Objectives: To study reproductive outcomes in different polycystic ovary syndrome (PCOS) phenotypes after in vitro fertilisation (IVF) treatments. Material and Methods: It is a prospective observational study, conducted from October 2024 to April 2025 at the Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi. Women undergoing IVF were screened for the presence of PCOS and diagnosed based on Rotterdam’s criteria. These women were then subcategorised into the four PCOS phenotypes based on their presenting features. All women with PCOS who were scheduled for assisted reproductive technologies (ART) procedures during the study period and met the inclusion criteria were enrolled in the study. Metabolic disorders were screened with lipid profiles, mean blood glucose levels, and free androgen index. Primary outcomes studied were the β hCG positive rate, implantation rate per transfer, clinical pregnancy rates after the first transfer, and early pregnancy loss rate. Secondary outcomes studied were total dose of gonadotropins used, days of stimulation, number of oocytes retrieved, number of oocytes fertilised, number of cleaved embryos, fertilisation rate, median utilisable blastocyst number per patient, blastulation rate, and utilisable blastocyst rate. Results: There were 10 (18.9%) patients with phenotype A, 6 patients in phenotype B (11.3%), 15 in phenotype C (28.3%), and 22 in phenotype D (41.5%). The most prevalent phenotype was D (41.5%). Women with phenotype A though, had higher serum AMH levels ( p -value = 0.006), and had a higher median utilisable blastocyst number per patient ( p value = 0.024), but the β-hCG positive rate, implantation rates after first embryo transfer, clinical pregnancy rate, and early pregnancy loss rate were similar in the patients with different phenotypes of PCOS. There was no statistical difference in the total dose of gonadotropins used, number of oocytes retrieved, oocytes fertilised, cleaved embryos, fertilisation rate, blastulation rate, and utilisable blastocyst rate. Metabolic disorder screening results indicated higher cholesterol levels in patients with Phenotype B ( p value = 0.01), although no difference was noted in levels of HDL, LDL, non-HDL, triglycerides, and mean glucose levels in the patients with different phenotypes of PCOS. Conclusion: Our study results suggest that reproductive outcomes, including β hCG positive rate, implantation rate per embryo transfer, clinical pregnancy rate after first embryo transfer, and early pregnancy loss rates, were similar amongst patients with different phenotypes of PCOS. Patients with phenotype A had higher serum AMH levels and had a higher median utilisable blastocyst number per patient, but the utilisable blastocyst rate was comparable across all the phenotypes of PCOS. The study is underpowered to detect differences in reproductive outcomes due to the smaller number of patients enrolled in the study.
Gestational diabetes mellitus (GDM) poses significant challenges in modern obstetrics, driving increased monitoring and intervention. Emerging evidence suggests that the embryo's exposure to maternal hyperglycaemia and the consequent hyperinsulinaemia, leading to epigenetic changes and accelerated foetal growth, occurs much earlier than the typical 24–28-week screening window. Early epigenetic changes are the determinants of future health. Current research, though, demonstrates a moderate maternal and foetal benefit in treating GDM; the available data are not supportive of the prevention of long-term cardiometabolic health risks in the offspring despite treatment in mid-trimester. Pre-pregnancy maternal body mass index (BMI) and excessive gestational weight gain are more potent predictors of higher birth weight and macrosomia than mid-trimester hyperglycaemia alone. While treating hyperglycaemia is essential, addressing pre-pregnancy maternal high BMI is equally important.
Recent advancements in cancer therapy and reproductive technologies have given new possibilities for fertility preservation (FP) in cancer survivors. FP is the procedure to preserve sperm, egg, embryo, and reproductive tissue with the goal of preserving fertility and maintaining reproductive health in people who are at risk of adverse effects of gonadotoxic treatment, non-oncologic malignancies, age-related complications, and certain metabolic or autoimmune disease conditions. Earlier results on survival and live birth rates in embryo and oocyte/semen cryopreservation in post-pubertal patients indicate that FP methods are first-line, whereas in prepubertal patients, ovarian or testicular tissue cryopreservation and subsequent transplantation are recommended. New approaches such as orthotopic transplantation, cryopreserved tissue, or artificial ovarian maturation in vitro , or activation of folliculogenesis or spermatogenesis in vitro have also been developed. However, further research and prior preservation counselling for all patients is required for those who are at risk. The current review mainly focuses on different options of FP techniques in patients undergoing gonadotoxic cancer treatments for preserving their reproductive health and future fertility.
