BACKGROUND:Obesity has become a major health problem across the world. In women, it is known to cause anovulation, subfecundity, increased risk of fetal anomalies and miscarriage rates. However, in women going for assisted reproduction the effects of obesity on egg quality, embryo quality, clinical pregnancy, live birth rates are controversial.OBJECTIVES:To assess the effect of women’s body mass index (BMI) on the reproductive outcome of non donor In vitro fertilization (IVF)/Intracytoplasmic sperm injection (ICSI). The effects of BMI on their gonadotrophin levels (day 2 LH, FSH), gonadotrophin dose required for ovarian stimulation, endometrial thickness and oocyte/embryo quality were looked at, after correcting for age and poor ovarian reserve.MATERIALS AND METHODS:Retrospective study of medical records of 308 women undergoing non donor IVF cycles in a University affiliated teaching hospital. They were classified into three groups: normal weight (BMI<25 kg/m2), overweight (BMI>25 <30 kg/m2) and obese (BMI>30 kg/m2). All women underwent controlled ovarian hyper stimulation using long agonist protocol.RESULTS:There were 88 (28.6%) in the normal weight group, 147 (47.7%) in the overweight and 73 (23.7%) in the obese group. All three groups were comparable with respect to age, duration of infertility, female and male causes of infertility. The three groups were similar with respect to day 2 LH/FSH levels, endometrial thickness and gonadotrophin requirements, oocyte quality, fertilization, cleavage rates, number of good quality embryos and clinical pregnancy rates.CONCLUSION:Increase in body mass index in women does not appear to have an adverse effect on IVF outcome. However, preconceptual counselling for obese women is a must as weight reduction helps in reducing pregnancy-related complications.

Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index.

Background Multiple pregnancy and preterm delivery are well-known complications of IVF/ICSI treatment. Fetal reduction is also performed in the cases of high order multiple pregnancy. There is increased impetus on transferring fewer embryos, preferably only one in younger women. Materials and Methods 186 women, who conceived following IVF/ICSI treatment participated in a questionnaire study regarding their knowledge and attitudes towards multiple embryo transfer, fetal reduction and multiple pregnancy Results A majority of women said that they were aware of the complications of multiple pregnancy (90%) and preterm delivery (85%). Nevertheless, none of them opted for a single embryo transfer. A positive pregnancy test was more important to most women than the outcome of that pregnancy (74%). Fetal reduction did not pose any moral concerns to most women (67%). Anxiety about the safety of the remaining twins persisted throughout pregnancy (73%). Having twin babies did not affect the quality of life of most women (74%). Conclusion Indian women were similar with their western counterparts in desiring multiple embryo transfer in order to maximize their chance of getting a positive pregnancy result. The negative impact of twin or higher order pregnancy appears to be disregarded by the women prior to getting pregnant. The confidence of the treating physician to offer single embryo transfer also appears to affect the patients’ choices.

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A 30 year old woman presented 12 days after embryo transfer with lower abdominal pain and orange vaginal discharge. She was diagnosed to have pyometra. A conservative management with drainage of the pyometra was followed by an uneventful pregnancy and term delivery. Conservative management in a case of pregnancy with pyometra needs close supervision to ensure maternal and fetal well being.

Introduction Poor responders have suboptimal outcomes following conventional in vitro fertilization/intracytoplasmic sperm injection treatment. There is some evidence that transdermal testosterone and growth hormone may help in improving live birth rates in this group. Aim To present a case series of women who had sequential transdermal testosterone and growth hormone treatment in view of their being expected poor responders or with a history of previous poor oocyte or embryo quality. Setting Private assisted reproduction clinic. Materials and methods A total of 24 women underwent 30 cycles of controlled ovarian stimulation. Ten patients out of 24 had previous poor assisted reproductive technology outcomes, of which 4 were poor responders. Fourteen were expected poor responders. The women used approximately 1.2 gm of transdermal testosterone from day 5 to 25 along with a standard oral contraceptive pill. Growth hormone was given at 8 units/day subcutaneously from day 2 along with the gonadotropins in the antagonist protocol. Results The mean age of the women was 34.92 years (±3.6). The average duration of subfertility was 7.54 (±4.005) years. The mean antral follicle count was 9 (±3.28) and the mean anti-Mullerian hormone level was 1.2 ng/mL (±0.56). The mean number of eggs collected was 8 (±5.45). Number of mature (M2) eggs was 6.6 (±4.5) Mean number of eggs fertilized was 5.04 (±4.03); clinical pregnancy rate was 8/24 (33.3%) and ongoing pregnancy rate was 4/24 (16.6%). Conclusion This case series shows an encouraging clinical pregnancy rate. The reduced ongoing pregnancy rate probably reflects the suboptimal gamete quality. Further randomized controlled trials (RCTs) are needed to assess the efficacy of sequential transdermal testosterone and growth hormone therapy in poor responders. Clinical significance The ongoing pregnancy rate in this group with poor prognosis seems encouraging, and further well-designed RCTs would help in assessing the merits of this sequential therapy. How to cite this article Balasubramanyam S. Sequential Use of Testosterone Gel and Growth Hormone in Expected Poor Responders and those with Previous Poor Assisted Reproductive Technology Outcomes: A Pilot Study. Int J Infertil Fetal Med 2017;8(1):1-4.

Introduction: Prior to the era of in vitro fertilization, no options for conception were available to women with primary ovarian insufficiency, decreased ovarian reserve, or genetically transmittable diseases. Oocyte donation (OD) has been used in such women for almost 30 years. It also offers an opportunity to study the participation of the uterus in the process of human embryo implantation. Aim: To identify recipient variables that may have a significant impact on the pregnancy outcome of an OD program.