Background: Polycystic ovarian syndrome (PCOS) is a multisystemic endocrine disorder associated with metabolic and psychological alterations. While psychological distress in PCOS is widely documented, pulmonary function and its relationship to psychological health have not yet been explored in sufficient depth. Aim: To assess pulmonary function and psychological distress among women with PCOS and to examine the relationship between respiratory parameters and psychological variables. Settings and Design: A cross-sectional observational study conducted among women with clinically confirmed PCOS in institutional and community settings. Materials and Methods: Women of early reproductive age with diagnosed PCOS were included. Pulmonary function was assessed using spirometric parameters, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, peak expiratory flow rate and maximal voluntary ventilation (MVV). Psychological distress was evaluated using the Depression Anxiety Stress Scale-21. Participants were additionally stratified based on duration since PCOS diagnosis to explore potential duration-related differences. Statistical Analysis Used: Data were analysed using SPSS version 23. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. Pearson’s correlation coefficient was used to determine associations between pulmonary function parameters and psychological distress scores. P <0.05 was considered statistically significant. Results: A total of 298 women participated in the study, with a mean age of 22.03 ± 3.30 years. Pulmonary assessment showed mildly reduced lung volumes with lower mean FVC and FEV1 values, while the FEV1/FVC ratio remained preserved, suggesting the absence of airflow obstruction. Psychological evaluation demonstrated mild to moderate levels of stress, anxiety and depression. Significant inverse correlations were observed between FVC and MVV with stress and anxiety, indicating an association between psychological distress and reduced ventilatory capacity. Strong positive correlations were also observed between psychological domains. Participants with a longer duration of PCOS demonstrated higher levels of psychological distress and lower ventilatory parameters. Conclusion: Women with PCOS demonstrate reduced pulmonary function and significant psychological distress, with inverse associations between respiratory and psychological parameters.
Marker chromosomes derived from the Y chromosome are rare and can present with either disorders of sex development (DSD) or infertility. We assessed a unique case of a 38-year-old Indian male who presented with primary infertility and azoospermia. Cytogenetic analysis demonstrated a karyotype of 46,X,+mar, and further fluorescence in situ hybridisation studies confirmed the marker to be of Y chromosomal origin. Microarray revealed an interstitial deletion of 15.7 Mb spanning Yq11.1-q11.23 with preservation of the Yp arm. Multiplex polymerase chain reaction showed complete loss of the azoospermia factor (AZF) a, AZFb and AZFc regions. Based on integrated cytogenetic and molecular findings, the final karyotype was revised to 46,X,der(Y)del(Y)(q11.1q11.23). Interestingly, the marker chromosome retained the sex-determining region Y (SRY) gene, explaining the development of a male phenotype, but the absence of the AZF loci accounted for the failure of spermatogenesis. This case highlights the importance of integrated cytogenetic and molecular approaches in evaluating unexplained male infertility and represents a rare example of SRY-positive testicular DSD associated with a Y-derived marker chromosome lacking critical spermatogenic regions.
Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies, involuntarily ending before 24 weeks of gestation. Approximately 2%-5% of couples with recurrent miscarriages carry a balanced structural chromosomal anomaly. A non-consanguineous couple with a history of RPL was referred to the institute for genetic evaluation. The male and the female partners were of ages 31 and 30 years, respectively. The reproductive history of the female partner revealed three missed abortions during the 8th-10th week of pregnancy. The karyotype of the female partner revealed balanced chromosomal translocation between the long arm of chromosome 1 and the short arm of chromosome 10 (46, XX, t(1;10)(q32;p14)) with a clinically normal phenotype. The male partner had a normal karyotype (46, XY).