Objectives: The study aims to understand how coping strategies mediate the relationship between self-esteem and the Fertility Quality of Life (FertiQoL) in women preparing for in vitro fertilisation (IVF)-embryo transfer (ET). Material and Methods: A cross-sectional study was conducted among 346 women preparing for IVF in Kerala, India. Data were collected using a personal data schedule, the FertiQoL questionnaire, the Rosenberg self-esteem scale, and the Copenhagen Multi-Centre Psychosocial Infertility (COMPI) coping strategy scale. Mediation analysis was performed using the PROCESS macro for SPSS (Model 4). Results: The result shows that the total effect of self-esteem on FertiQoL was significant (b = 2.2454, SE = 0.1363, t (346) = 16.4782, p <0.001, 95% CI [1.9774, 2.5135], β = 0.6596). The direct effect of self-esteem on FertiQoL also remained significant (b = 1.6343, SE = 0.1487, t (346) = 10.9940, p <0.001, 95% confidence interval (CI) [1.3419, 1.9267], β = 0.4803). This suggests that self-esteem continues to uniquely contribute to the FertiQoL, independent of its effect on coping strategies. The indirect effect of self-esteem on FertiQoL through coping strategies was statistically significant (b = 0.6111, Bootstrap SE = 0.1041, 95% bias-corrected CI [0.4147, 0.8285] β = 0.1796). Conclusion: These findings suggest that coping strategies serve as a partial mediator in the relationship between self-esteem and FertiQoL for women undergoing IVF. Consequently, interventions focused on enhancing self-esteem and coping strategies may improve the overall QoL for women in IVF treatment.
A 32-year-old woman with recurrent microinvasive seromucinous borderline ovarian tumour (SMBOT) and low ovarian reserve presented for fertility preservation prior to definitive surgery. After multidisciplinary evaluation, she underwent right adnexectomy and left ovarian cystectomy, with pathology confirming microinvasive SMBOT and no extraovarian spread. Controlled ovarian stimulation using a progestin-primed ovarian stimulation (PPOS) protocol with letrozole minimised oestrogen exposure was done and resulted in eight retrieved oocytes and four blastocysts. Following an initial failed frozen embryo transfer (FET), a second stimulation cycle produced two additional blastocysts. Hysteroscopy identified chronic endometritis, which was treated before a natural-cycle frozen transfer of a single 4AA blastocyst, resulting in an ongoing singleton intrauterine pregnancy. This case demonstrates that thoughtfully planned, low-oestrogen stimulation and coordinated oncologic surveillance may allow safe fertility preservation in selected patients with recurrent microinvasive SMBOT.
Objectives: Pregnancies among women living with human immunodeficiency virus (HIV) remain associated with adverse perinatal outcomes in sub-Saharan Africa despite widespread antiretroviral therapy. The placenta plays a central role in foetal growth and maternal-foetal exchange, and gross placental examination offers a low-cost approach for identifying clinically relevant abnormalities in resource-limited settings. However, data from Southern Nigeria are limited. Thus, we aimed to compare gross placental morphometry and morphological features between HIV-positive pregnant women and HIV-negative controls in Uyo, Southern Nigeria. Material and Methods: This hospital-based case-control study examined placentas from 48 HIV-positive and 96 HIV-negative mothers. Placental weights were measured before and after formalin fixation and categorised using gestational age-adjusted standards. Gross features of the foetal membranes, umbilical cord, and placental disk were systematically assessed. Between-group comparisons employed non-parametric and categorical tests, with significance set at p <0.05. Results: Placentas from women living with HIV had significantly lower weights before and after fixation compared with HIV-negative controls (p = 0.001 and p <0.001, respectively). Gestational age-adjusted placental weight categories also differed significantly between groups. Umbilical cord length was shorter in HIV-positive pregnancies (p = 0.026), and cord discolouration was more frequent (p = 0.010). Most foetal membrane and placental disk features showed no significant differences. Conclusion: Pregnancies among women living with HIV are associated with reduced placental weight, shorter umbilical cords, and increased cord discolouration, reflecting subtle but clinically relevant placental compromise. Routine gross placental examination may help identify at-risk pregnancies in resource-constrained settings.
