Unexplained infertility: An approach to diagnosis and management

Kamath, Mohan S; Deepti, Mogili Krishna

doi:10.4103/0973-4651.194461

Cited by 9 publications

(9 citation statements)

References 2 publications

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“…Women with unexplained infertility (n = 50); duration of infertility more than two years with regular menstrual cycles (21–35 days), normal endocrine profile (normal levels of FSH (<11 IU/L) in early follicular phase (day 2–5), normal Prolactin levels (<20 mg/L) in serum, normal thyroid levels), pelvic ultrasonography with patent fallopian tubes, intact ovaries and uterus, no prior ovarian surgery with normal semen profile of their husband [ 9 , 15 ] age 24 to 35 years booked for ICSI treatment were included in the study.…”

Section: Methodsmentioning

confidence: 99%

Impact of serum and follicular fluid kisspeptin and estradiol on oocyte maturity and endometrial thickness among unexplained infertile females during ICSI

et al. 2020

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Objective To relate serum and follicular fluid (FF) kisspeptin and estradiol levels in different stages of stimulation during Intracytoplasmic Sperm Injection (ICSI) with oocyte maturity and endometrial thickness among unexplained infertile females. Methods This cross-sectional study was carried out at the Australian Concept Infertility Medical Centre from March 2017 till March 2018. Fifty unexplained infertile females, booked for ICSI, were included in the study. Serum kisspeptin and estradiol were estimated by Enzyme-Linked Immunosorbent Assay in all four stages; 1: follicular stimulation, 2: ovulation induction, 3: oocyte pickup, and 4: embryo transfer. FF was aspirated during oocyte retrieval (stage 3) for the analysis of KP and estradiol. Pregnancy outcomes were categorized as non-pregnant, preclinical abortion, and clinical pregnancy. Results The age of the study subjects was 32.04 ± 2.29 (Mean±SD) years, with mean BMI of 28.51 ± 4.15 (Mean±SD) kg/m 2 . Mean serum kisspeptin and estradiol levels increased in all subjects as the stimulation proceeded stages 1–3; however, the mean dropped after retrieval of the oocytes (stage 4). Out of 27 female subjects who completed the cycle, 17 remained non-pregnant, 4 had preclinical abortion, and 6 acquired clinical pregnancy. The FF kisspeptin concentration was significantly higher than serum concentrations and positively correlated with serum and FF estradiol concentrations. FF-kisspeptin correlated with serum kisspeptin in Stage 3 (r = 0.930, p<0.001), maturity of oocyte (r = 0.511, p = 0.006) and endometrial thickness (r = 0.522, p = 0.005). Kisspeptin in stage 3 was also found to correlate with endometrial thickness (r = 0.527, p = 0.005) and with estradiol (r = 0.624, p = 0.001) independently. Conclusion Increase in serum and FF-kisspeptin and estradiol levels from stages 1 to 3, resulted in an optimum endometrial thickness, probability of fertilization of oocytes and chances of clinical pregnancy in Assisted Reproductive Techniques /ICSI cycles of unexplained infertile females.

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Section: Methodsmentioning

confidence: 99%

Impact of serum and follicular fluid kisspeptin and estradiol on oocyte maturity and endometrial thickness among unexplained infertile females during ICSI

et al. 2020

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“…The long GnRH agonist protocol: The long GnRH-agonist protocol for COH included down-regulation of pituitary gland with subcutaneous injection of GnRH-agonist (0.1 mg/d) that was begun on 21 st d of the preceding menstrual cycle, then gonadotropin injection administered subcutaneously on the 2 nd or 3 rd d of menstruation at different dosages according to the patient's age and previous response of ovulation induction. When at least three follicles had reached 18 mm in diameters HCG injection (10,000 IU) was used for triggering were applied 34-36 h prior to oocytes retrieval [8]. The antagonist protocol included administration of gonadotropin on the 2 nd or 3 rd d of menstruation at different dosages according to the patient's age and previous response of ovulation induction then down-regulation of pituitary gland with SC injection of GnRH antagonist when follicular size reached 14 mm in diameter then triggering were applied 34-36 h prior to oocytes retrieval [9].…”

