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Nagulapalli A, Vembu R, Pandurangi M, Nellepalli SR. Luteinizing Hormone/Human Chorionic Gonadotropin Receptor N312S Single-Nucleotide Polymorphism and Its Impact on Clinical and Reproductive Outcomes in Assisted Reproductive Technology: A Prospective Cohort Study. Cureus 2023; 15:e47217. [PMID: 38022167 PMCID: PMC10652146 DOI: 10.7759/cureus.47217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The aim of this study was to determine the genotypic distribution of luteinizing hormone/human chorionic gonadotropin receptor (LHCGR) N312S single-nucleotide polymorphism (SNP) and to investigate its impact on clinical and reproductive outcomes in infertile Indian women undergoing assisted reproductive technology (ART). Study design and settings This was a prospective cohort study conducted at a tertiary care university hospital. Subjects and methods Infertile women aged between 21 and 40 years undergoing ART with an antagonist protocol were enrolled in this study. A 2-ml sample of peripheral venous blood was collected from each woman and genotyped for the LHCGR N312S SNP. Participants were divided into three groups based on their SNP: NN, NS, and SS. All subjects underwent controlled ovarian hyperstimulation (COH) through a gonadotropin-releasing hormone (GnRH) antagonist protocol and intracytoplasmic sperm injection (ICSI). Of the 140 women recruited based on selection criteria, 128 underwent embryo transfer. We compared the genotypic distribution of the LHCGR N312S SNP, baseline characteristics, clinical outcomes, and reproductive outcomes in ART among the three groups. Data were analyzed using IBM SPSS Statistics for Windows, Version 29 (Released 2022; IBM Corp., Armonk, New York, United States). The chi-square test and Fisher-Irwin test were employed to evaluate significant differences among the qualitative categorical variables. A p-value of less than 0.05 was considered statistically significant. Results Among the test subjects, 19.3% were homozygous for the LHCGR N312 SNP (NN group), 38.6% were heterozygous (NS group), and 42.1% were homozygous for the LHCGR S312 SNP (SS group). Baseline characteristics were similar among the three groups. In terms of ovarian reserve tests, significantly lower anti-Müllerian hormone (AMH) levels were observed in the SS group compared to the NS and NN groups (2.8 ± 2.1 vs. 3.2 ± 2.5 vs. 4.3 ± 3.3; p=0.03). No significant differences were observed in COH outcomes such as duration of stimulation, total gonadotropin requirement, oocyte yield, or the number of good-quality embryos among the three groups. The cumulative pregnancy rate (82.9% vs. 50.0% vs. 38.2%, p=0.0005), cumulative clinical pregnancy rate (78.8% vs. 44.7% vs. 34.5%, p = 0.0005), and cumulative live birth rate (50.0% vs. 20.2% vs. 20.0%, p=0.005) were significantly higher in the NN group than in the NS and SS groups. Conclusion The study's findings suggest that LHCGR N312 may help predict reproductive outcomes in ART, which may aid in providing better counseling to infertile couples. We need more studies on individualized/personalized COH using pharmacogenomics for follicle-stimulating hormone (FSH) and luteinizing hormone (LH) supplementation based on combined FSH and LH receptor SNP and to assess their effects on ART outcomes.
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Affiliation(s)
- Amulya Nagulapalli
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Radha Vembu
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Monna Pandurangi
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sanjeeva R Nellepalli
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Manivannan A, Pandurangi M, Vembu R, Reddy S. Exophytic Subserosal Uterine Adenomyomatous Polyp Mimicking Malignancy: A Case Report. Cureus 2023; 15:e43675. [PMID: 37600435 PMCID: PMC10435929 DOI: 10.7759/cureus.43675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
The epidemiological profile of adenomyosis has drastically changed in recent years due to advancements in imaging techniques. Even though adenomyosis is not uncommon in women of childbearing age, we present an intriguing case of a 30-year-old woman with long-standing progressive dysmenorrhea and infertility who had a posterior wall exophytic adenomyomatous polyp with full-thickness pseudo-invasion out of the uterine serosa into the right ovarian endometriotic cyst, mimicking malignancy. After surgical excision, the patient spontaneously conceived and delivered a live-term baby, soon after which she experienced an early recurrence. Clinicians must be aware of the distinctive features of different subtypes of adenomyosis to plan treatment and avoid invasive surgery.