Scientific writing is an essential skill for clinicians and researchers to disseminate their research findings effectively. This narrative review discusses key aspects, including the formulation of an appropriate research question, the selection of suitable study designs, the identification of the right journal for submission and the structuring of manuscripts according to the IMRAD (Introduction, Methods, Results And Discussion) format. It highlights the importance of reporting guidelines, precise and compelling scientific writing, appropriate sample size calculation, selection of meaningful outcome measures in reproductive medicine and drafting balanced conclusions. This review also provides a concise overview of international recommendations and best practices for manuscript preparation to ensure clarity, transparency, reproducibility and completeness in scientific reporting. Ethical research practices, including avoidance of plagiarism, fabrication, falsification, inappropriate use of artificial intelligence and issues related to authorship and disclosure of competing interests, are also addressed. In addition, common reasons for manuscript rejection are outlined to help researchers improve the quality and impact of their submissions.
Deep infiltrating endometriosis (DIE) is a severe pathology requiring complex pelvic surgery, which carries a rare but serious risk of uterine rupture during pregnancy. We report a primiparous patient who achieved pregnancy through in vitro fertilisation 11 months after laparoscopic resection of a rectovaginal DIE nodule. At 32 + 3 weeks of gestation, altered foetal rhythm and maternal anaemia led to an emergency caesarean section, revealing a rupture of the posterior uterine wall. The post-partum period was uneventful despite significant psychological stress. This case highlights retrocervical surgery and monopolar energy use as potential risk factors for uterine rupture. It underlines the importance of a morphological assessment of the posterior uterine segment, personalised preconception and prenatal care and thorough patient counselling regarding potential obstetric risks in patients undergoing surgery for DIE, especially in the absence of specific international recommendations.
Background:Miscarriage is defined as a spontaneous loss of pregnancy before 20 weeks of gestation. According to ASRM and ESHRE, two or more consecutive pregnancy losses are referred to as recurrent spontaneous abortion (RSA). Approximately 15% women are at risk of miscarriage worldwide and 7.4% women are at risk of RSA in India. Genetic link is the most important factor responsible for the pathogenesis of RSA. Several genes, such as HLA, FOXP3, MMP and CTLA-4, play crucial roles in this disorder. Aim:The present study was designed to evaluate the possible association of CTLA-4 with the susceptibility and/or protection to RSA. Settings and Design:A total of 110 subjects (55 RSA cases and 55 controls) were included for this case-control study from the Indian Bengali population, aged between 19 and 35 years. Materials and Methods:Genotyping was carried out by the PCR-RFLP method. The concentration of soluble CTLA-4 (sCTLA-4) was quantified in serum using sandwich ELISA kit. Statistical Analysis Used:Genotypic data were statistically analysed using IBM-SPSS (v27), and concentration of sCTLA-4 was determined using Sigma plot (v14). Odds ratios (ORs), 95% confidence intervals and χ 2 test were performed for genotyping data, while the t-test was used for sCTLA-4 data. Bonferroni corrected P < 0.05 was considered statistically significant. Results:The findings revealed an association between CTLA-4 +49A>G variant and reduced risk of RSA under allelic (A versus G: P = 0.049, OR = 0.522), codominant (AA versus AG: P = 0.027, OR = 0.39), dominant (AA versus AG + GG: P = 0.022, OR = 0.379) and over dominant (AG versus AA + GG: P = 0.036, OR = 0.411) inheritance models. However, no significant association was observed between the CTLA-4-1722T>C variant and RSA. Serum sCTLA-4 concentration was significantly lowered in RSA patients as compared to controls (23.82 ± 2.71 ng/ml versus 26.66 ± 3.74 ng/ml, P = 0.0002). Conclusion:In conclusion, the findings of this preliminary study indicate that the CTLA-4 gene +49A>G (rs231775) variant may contribute to RSA risk in the Indian Bengali population. Further, the finding of reduced sCTLA-4 level suggests the increased risk of RSA. However, further study in a large cohort is warranted to strengthen the findings of the present study.