Ectopic pregnancy is a common obstetric emergency, occurring in approximately 2–3% of pregnancies. Heterotopic pregnancy, defined as the coexistence of intrauterine and ectopic gestations, is rare but increasingly encountered with the widespread use of assisted reproductive technologies, accounting for nearly 1% of in vitro fertilisation (IVF) pregnancies. Early diagnosis remains challenging, particularly in IVF patients, where ovarian hyperstimulation–related ascites may obscure clinical and ultrasonographic findings. We report a case of a 32-year-old woman with primary infertility who conceived following IVF and frozen embryo transfer and presented with mild abdominal pain and vaginal bleeding after a positive pregnancy test. Ultrasonography revealed twin intrauterine gestations with a concomitant ruptured right tubal ectopic pregnancy and free intraperitoneal fluid. Emergency laparoscopic evaluation confirmed a ruptured right ampullary ectopic pregnancy, and laparoscopic salpingectomy was successfully performed. The patient had an uneventful postoperative recovery and was discharged on postoperative day one. The intrauterine twin pregnancy progressed without complications, and at 36 weeks of gestation, an emergency caesarean section was performed for premature rupture of membranes with breech presentation of both fetuses, resulting in the delivery of healthy male and female neonates. This case highlights that heterotopic pregnancy should be considered even in the presence of a confirmed intrauterine gestation, particularly following assisted reproductive techniques. Early transvaginal ultrasonography by experienced clinicians is essential for timely diagnosis, and laparoscopic management of the ectopic component is a safe and effective treatment option that can preserve the ongoing intrauterine pregnancy and achieve favourable maternal and perinatal outcomes.
Mitochondria, recognised mainly for their role in adenosine triphosphate (ATP) production, are now understood to be pivotal regulators of reproductive function, extending their influence to gametogenesis, fertilisation, and early embryonic development. In males, mitochondrial dysfunction and excessive reactive oxygen species (ROS) generation compromise sperm motility, deoxyribonucleic acid (DNA) integrity, and fertilisation potential, contributing to infertility. Similarly, in females, proper mitochondrial activity is essential for oocyte maturation and embryonic viability, with mitochondrial DNA (mtDNA) abnormalities increasingly associated with ovarian ageing and diminished fertility. Emerging evidence also highlights the role of mitochondrial epigenetics, such as mtDNA methylation, non-coding ribonucleic acid (RNA) regulation, and retrograde signalling, in modulating reproductive outcomes. Disruptions to these pathways from ageing, metabolic disorders, environmental stressors, or assisted reproductive technologies (ART) can impair fertility in both sexes. Promising therapeutic strategies, including mitochondrial transfer, antioxidant supplementation, and modulation of mitochondrial dynamics, are still under investigation. A deeper understanding of mitochondrial function and its epigenetic interactions offers novel avenues for the diagnosis and treatment of infertility.
The measures employed by fertility clinics to prevent Assisted Reproductive Technologies mix-ups are labelling of all labware and manual double-witnessing protocols. Advanced cutting-edge technological solutions for electronic witnessing are also being developed. One such recent innovation is the introduction of the Electronic Witnessing System (EWS) in infertility clinical practice. The goal of the EWS is to ensure accurate identification and prevent mix-ups. Critical points during the clinical and laboratory in vitro fertilisation (IVF) procedures are identified where mismatching of gametes and embryos may occur. These critical points are ovum pick-up, sperm collection, preparation of sperm, insemination[Intrauterine insemination (IUI), IVF, Intracytoplasmic sperm injection (ICSI)], transferring gametes and embryos between tubes or dishes, embryo transfer, and embryo or gamete cryopreservation.
