"Newer surgical approach to prevent re-stenosis following canalisation of cervico-vaginal atresia." Journal of Obstetrics and Gynaecology, 35(8), pp. 863–864

Dysregulation in the expression of endometrial cytokines, matrix metalloproteases, angiogenic and vasoactive factors during peri-implantation window are associated with unreceptive endometrium. The present study focuses on identifying the key molecules contributing towards poor endometrial receptivity during peri-implantation period in women with idiopathic recurrent spontaneous miscarriage (IRSM). A prospective case-controlled study carried out on 66 women with IRSM reporting for treatment at the Institute of Reproductive Medicine, Kolkata, India between January 2010to December 2012. 50 fertile women undergoing sterilization were included in the study as controls. All women were age below 35 years and having average BMI. Blood samples were collected from all women during mid secretory phase and serum was extracted from it. Levels of Interleukin-10 (IL-10), vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in serum were assessed by ELISA. Multivariate analysis was performed to identify the key factor contributing towards poor endometrial receptivity in IRSM women. Serum expression of IL-10, VEGF, eNOS and TIMP-1 were observed to be significantly lower and MMP-9 was significantly higher in women with IRSM compared to controls. IL-10 was identified as the key contributory factor for poor endometrial receptivity in women with IRSM. Further, 62.58 pg/ml is the serum cut-off level of IL-10 beyond which endometrial receptivity is impaired in women with IRSM. As part of routine clinical examination, IL-10 may be assessed in serum of women with IRSM. Adequate clinical measures for preventing early pregnancy loss can be taken if the serum IL-10 expression is found beyond the threshold level in these women.

There has been a slow but steady increase in the number of women above 40 years of age seeking infertility treatment worldwide. A critical appraisal on treatment modalities offered to women above 40 years of age in our clinic and subsequent treatment outcome is provided. All women above 40 years of age treated for infertility at Institute of Reproductive Medicine, Kolkata, India over a period of four years (2008-2012) were analyzed retrospectively. Out of the 943 elderly (>40 years) women, IVF was performed in 782 women. Out of these 782 women, IVF was performed either with their own egg (n=225) or donor egg (n=235) or donor embryo (n = 210) or surrogacy (n=13). In the remaining 161 women, conventional treatment modalities such as IUI (n=51), ovulation induction (n=94) or sequential estrogen/progesterone (E/P) down-regulation (n=16) were carried out. A total of 176 pregnancies were achieved out of 943 women (18.66%). 148 out of 782 women achieved pregnancy following treatment with IVF (18.92%). 28 out of 161 women achieved pregnancy in the conventional treatment group (17.39%). Among women treated with IVF, pregnancy outcome with own egg, donor egg, donor embryo and surrogacy was observed to be 10.8%, 25.95%, 21.9%, 46.15% with a viable delivery of 4.62 %, 20.85%, 10.47% and 15.38%, respectively. Similarly miscarriage rate were found to be 5.7%, 0%, 32.6%, 16.6%, respectively. Pregnancy outcome due to conventional treatment modalities was 7.8% with IUI, ovulation induction protocols (22.3%) and sequential E/P treatment (18.7%). Miscarriage rates were found to be similar between the three groups (5.8%, 7.4%, 6.25%, respectively). IVF especially with donor egg/embryo and surrogacy appears to be the treatment of choice in elderly women for better pregnancy outcome. Alternatively, ovulation induction following sequential E/P down regulation could be considered in elderly women who cannot afford IVF.

The ideal method for sperm selection during Intracytoplasmic sperm injection (ICSI) is still ill-defined. Identification of a viable spermatozoon amongst immotile spermatozoa for ICSI often becomes difficult. Ninety-six ICSI cycles were selected and divided into Group A (azoospermic, n = 58) and Group B (complete asthenozoospermic, n = 38). Oocytes having birefringent meiotic spindle and zona pellucida thickness <20 μm were selected for ICSI. Groups A and B were further divided into A1, A2 and B1, B2, respectively, based on the type of ICSI performed. In Group A1, a motile spermatozoon with normal morphology was injected into a metaphase-II (M-II) oocyte. In Group B1, spermatozoon showing coiling of tail following modified hypo-osmotic swelling test was injected into M-II oocytes. In Groups A2 and B2, ICSI was performed by injecting a spermatozoan with birefringent head. Pronuclear morphology, fertilisation rate, embryo grading and pregnancy rate were assessed. ICSI outcome measures were better in Group A2 than in Group A1 but were statistically insignificant. However, significantly higher percentage of Z1 and Z2 zygotes, Grade I and Grade II embryos and pregnancy rate were observed in Group B2 as compared to Group B1. Selection of birefringent spermatozoa shows promising results in asthenozoospermic men and men undergoing testicular sperm aspiration or extraction before ICSI.

Background: The effect of follicular fluid (FF) oxidative stress (OS) on meiotic spindle (MS) formation in oocytes and subsequent outcome in women with polycystic ovarian syndrome (PCOS) are evaluated in this study. Methods: 326 oocytes from 35 PCOS women (group A) and 208 oocytes from 32 women with tubal infertility (group B) were visualized for MS using PolScope. FF was analyzed for OS markers including reactive oxygen species (ROS), lipid peroxidation and total antioxidant capacity (TAC). Group A was further classified into groups A1 and A2, and group B into groups B1 and B2 depending upon the presence or absence of MS, respectively. Results: MS formation was absent in a significantly higher number of oocytes in group A compared to group B (p ≤ 0.05). OS markers were significantly higher in group A compared to group B (p ≤ 0.05). Fertilization rate, number of good quality embryos and clinical pregnancy rates were higher in group B compared to group A, though not statistically significant. FF ROS was significantly higher and TAC significantly lower in groups A2 and B2 compared to groups A1 and B1 (p < 0.001). Conclusion: The presence of MS and oocyte maturation in PCOS women showed a positive correlation with low levels of OS.