Background: Conventional semen analysis may overlook defects in sperm nuclear integrity, whereas molecular markers such as DNA Fragmentation Index (DFI) and protamine deficiency provide complementary information on sperm chromatin quality. Aim: The aim of this study was to investigate the associations between conventional semen parameters and two clinically relevant markers of sperm chromatin integrity: DFI and protamine deficiency assessed by chromomycin A3 (CMA3) staining. Settings and Design: This was a cross-sectional analytical study conducted in a certified private andrology laboratory operating under standardised quality control protocols. Materials and Methods: A total of 150 men undergoing fertility evaluation between 2022 and 2024 were included. Semen analysis was performed according to the World Health Organization 2021 guidelines;[1] DFI was assessed using the Halosperm sperm chromatin dispersion test, and chromatin maturity was evaluated by CMA3 staining. Statistical Analysis Used: Non-parametric statistical methods were applied to evaluate correlations between molecular markers (DFI and CMA3) and semen parameters. Results: Elevated DFI and CMA3 were significantly and inversely correlated associated with total motility, progressive motility, vitality and normal morphology (P < 0.01), while DFI correlated positively with CMA3 positivity (ρ = 0.54, P < 0.001). Men with DFI >30% or CMA3 >40% showed significantly reduced semen quality parameters. Conclusions: DFI and CMA3 are strongly associated with key semen parameters and provide complementary information on sperm nuclear integrity with potential clinical relevance in male infertility.
Background:Recurrent implantation failure (RIF) remains a major challenge in assisted reproductive technology. Acupuncture has been used as a complementary therapy to improve pregnancy outcomes, but its efficacy in women with RIF remains uncertain. Aim:The aim of this study was to determine whether a standardised two-session peri-transfer acupuncture protocol, compared with no acupuncture, is associated with improved live birth rate in women with RIF undergoing frozen embryo transfer (FET). Clinical pregnancy and ongoing pregnancy were secondary outcomes. Settings and Design:This retrospective cohort study used medical records from Hung Vuong Hospital, Ho Chi Minh City, Vietnam, between January 2019 and December 2023. Materials and Methods:Data from 2586 women were reviewed. Women aged 18-45 years with at least three failed embryo transfers involving good-quality embryos were eligible. Donor cycles, surrogacy cycles, pre-implantation genetic testing cycles and abnormal uterine conditions were excluded. Participants were classified into acupuncture and non-acupuncture groups according to treatment choice. All underwent blastocyst-stage FET. Statistical Analysis Used:Continuous variables were compared using the independent t-test and categorical variables using the Chi-square test. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) with 95% confidence intervals. Results:A total of 1969 women were included: 1110 in the acupuncture group and 859 in the non-acupuncture group. Clinical pregnancy, ongoing pregnancy and live birth rates were comparable between the groups, with AORs of 0.97, 0.95 and 0.91, respectively. Conclusions:This standardised two-session peri-transfer acupuncture protocol was not associated with improved reproductive outcomes in women with RIF undergoing FET.
Background:In present times, many women in their forties are seeking fertility treatment because of delayed marriage and childbearing. They often face the dilemma of whether to try in vitro fertilisation (IVF) with self-oocytes or donor oocytes. Quoting IVF success in terms of per oocyte pick-up (OPU) or per embryo transfer (ET) cycle can be misleading, as many patients undergo pooling IVF cycles or use PGT-A for best embryo selection. Cumulative live birth rate (CLBR) per woman offers a more realistic measure of treatment efficacy, best suited for patient counselling. Aim:To evaluate CLBR in self-oocyte IVF cycles in women more than 40 years of age. Settings and Design:Retrospective study analysing patient data from the electronic medical record system of various centres of a single fertility chain between January 2019 and December 2023. Materials and Methods:Women aged >40 years who underwent one or more oocyte retrievals using self-eggs were included. Exclusion criteria were donor oocyte cycles and oocyte cryopreservation cycles. Reproductive outcomes included clinical pregnancy rate (CPR), miscarriage rate (MR) and CLBR per woman. Statistical Analysis Used:Data was analysed using descriptive and inferential statistics. Continuous and categorical variables were summarised as frequencies and percentages. Age was grouped, and treatment outcomes (OPU, embryo availability, ET, clinical pregnancy, miscarriage and live birth) were expressed as proportions by age group. Distribution between age and categorical outcomes was assessed using the Chi-square test of independence, with significance set at P < 0.05. Analyses were performed using SPSS version 21.0. Results:Among 1,088 women (mean age: 41.56 ± 1.82 years), embryo formation occurred in 69.67% and ET in 62.22%. The CPR was 17.92%, MR 40%, and live birth rate 10.75%. CLBR per woman declined steeply with increasing age - 14.35% at 40 years, 9.63% at 42 years, and 0% beyond 47 years (P < 0.05). Conclusion:CLBR in women aged >40 years declines markedly with advancing age, with negligible live birth rates beyond 45 years despite multiple cycles.
