to fertility like age of menarche, menstrual cycle length and occupational factors were collected by review of medical records at screening visit. Most recent AMH assay and antral follicle count (AFC) where the subject has not taken any contraceptives 12 months prior to the test were collected. RESULTS: Age of woman, years of marriage, years of infertility and smoking have shown effect on ovarian reserve testing like AMH and AFC. The other physical characteristics which were evaluated and considered to affect the ovarian reserve like body mass index BMI, occupational exposures, age at menarche and menstrual cycle length have not shown statistically significant correlation. CONCLUSION: Age of woman and years of infertility are inversely proportional to ovarian reserve markers, namely AMH and AFC. Addictions like smoking and alcohol affect ovarian reserve.
ABSTRACT
STUDY QUESTION: What are the good practices for the use of ADD-ON Treatments in IVF cycles in INDIA? WHAT IS ALREADY KNOWN: Add on treatments in IVF are procedures and technologies which are offered to patients in hope of improving the success rates. A lot of add on treatments exist; most of them have limited evidence and data for the Indian patient population is miniscule. These interventions may have limited effects, so it is imperative that any new technology that is offered is evaluated properly and has enough evidence to suggest that it is safe and effective. STUDY DESIGN SIZE DURATION: This is the report of a 2-day consensus meeting where two moderators were assigned to a group of experts to collate information on Add on treatments in IVF in INDIA. This meeting utilised surveys, available scientific evidence and personal laboratory experience into various presentations by experts on pre-decided specific topics. PARTICIPANTS/MATERIALS SETTING METHODS: Expert professionals from ISAR representing clinical and embryology fields. MAIN RESULTS AND THE ROLE OF CHANCE: The report is divided in various components including the health of the Offspring, the various ADD ons available to an ART center, consensus points for each technology & qualifications and trainings for embryologists, the report and recommendations of the expert panel reflect the discussion on each of the topics and try to lay down good practice points for labs to follow. LIMITATIONS REASONS FOR CAUTION: The recommendations are solely based on expert opinion. Future availability of data may warrant an update of the same. WIDER IMPLICATIONS OF THE FINDINGS: These guidelines can help labs across the country to standardise their ART services and improve clinical outcomes, it will also motivate clinics to collect data and report the use of Add ons to the national registry. STUDY FUNDING/COMPETING INTERESTS: The consensus meeting and writing of the paper was supported by funds from CooperSurgical India.
ABSTRACT
Progesterone hypersensitivity is a rare phenomenon which can occur after both endogenous and exogenous exposures. We present a case of hypersensitivity to various forms and routes of exogenous progesterone. A 27-year-old female presented with primary infertility. Investigations revealed Grade 1 endometriosis and polycystic ovary syndrome. Three cycles of intrauterine insemination were attempted which were unsuccessful and in vitro fertilization was proceeded. Six blastocysts of Grade A were formed and cryopreserved. Artificial cycle was used for endometrial preparation for frozen embryo transfer (FET). However, due to failure to use exogenous progesterone due to hypersensitivity reaction, Modified Natural Cycle (MNC) was used. A follicle was formed using ovulation induction with tamoxifen and human menopausal gonadotropin. Ovulation was induced by human chorionic gonadotropin (hCG), and natural progesterone from corpus luteum was used. FET was done when endometrium was 8 mm. Pregnancy was confirmed by transvaginal ultrasound and ß-hCG levels and continued uneventfully. Endogenous progesterone can be used as an alternative for endometrial preparation for FET in patients with exogenous progesterone hypersensitivity.