This randomised controlled trial aimed to assess the efficacy of Atosiban in women undergoing frozen embryo transfer. The specific objectives were to assess the clinical pregnancy rate (PR), implantation rate (IR), biochemical PR and first-trimester miscarriage rate. The study was conducted at Akanksha in vitro fertilisation (IVF) Centre, New Delhi, from 28 December 2024 to 28 May 2025. A total of 100 women aged 23–40 years undergoing an frozen embryo transfer (FET) cycle were included in the study. Other inclusion criteria are body mass index (BMI) < 30 kg/m 2 , normal uterus on 2D ultrasonography, endometrial thickness ≥ 7 mm on the day of starting progesterone, and at least two good-quality embryos - blastocyst (4AA, 4AB, 4BA, 3AA) transferred. Uterine factors like Ashermann’s syndrome, space-occupying lesions like adenomyosis, fibroids and recurrent implantation failure were excluded from the study. Patients who underwent FET cycles were categorised into two groups: Group A (50 patients)— patients who underwent FET after administration of Atosiban; Group B (50 patients)—patients who underwent FET without prior administration of Atosiban, hence acting as controls. The randomisation of patients was done by a computer-based programme into two groups. A baseline scan was done on Day 2/Day 3. Endometrial preparation was done by sequential incremental administration of oral oestradiol until endometrial thickness was ≥7 mm, followed by oestradiol combined with injectable progesterone as luteal phase support, P + 5 days, where P stands for progesterone (P + 5 refers to 5 days of administration of progesterone). Atosiban IV bolus of 6.75 mg was administered 30 minutes before embryo transfer. Frozen embryo transfer was done in both groups, in which two good-quality blastocysts (4AA, 4AB, 4BA, 3AA) were transferred. A urine pregnancy test or serum beta-human chorionic gonadotrophin (HCG) levels were done 14 days after FET. In case of a positive pregnancy test, the patient was followed up at 6–7 weeks of gestation to assess the pregnancy outcome. In case of a viable pregnancy, the patient was followed up at 11–12 weeks of gestation. Baseline characteristics of both the study groups—age, duration of infertility, S.Antimullerian hormone (AMH), antral follice count (AFC), S.Estradiol—were similar. Group A patients in whom Atosiban was given prior to embryo transfer demonstrated a statistically significantly higher clinical PR as compared to Group B patients without Atosiban (58 vs. 38, p < 0.05). Group A patients demonstrated a higher IR as compared to Group B (33.33 vs. 23.80, p < 0.12), and the biochemical PR was also higher in Group A patients as compared to Group B patients without Atosiban (20 vs. 14, p < 0.42), but the differences were not statistically significant. The first-trimester miscarriage rate was lower in Group A with Atosiban as compared to Group B without Atosiban (17.24 vs. 21.05, p < 1); however, the difference was statistically not significant. The administration of Atosiban before embryo transfer in women has led to an increase in the clinical PR, thus increasing the success rate of the assisted reproductive technology (ART) cycle.