Background:Blastocyst diameter is a key morphometric indicator used to predict implantation. Some studies suggest, well-expanded blastocysts generally demonstrate significantly higher clinical pregnancy and live birth rates compared to smaller embryos. Aim:The aim of this study was to investigate the predictive efficacy of morphometric parameters of a blastocyst on clinical pregnancy in in vitro fertilisation (IVF) cycles. Settings and Design:This was a prospective cohort study conducted at a tertiary care academic institution, involving 84 IVF/intracytoplasmic sperm injection cycles with a single blastocyst transfer in the fresh IVF cycle. Materials and Methods:All the blastocysts were assessed using a calibrated annotation tool in Embryo viewer (EmbryoScope, Vitrolife, Sweden) to measure specific variables, such as maximum blastocyst width and area of each blastocyst at 118-120 h post-insemination, just before embryo transfer. Statistical Analysis Used:Continuous variables were compared using independent t-test or Mann Whitney U-test. For three -group comparisons, analysis of variance or the Kruskal-Wallis test was applied. Results:Among the women who had a clinical pregnancy, the mean width of the transferred blastocyst was significantly (P < 0.0001) larger (182.96 μm) than in those who did not conceive (144.09 μm). The empirical optimal cut-off of blastocyst diameter, which will lead to clinical pregnancy, was found to be 159.5 μm with a sensitivity of 92% and specificity of 85%. Significantly (P < 0.0001) larger blastocyst area 26,239 μm2 (95% confidence interval [CI]: 24,686-27,792 μm2) was also seen among women with clinical pregnancy versus women without clinical pregnancy, 16,381 μm2 (95% CI: 15,091-17671 μm2). The empirical optimal cut-off of blast area was found to be 20,134 μm2 with a sensitivity of 90% and a specificity of 85%. The receiver operating characteristic curve was plotted for blastocyst diameter and blastocyst area, and the area under the curve for blastocyst diameter and blastocyst area was 0.934 and 0.930, respectively. Conclusion:Objective morphometric evaluation of blastocyst width and area provides a simple, non-invasive and reliable predictor of clinical pregnancy in IVF cycles.
Background: Low-dose aspirin (LDA) has been used during assisted reproduction; however, the evidence supporting its use remains conflicting. Aim: To assess whether LDA improves the clinical pregnancy rate (CPR) in a patient’s first autologous, programmed, single frozen embryo transfer (FET) cycle with an euploid embryo. Settings and Design: Retrospective cohort study at an academic center. Materials and Methods: A retrospective cohort study of all first autologous, programmed, single FETs of a single euploid embryo performed at our academic center between 2020 and 2022 assessed the association between LDA and CPR and live birth rate (LBR). A subgroup analysis assessed the prevalence of hypertensive disorders of pregnancy (HDP). Statistical Analysis Used: Chi-square tests of association and fixed-effects multivariable logistic regression were performed. Among patients with a live birth, Chi-square tests of association were utilised. Binary logistic regression was performed, adjusting for age and body mass index. Data were analysed using SAS software, version 3.8, Enterprise Edition (SAS Institute Inc., Cary, NC, USA). Statistical significance was set at P < 0.05. Results: Two hundred seventy FETs resulted in 189 clinical pregnancies, and 153 live births. LDA was not associated with CPR or LBR. LDA was also not associated with HDP, although this outcome was only able to be assessed among one hundred twenty patients (78% of all live births). Conclusion: LDA use was associated with neither clinical pregnancy nor live birth among autologous, euploid, programmed, single FET cycles.