Section: Control Ovarian Hyperstimulation (Coh)mentioning

confidence: 99%

The impact of age and BMI on oocyte maturation and embryo development

Al-Obaidi¹,

Mahdi²,

Alwasiti³

2018

biomedicalresearch

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Background: Ovarian oogenesis is under the control of gonadotropins. In the human ovary, each fully grown oocyte resumes maturation in response to gonadotrophins. This process is completed after oocytes reach metaphase stage of second meiotic division (MII) stage. The aim of this prospective, clinical trial was to perceive the age and BMI effect on oocytes maturation and embryos development in women undergoing control ovarian hyperstimulation. Method: A total of 40 infertile women undergoing ovarian hyperstimulation their age range between 18-40 y old were included in this study using two type of protocol: long agonist and antagonist. Result: Significant negative correlation was observed between the age and the number of retrieved MII oocytes. Significant negatively effects of the BMI on the number of MII oocytes while significant positive correlation between the BMI and the fertilization rate was noticed. Conclusion: There are negative effects of age and BMI on the oocytes number and quality.

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“…Criteria for diagnosis of unexplained infertility included: i) infertility for at least 2 years; ii) normal history and physical examination; iii) adequate coital frequency; iv) three normal semen analyses; v) regular monthly menstrual cycles with biphasic BBT and luteal phase ≥ 12 days; vi) adequate cervical mucus and a normal post coital test; vii) normal luteinizing hormone, follicle stimulating hormone, prolactin, testosterone, and progesterone (P); viii) normal hysterosalpingography and laparoscopic findings. 2 All volunteers had regular menstrual cycles every 28-32 days. All study participants underwent transvaginal ultrasonographic monitoring of ovulation commencing from days 8-10 of menstrual cycle using a 3.5 to 8.5 MHz vaginal transducer (Shimadzu SBU 350, Japan).…”

Section: Participantsmentioning

confidence: 99%

“…In 15-30% of infertile women, no apparent cause of infertility is found during infertility work-up and the type of infertility is categorized as unexplained infertility. 2 Although, Assisted Reproductive Technology (ART) has given a new ray of hope for such couples, success rate is still not more than 30% in best of ART laboratories. 3 synchronous development of endometrium which is receptive to blastocyst implantation.…”

Section: Introductionmentioning

confidence: 99%

Cellular homeostasis, implantation window and unexplained infertility: role of phosphatase and tensin homolog deleted on chromosome 10

Makker

Goel

Manu

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background: Balance between endometrial cell proliferation and apoptosis is crucial for successful embryo implantation. PTEN (phosphatase and tensin homolog deleted on chromosome 10), a pro-apoptotic factor, is proposed to be one of the signaling proteins through which estrogen and progesterone act to affect cellular homeostasis. Although reports in literature have suggested role of PTEN in regulating endometrial cell proliferation and apoptosis during window of implantation, its involvement in women with unexplained infertility is not clear. In the present study, we examined expression, cellular distribution and activation status of PTEN, cell proliferation, and apoptosis in midsecretory endometrium from women with unexplained infertility as compared to fertile controls.Methods: Endometrial biopsies from infertile (n=11) and fertile women (n=22) were used for immunohistochemical evaluation of PTEN, phospho-PTEN and Ki67. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling assay was performed for detection of apoptotic cells.Results: Biopsies from infertile women as compared to fertile controls demonstrated statistically significant: i) decrease in nuclear PTEN (P < 0.001), increase in nuclear phospho-PTEN (P < 0.05), increase in nuclear and cytoplasmic phospho-PTEN/PTEN ratio (P < 0.001 and P < 0.05 respectively) in endometrial stroma, ii) increase in cytoplasmic phospho-PTEN (P < 0.001) and phospho-PTEN/PTEN ratio (P < 0.05) in glandular epithelium (GE), iii) increase in Ki67 labeling in GE (P < 0.01) and stroma (P < 0.05) and, iv) decrease in (P < 0.001) apoptosis.Conclusions: Altered PTEN expression and associated modulation in cellular homeostasis during the implantation window might contribute to mechanism underlying unexplained infertility.

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Unexplained infertility: An approach to diagnosis and management

Cited by 9 publications

References 2 publications

Impact of serum and follicular fluid kisspeptin and estradiol on oocyte maturity and endometrial thickness among unexplained infertile females during ICSI

Impact of serum and follicular fluid kisspeptin and estradiol on oocyte maturity and endometrial thickness among unexplained infertile females during ICSI

The impact of age and BMI on oocyte maturation and embryo development

Cellular homeostasis, implantation window and unexplained infertility: role of phosphatase and tensin homolog deleted on chromosome 10

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