Polycystic Ovary Syndrome (PCOS) is a very prevalent endocrine disorder among women of reproductive age, occurring in approximately 4%-20% of women worldwide. It is associated with anovulation, hyperandrogenism, and polycystic ovarian morphology and has the potential to cause a variety of reproductive disorders, such as infertility and pregnancy complications. PCOS is also attributed to significant metabolic risk, such as insulin resistance, obesity, dyslipidaemia, and cardiovascular risks. Due to the nature of this disorder, lifestyle modification, better still, diet, is recommended as first-line management to minimise both reproductive and metabolic morbidity in women with PCOS. This paper will therefore endeavour to find out what is the optimal diet for PCOS patients to minimise the risk of chronic diseases. This review article presents different dietary management strategies that have been experimented with in PCOS women and how they are impacting reproductive, metabolic, and endocrine health. Analysis conducted in this study includes some types of diets, including calorie diets, fat diets, pulse diets, and supplement diets like curcumin diet, cinnamon diet, inositol diet, and vitamin D diet. The effectiveness of commercial diet replacements and their impact on weight loss and metabolic improvement is also discussed. The review contains a meta-analysis of observational studies and randomised controlled trials which have contrasted the effect of such diets upon endpoints like weight loss, insulin sensitivity, balance of hormones, regularity of menses, and quality of life. Literature provides the positive impact of dietary modification on PCOS clinical endpoints. Some women with PCOS were noted to have weight gain, insulin sensitivity, and lowered levels of hyperandrogenism on following specific diets. Also, calorie-restricted diets caused weight loss and improved metabolic control in glucose and lipid profiles. Pulse-based diets such as chickpeas and legumes also raised cardio-metabolic risk factors. Supplementation with curcumin, cinnamon, and inositol diets was found to possess the potential to reduce inflammation, enhance insulin sensitivity, and improve ovarian function. Besides this, Mediterranean and DASH diets proved to be most effective in improving ovarian function, reducing the levels of androgens, and enhancing fertility outcomes. Moreover, an exercise regimen along with diet can further enhance the reproductive and metabolic status in PCOS women. This review shows that diet control is a key component to control the clinical presentation of PCOS. A Mediterranean dietary model, based on whole foods, healthy fats, and low-glycaemic carbohydrates, is one of the strongest dietary models for the control of the metabolic abnormalities related to PCOS, such as insulin resistance and hyperandrogenism. Furthermore, supplements such as curcumin, cinnamon, inositol, and vitamin D can supplement these activities to enhance the sensitivity of insulin, reduce inflammation, and promote hormonal balance. Finally, commercial meal-replacement drinks can also help one lose weight, which typically tends to remain challenging in women with PCOS. A basic approach of a Mediterranean diet complemented by lifestyle adjustments by the form of regular exercise and psychotherapy altogether illustrates the most effective way of treating PCOS.
Follicle formation is a critical determinant of the size of the primordial follicle pool and is essential for fertility. This process occurs during definitive histogenesis. Follicles secrete essential hormones required for proper endocrine functioning and are also the chief suppliers of steroid sex hormones. Additionally, they also produce other local regulators. Throughout childhood and puberty, the human ovary presents differences in the follicle population. Ovarian granulosa cells play a significant role in every stage of follicular growth through proliferation, steroidogenesis and production of autocrine and paracrine factors. This review outlines the events of folliculogenesis at different stages and the factors influencing this complex pathway.
Reproduction, a fundamental biological process, is vital for ensuring species continuity. Despite its complexity, sexual reproduction increases genetic diversity and allows for more efficient removal of deleterious mutations, ultimately enhancing fitness and survival. However, human fertility rates have been steadily declining, with approximately 17.5% of the global adult population affected by infertility (WHO, 2023). 30%–40% of these cases are attributed to female factors, which can be genetic, chromosomal, hormonal, physiological or epigenetic. Zona Pellucida (ZP), a glycoprotein matrix surrounding a mammalian oocyte, plays a crucial role in folliculogenesis, fertilisation, and embryo protection. Human ZP is made up of four glycoproteins (ZP1–4), out of which ZP2 is essential for species-specific sperm binding, structural integrity, and embryo development. Female knockout mice lacking ZP2 exhibit infertility, indicating its critical role in oocyte maturation and fertilisation. Post-fertilisation, ovastacin-mediated ZP2 cleavage prevents polyspermy, a critical step ensuring viable embryonic development. Hence, female infertility can be caused by mutations in the ZP2 gene, which often present phenotypically as defective ZP formation, impaired oocyte development, and compromised fertilisation in infertile female patients. In this review article, we discuss the role played by ZP2 and how mutations in this gene can cause female infertility. Understanding the effects of mutations in the ZP2 gene in females will provide valuable insights into infertility mechanisms and their possible treatment strategies.