Background: Oocyte retrieval requires effective sedation that ensures patient comfort without compromising reproductive outcomes. Although multiple sedative agents are routinely employed during oocyte retrieval, the optimal sedative regimen remains an active research area. Aim: The aim of this study was to compare the analgesic efficacy and safety of Ketodex (ketamine–dexmedetomidine) versus Ketofol (ketamine–propofol) for procedural sedation for oocyte retrieval during in vitro fertilisation (IVF) procedures. Settings and Design: Double blinded, single-centre, randomised controlled pilot study at a tertiary-care IVF centre. Materials and Methods: Sixty American Society of Anesthesiologists I–II women (20–40 years) scheduled for transvaginal oocyte retrieval were randomised to receive Ketofol (ketamine + propofol) or Ketodex (ketamine + dexmedetomidine) (n = 30/group). The primary outcome was to determine the mean pain scores during oocyte retrieval and within the first 2 h post-procedure by using the Visual Analogue Scale (VAS). Rescue analgesia (fentanyl) and peri-procedural adverse events were recorded. Embryological outcomes included fertilisation and cleavage rates. An exploratory cumulative pain score (CPS), integrating early pain burden with opioid requirement, was also analysed. Statistical Analysis Used: Two-group comparison was done with the Mann–Whitney U-test (non-normal data) and independent t-test (normal data). For comparing repeated measures of pain scores over time within groups, the Friedman test was employed. Results: VAS scores decreased over time in both groups, but were significantly lower in the Ketodex group at all post-operative time points (10 min; 30 min; 1 h; 2 h, P < 0.001). Intraoperative fentanyl requirement was significantly higher with Ketofol compared with Ketodex (median 20.67 μg vs. 0 μg; P < 0.001). Apnoea occurred in 53.3% of Ketofol patients and in none of the Ketodex patients (P < 0.001). Fertilisation rates and cleavage rates were comparable between groups. Exploratory CPS was significantly lower in the Ketodex group (P < 0.001). Conclusion: Ketodex demonstrated superior analgesic efficacy, opioid sparing and improved safety compared to Ketofol.
Background: PCOS is associated with substantial psychological morbidity related to its clinical features and associated infertility. Aim: To compare psychological morbidity and fertility quality of life (FertiQoL) amongst infertile women with and without PCOS and to correlate the psychological parameters with clinical, socio-demographic, endocrine and metabolic parameters. Settings and Design: Analytical cross-sectional study. Materials and Methods: Psychological assessment was done using validated questionnaires for Stress (Perceived Stress Scale); Anxiety (Hamilton Anxiety Rating Scale); depression (Patient Health Questionnaire-9) and quality of life (FertiQoL tool [core]). The main outcome measure was psychological morbidity and FertiQoL scores and correlation of these with clinical, socio-demographic, endocrine and metabolic parameters. Statistical Analysis Used: The categorical data were analysed using the Chi-square or Fisher’s exact test. Shapiro–Wilk test/t-test was used to assess the normality and Spearman’s rank correlation was applied for correlation analysis. A two-tailed P < 0.05 was considered statistically significant. Results: Stress and anxiety were significantly higher in non-PCOS women. Depression and FertiQoL scores were comparable between the two groups. Amongst PCOS women, longer infertility duration and obesity were associated with the lower quality of life based on FertiQ_E, FertiQ_MB and total FertiQoL scores. In non-PCOS women, obese women were more likely to have depression and lower quality of life. Longer duration of infertility led to depression and poor FertiQ_E scores. On regression analysis in PCOS women, BMI was independent factor having positive association with depression, anxiety and negative association with individual and total FertiQoL scores. Conclusions: PCOS women had comparable depression and FertiQoL scores and lower levels of anxiety and stress when compared to non-PCOS women. Longer duration of infertility and obesity were associated with depression and lower quality of life irrespective of cause.