Globally, there is a paradigm shift towards frozen embryo transfers (FET). The protocols are divided into two categories based on the presence or absence of ovulation: natural cycle (NC) and artificial cycle (AC). Although pregnancy rates appear comparable in most studies, there is emerging evidence suggesting a potential association between AC-FET cycles and adverse obstetrical and perinatal outcomes. Suboptimal endometrial preparation and/or absence of the corpus luteum (CL) has been implicated as a potential aetiology. A shift towards NC-FET protocols has been explicitly propagated in the literature for safer maternal and neonatal outcomes. To optimise the NC-FET cycles with both true NC-FET and modified NC-FET, the role of progesterone as luteal phase support (LPS) is emphasised, though there is no consensus in the literature on using progesterone as LPS in these FET cycles. We provide a review based on the biological rationale and clinical evidence for progesterone as LPS in true NC-FET cycles and modified NC-FET cycles: whether it is required, can serum progesterone levels help in individualising LPS, and is there an optimum point in the luteal phase to begin progesterone supplementation?
The traditional concept of starting controlled ovarian stimulation (COS) exclusively in the early follicular phase has been challenged by the recent evidence on the multiple wave theory of follicular recruitment within a menstrual cycle. This understanding has led to the development of a new ovarian stimulation protocol for in vitro fertilisation (IVF) known as Dual stimulation or DuoStim, especially for poor responders. Dual stimulation implies follicular phase stimulation (FPS) followed by luteal phase stimulation (LPS) within the same menstrual cycle. The main advantage of this protocol includes an increase in the number of oocytes and embryos obtained per menstrual cycle, thus improving the chance of live birth per DuoStim cycle compared to single conventional stimulation. Dual stimulation appears to be beneficial for poor responders and advanced maternal age women, especially to rescue poor blastocyst yield after one conventional COS and avoid further maternal ageing between IVF attempts. This strategy appears to have led to a significant reduction in patient dropout rates in these women. It is also a relevant approach for patients undergoing the accumulation of embryos for pre-implantation genetic testing, where one aims to maximise the number of oocytes/embryos in a limited period. The majority of evidence has shown better performance of LPS in comparison to FPS in the context of the number of oocytes and embryos obtained in DuoStim cycles. However, mandatory freeze all, high cycle cancellation and lengthening of stimulation days in LPS are a few drawbacks. However, presently, multicycle counselling using DuoStim or similar protocols appears to be a relevant change needed in IVF to increase oocyte/embryo number in a short time frame and thus reduce attrition.
Mitochondrial mutations cause debilitating health conditions, and assisted reproduction broadens novel treatment options in women with mitochondrial mutations to reduce the risk of the mutations in their offspring. This editorial elaborates on the Mitochondrial Donation Programme licensed in the United Kingdom as a risk-reduction fertility treatment option for women suffering from mitochondrial mutation. This is the first licensed fertility treatment programme for women with mitochondrial mutation in the world, followed by the Australian parliament licensing it, and it is currently in the process of setting up the programme.
Particularly during ageing, the hypothalamic–pituitary–gonadal axis in mammals is governed by Gonadotropin-releasing hormone-I (GnRH-I), a fundamental neuropeptide. Polyamines are organic compounds with multiple amino groups. These are significant aliphatic amines that are expressed in the brain and show variations with ageing. As they are polycationic, they modulate the activity of negatively charged biomolecules such as DNA, RNA, proteins and phospholipids, thereby regulating various cellular and genetic functions. Correlations, both positive and negative, exist between polyamines, their associated factors, gonadotropin-releasing hormone (GnRH) and gonadotropin‐inhibitory hormone (GnIH). Notably, recent studies suggested polyamines enhance the activity of GnRH-I while simultaneously inhibiting GnIH. Polyamines also play a role in alternative splicing (AS). AS is significant for increasing the variety of the transcriptome and proteome, mainly in mammals. For example, putrescine has been shown to regulate the AS in the GnRH gene of the hypothalamus of rodents. While these findings highlight intriguing mechanisms, their translatability to humans remains to be clarified.