Background: Sperm cryopreservation may have detrimental effects on sperm parameters freezing and thawing. Aim: In this study, the effects of plasma-rich in growth factors (PRGFs) at different stages of freezing-thawing on sperm parameters in normozoospermia and asthenoteratozoospermia (AT) were evaluated. Settings and Design: Aprospective experimental study conducted in two phases to evaluate the timing of PRGF addition during sperm freezing and to assess the cryoprotective effects of PRGF on AT samples. Materials and Methods: In the first phase, 20 normal semen samples were included in the study. After preparation, the spermatozoa were divided into the following groups: A control group that was frozen and thawed without PRGF, and three groups that received 1% PRGF before freezing, during equilibration and after thawing. The method of cryopreservation was rapid freezing. Sperm motility, viability, normal morphology, deoxyribonucleic acid (DNA) fragmentation, reactive oxygen species (ROS) levels and mitochondrial membrane potential were evaluated in different groups before freezing and after thawing. In the second phase, 1% PRGF was added to 10 AT samples, and the parameters were evaluated as in the first stage and compared with the control group. Statistical Analysis Used: One-way analysis of variance with Tukey’s post hoc test and the Kruskal–Wallis test with Dunn’s post hoc test were applied as appropriate. Results: In the first phase, progressive motility in all groups was significantly reduced after thawing compared to fresh spermatozoa. Furthermore, in the group that received PRGF during equilibration, the sperm total motility and viability increased significantly compared to the control group. The rate of DNA fragmentation and ROS also increased significantly in all groups, except in the during equilibration group. In the second phase, the group treated with 1% PRGF after thawing showed no significant differences in total motility, viability, ROS or DNA integrity compared to the fresh spermatozoa. Conclusion: Adding 1% PRGF to the freezing medium during the equilibration process yields effective results. PRGF effectively preserves sperm motility, viability and DNA integrity in AT samples.
Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility. Letrozole is the first-line agent for ovulation induction; however, response to the standard 5-day regimen may be suboptimal in some women. Aim: The aim is to compare the efficacy and safety of an extended 10-day letrozole regimen with the conventional 5-day regimen for ovulation induction in infertile women with PCOS. Settings and Design: Prospective, open-label, parallel-group randomised controlled trial conducted at a tertiary care centre in North India. Materials and Methods: Eighty infertile women with PCOS (Rotterdam criteria, 2003) were randomised to receive either letrozole 2.5 mg daily for 10 days or 5 days. Up to three ovulation induction cycles were allowed. Follicular monitoring was performed using transvaginal ultrasonography. Ovulation was triggered with human chorionic gonadotropin, followed by timed intercourse. Statistical Analysis Used: Continuous variables were analysed using the t-test or Wilcoxon–Mann–Whitney U test. Categorical variables were compared using the Chi-square or Fisher’s exact test. A P < 0.05 was considered statistically significant. Results: The 10-day regimen showed a significantly higher follicular response in the first cycle compared to the 5-day regimen (85.0% vs. 52.5%, P = 0.002). Dose escalation and gonadotropin use were significantly lower in the extended regimen group. No cases of ovarian hyperstimulation syndrome were reported. Pregnancy rates were comparable between groups. Conclusion: The extended 10-day letrozole regimen significantly improves follicular response without increasing adverse outcomes and may improve cycle efficiency in women with PCOS.
Background: Infertility is a complex health issue with psychological, social and economic implications, particularly in rural and traditional communities. Aim: To evaluate the psychological, psychosocial and economic factors influencing infertile couples attending a tertiary care hospital. Settings and Design: Cross-sectional observational study conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital in South India. Materials and Methods: A total of 175 couples with primary infertility were assessed using the following validated tools – anxiety (Hamilton Anxiety Rating Scale), depression (Hamilton Depression Rating Scale), social support (Multidimensional scale of perceived social support), global life satisfaction (Satisfaction with life scale) and socioeconomic status (SES) through Modified BG Prasad classification (2024). Statistical Analysis Used: Data were analysed using SPSS version 23.0. Chi-square test, Fisher’s exact test and independent t-test were used; P < 0.05 was considered statistically significant. Results: Mean age was 26.9 ± 4.7 years for females and 28.5 ± 3.6 years for males. Moderate-to-severe anxiety was seen in 17.7% and moderate depression in 10% of women. Women showed significantly higher anxiety (P < 0.001) and similar rates of depression compared to men. High family support (60.6%) and better SES correlated positively with life satisfaction (P < 0.001). Conclusion: Infertility affects psychological and social well-being, particularly in women. Family support and socioeconomic stability are key determinants of better life satisfaction. Psychosocial support should be integrated into infertility care, especially in rural settings.
Background: Sexual disorders such as erectile dysfunction (ED), premature ejaculation (PE), low sexual desire (LSD) and vaginismus substantially affect psychosocial well-being yet remain underreported in India due to stigma, limited provider training and fragmented care pathways. Aim: The aim of this study was to examine help-seeking patterns, delays in care and prior treatment attempts amongst patients presenting with sexual disorders. Settings and Design: This was a retrospective observational study using anonymised records from a specialised sexual health clinic in India (January 2022–December 2024). Materials and Methods: Records of patients with ED (n = 8980), PE (n = 9460), LSD (n = 1135) or vaginismus (n = 318) were analysed. Variables included symptom duration, previous consultations and self-medication. Statistical Analysis Used: Descriptive statistics were analysed using the Statistical Package for the Social Sciences. Results: Most patients (72%) had not sought formal care before presentation, and 46% reported symptoms for more than 1 year. Self-medication was common in ED (12.7%) and PE (11.3%), particularly amongst individuals over 30 years, but uncommon in vaginismus (0.6%). Prior consultations were limited (ED: 24.5%; PE: 21.0%), and patients under 30 years were least likely to have accessed care. Older age correlated with greater self-medication (r = 0.32, P < 0.05), and longer symptom duration correlated with previous consultation attempts (r = 0.28, P < 0.05). Diagnostic category influenced delay, with ED and PE associated with the longest help-seeking intervals. Conclusion: Substantial delays in help-seeking persist across sexual health diagnoses, especially amongst younger patients and those with ED or PE was observed. These findings highlight gaps in awareness, accessibility and confidence in seeking care. Strengthening clinician training, improving public education and expanding telehealth pathways may support earlier presentation and better outcomes.
Aim: To assess the feasibility of retrieving viable spermatozoa in hanging deaths and their correlation with post-mortem interval (PMI) and sperm quality parameters. Settings and Design: A descriptive observational study was conducted at the Department of Forensic Medicine and Toxicology, AIIMS Bhopal. Materials and Methods: PMSR was performed in 18 medicolegal autopsy cases involving males aged 18–49 years within 24 h of death using an in-house innovated vaso-epididymal wash technique. Sperm motility and viability were assessed using an automated semen quality analyser and the eosin dye exclusion test. Statistical Analysis Used: Data were analysed using descriptive statistics, Pearson’s correlation and Chi-square tests. Results: Motile sperm were recovered in 44.4% and viable sperm in 50% of cases. Mean motility and viability in positive samples were 14.5% and 29.9%, respectively. Viability stays up to 21.5 h post-mortem, peaking at 72%. No significant correlation was seen between PMI and sperm quality. A strong association between immotile and viable sperm supports a two-step degradation process, with motility loss preceding cellular death. Conclusion: Our results confirm the recovery of motile and viable sperm in 50% of hanging-related deaths up to 21.5 h post-mortem (peak 72%, P > 0.05), supporting the feasibility of PMSR. The findings challenge the linear model of time-dependent sperm degradation and emphasise the need for rapid processing and standardised medico-legal and ethical PMSR protocols in India.