This systematic review scrutinised the datasets used to train Artificial Intelligence (AI) tools developed for automated blastocyst assessment. It is widely acknowledged that the quality of these datasets significantly influences the performance of the AI models. Analysis of datasets from 26 studies highlighted considerable variations in various dataset parameters such as dataset size, data diversity, image quality, image capture mechanism and timing, class distribution, dataset endpoints and metadata usage. Some models incorporate morphokinetic or morphometric annotations and clinical metadata, whereas others rely solely on single-point static images. Many studies lack crucial information, such as image capture timing, embryo transfer strategy, and vital information related to the removal of confounding factors, such as uterine factors, hindering cross-study comparisons. Standardisation of datasets is vital for accurate assessment and comparison of commercially available AI models used for blastocyst assessment. The absence of standardised parameters and the lack of removal of confounding variables emphasise the need for greater transparency and standardisation in dataset creation and reporting. Future research should prioritise constructing a robust gold-standard large dataset that includes diverse imaging data and excludes confounding factors. In the absence of such a dataset, comparison of the AI model becomes very subjective.
In 2025, it is our considered opinion, based on 40 years of experience in full-time andrology and reproductive sciences, that varicocele as a cause of male infertility remains largely unproven. While some meta-analyses suggest a marginal benefit in specific patient subsets, these findings are often debated regarding their clinical significance or methodological limitations. Couples with impaired semen parameters can be effectively treated by intrauterine insemination and, if necessary, by advanced assisted reproductive technologies like intracytoplasmic sperm injection (ICSI). With unproven benefits, an invasive nature, no clear explanation for the actual mechanism of causation, an unpredictable outcome, and the availability of simpler, better alternatives like IUI and ICSI, I feel varicocelectomy is the unkindest cut of all.
In the investigations of infertile couples, the contribution of male partners has recently caught the attention of researchers, and more and more investigations like DNA fragmentation tests, microfluidics, physiological intracytoplasmic sperm injection, and intracytoplasmic morphological sperm injection are being resorted to for better Assisted Reproductive Technology (ART) results. Male fertility is intrinsically linked to overall health, with a growing body of evidence indicating that medical comorbidities and conditions detrimental to men’s health are consistently associated with compromised reproductive function. Considering the fact that 15% of the male human genome is dedicated to reproductive functions, it is plausible that other health disorders may also be associated with impairments in fertility. This study was planned to look into factors which are causing such a rise in male infertility and its association with various semen parameters. A cross-sectional study was undertaken over an 18-month period at the infertility clinic of a tertiary care centre, enrolling 151 infertile males exhibiting abnormal semen parameters in accordance with the WHO 2010 guidelines. A comprehensive evaluation of their biochemical and endocrinological profiles was performed, and the correlation between these parameters and semen abnormalities was systematically examined. A significant negative correlation was observed between various semen parameters and diastolic blood pressure (DBP), prolactin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), follicle-stimulating hormone (FSH), and oestrogen. DBP (mmHg) correlated negatively with sperm concentration (million/ml) (R = −0.161). CRP (mg/l) correlated with sperm concentration and total sperm count (×10 6 /ejaculate) (R = −0.180 and −0.208, respectively). ESR (mm/hour) correlated with sperm concentration and total sperm count (R = −0.214 and −0.198, respectively). FSH (IU/l) correlated with sperm concentration and total sperm count (R = −0.216 and −0.206, respectively). Prolactin (μg/l) correlated with sperm concentration, total sperm count, and total motile sperm count (TMSC) (R = −0.210, −0.264, and −0.191, respectively). Oestrogen (pg/ml) showed the strongest negative correlation with sperm concentration, total sperm count, and TMSC (R = −0.387, −0.357, and −0.171, respectively). Conversely, significant positive correlations were observed between semen parameters and both uric acid and lipid profile. Serum uric acid (mg/dl) correlated positively with sperm morphology (%) (R = 0.203). Low-density lipoprotein (mg/dl) correlated with sperm concentration and total sperm count (R = 0.231 and 0.259, respectively), while triglycerides (mg/dl) correlated with sperm concentration and total sperm count (R = 0.197 and 0.204, respectively). However, triglycerides also showed a significant negative correlation with total motility (%) and progressive motility (%) (R = −0.186 and −0.180, respectively). Our findings demonstrated that DBP, prolactin, ESR, CRP, FSH, and oestrogen exhibited significant negative correlations with various semen parameters, whereas uric acid and lipid profile parameters showed significant positive correlations. These results suggest that systemic health factors exert a considerable influence on male reproductive potential, highlighting the importance of evaluating overall health status in the assessment and management of male infertility.