Background: Infertility affects about 16.5% of adults in low- and middle-income countries, according to the World Health Organization, and represents a major global public health concern. Despite this burden, population-level estimates from South Asia remain limited. Objective: To address this gap, we conducted a systematic review and meta-analysis to estimate the pooled prevalence of infertility in South Asia and to assess the quality of existing studies. Materials and Methods: We systematically searched PubMed, Scopus and Embase from inception to 12 April 2025 for studies reporting infertility prevalence in South Asia, excluding studies that did not report the total population from which the prevalence was calculated. Two reviewers independently screened studies, extracted data and assessed study quality using the Joanna Briggs Institute checklist. A random-effects meta-analysis of proportions was performed, and heterogeneity was assessed using I² and Cochran’s Q statistics. Results: Of 4326 records screened, 16 studies met the inclusion criteria and were included in the systematic review, of which five were eligible for primary analysis. Except for one study from Nepal, the remaining studies were from India. The pooled prevalence of infertility was 8% (95% confidence interval [CI]: 5%–13%; I² = 98.6%). Community and hospital-based studies showed a prevalence of 10% and 8%, respectively. Primary infertility prevalence was 7% (95% CI: 2%–14%), while secondary infertility was 3% (95% CI: 0%–12%). Interpretation: The review shows a pooled prevalence that is lower than recent global estimates, highlighting the need for robust region-specific data. Limitations: Considerable variation in infertility definitions contributed to substantial heterogeneity and reduced comparability across studies. About one-third of the included studies were clinic-based, which are not ideal for estimating population prevalence. PROSPERO Registration: CRD42024623937.
Background: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder with a multifactorial aetiology, including genetic and epigenetic components. Despite increasing evidence highlighting the role of epigenetic modifications in PCOS, their contribution to disease progression remains unclear. Aim: This study aimed to investigate the role of DNA methylation in the aetiology of PCOS. Settings and Design: This is a hospital-based observational study. Materials and Methods: The materials and methods of this study were to examine the role of DNA methylation in PCOS. Genomic DNA was isolated using the QIAamp DNA Mini Kit, and DNA methylation profiling was performed using the Infinium Human Methylation 850K (EPIC) array in 43 PCOS cases compared with controls. Statistical Analysis Used: The Student’s t-test (two-tailed) was used to compare the means and derive statistical significance from the independent groups. The ChAMP software package was used for methylation analysis on the R interface v4.2.0. Results: Differential methylation analysis identified 243 differentially methylated CpG sites within 26 differentially methylated regions (DMRs) (|Δβ| > 0.1, P < 0.05). Notably, most DMRs were located in promoter regions near CpG islands and shores, with a significant proportion (23.07%) mapping to chromosome 6. The majority (76.9%) of DMRs exhibited hypomethylation, whereas the top two DMRs were hypermethylated. Functional enrichment analysis revealed that differentially methylated genes were associated with key pathways, including Th17 cell differentiation, steroid biosynthesis and autoimmune thyroid disease. Gene ontology analysis highlighted enrichment in immune-related biological processes, MHC protein complexes and molecular functions, including prenyltransferase and transaminase activities. Conclusion: Our findings underscore the potential contribution of epigenetic modifications to PCOS pathogenesis, particularly through immune regulation and steroid metabolism. Further studies with larger cohorts and functional validation are warranted to establish the role of these epigenetic changes in PCOS.