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Affiliation(s)
- Anu Manivannan
- Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Monna Pandurangi
- Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Radha Vembu
- Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sanjeeva Reddy
- Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Vembu R, Ragesh G, Reddy UM, Chandrasekar A. Seminal Oxidative Stress Biochemistry in Male Infertile Patients-An Overview. J Young Pharm 2023. [DOI: 10.5530/097515050334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Yuvaraj S, GopalaKrishnan M, Reddy S, Vembu R, Namboori Srinivasan S, Raja N, Pandurangi M, Nagireddy S, Raman G, Rajmohan L, Ramamoorthy S, Kumar V. O-261 In-vitro supplementation of vitamin B12 to improve post-thaw viability and DNA integrity. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does the supplementation of vitamin B12 protect the spermatozoa against damage caused by the freeze-thaw process further improving the overall post-thaw survival and DNA integrity?
Summary answer
The antioxidant property of vitamin B12 protects the spermatozoa and improves the post thaw motility, vitality, and reduces DNA damage caused by freeze-thaw process.
What is known already
Cryopreservation of spermatozoa is an effective way of fertility preservation in humans, often used in Assisted Reproductive Technology(ART). Despite the refinement in cryopreservation, the salvage of post-thaw sperms remains poor. The reactive oxygen species(ROS), that is formed as a result of freeze-thaw process is known to decrease the motility, plasma membrane integrity and increase the DNA fragmentation. Most vitamins have antioxidant properties, that protect the mammalian cells from oxidative stress one such vitamin is cyanocobalamin(vitamin B12). Vitamin B12 modulates oxidative stress through methionine synthase activity and also acts as a scavenger of ROS. Thus protecting the DNA against free radicals.
Study design, size, duration
This prospective observational study was performed for a period of 6 months in 111 men, who attended the fertility clinic. The study population included all semen samples except men with azoospermia, surgically retrieved samples and men on vitamin supplements. The study population contained men ageing between 21-40 years.
Participants/materials, setting, methods
Semen samples were analysed according to WHO 5th edition and were assessed for DNA fragmentation index (DFI) using sperm chromatin dispersion assay (SCD). The ejaculates were split into two as group A: semen samples with equal amount of cryoprotectant and group B: semen samples with equal amount of cryoprotectant supplemented with Vitamin B12 (2mg/ml). They were frozen for a minimum of 24 hrs. Post-thaw motility, vitality and DFI were assessed and compared.
Main results and the role of chance
The mean age of patients in our study was 34.26±4.7yrs. 58.5% of the study population had primary infertility. 37.8% of the study population had male factor infertility, 32.4% had oligoasthenoteratozoospermia(OAT), 31.1% had normozoospermia 16.2% had asthenoteratozoospermia, 13.5% had teratozoospermia, 3.6% had oligozoospermia and rest 2.7% had asthenozoospermia.
There was an overall increase in post thaw motility (41.59±18.09 vs 32.3±18.8,p=0.0005), progressive motility (21.54±13.02 vs 15.91±11.80,p=0.0005), vitality (57.14±15.09 vs 46.76±16.45,p=0.0005) and a significant decrease in DFI (26.69±10.03 vs 32.09±10.00,p=0.0005) in group B compared to group A.
Our study also demonstrated that, Normozoospermia patients had a significant increase in vitality (67.17±13.8 vs 58.51±12.0, p = 0.007) and lower DFI (22.68±9.3 vs 27.6±8.9, p = 0.02) in group B than in group A.
OAT patients had a significant increase in total motility (26.25±12.15 vs 15.7±11.4,p=0.0003), progressive motility (11.69±8.8 vs 6.14±5.8,p=0.0028), vitality (46.06±11.34 vs 34.31±12.99,p=0.0001) and significantly lower DFI (30.22±9.87 vs 36.08±9.7,p=0.012) in group B.
Teratozoospermia patients showed significant increase in progressive motility in group B (27.87±8.81 vs 19.33±10.69,p=0.02) and
Asthenoteratozoospermia patients showed significant increase in total motility (40.72± 13.14 vs 30.89±13.06,p=0.02) and vitality (54.39±12.28 vs 43.78±14.14,p=0.02) in group B.
However, in asthenozoospermic patients the parameters were comparable in both the groups.
Limitations, reasons for caution
Due to ethical reasons the samples were not used for in vitro procedures such as intrauterine insemination(IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection(ICSI). Hence, no inference was obtained regarding the fertilization rates/ pregnancy rates.
Wider implications of the findings
Our study demonstrated that with supplementation of vitamin B12 the recovery rate significantly increased and also preserved the DNA content. Among the various categories, supplementation of vitamin B12 to OAT samples was more beneficial as it improved the overall viability of the sperms.
Trial registration number
CSP/21/JUL/96/389
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Affiliation(s)
- S Yuvaraj
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - M GopalaKrishnan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Reddy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - R Vembu
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Namboori Srinivasan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - N Raja
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - M Pandurangi
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Nagireddy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - G Raman
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - L Rajmohan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Ramamoorthy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - V Kumar
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
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Bhat CS, Reddy NS, Vembu R, Pandurangi M. Dual extrauterine ectopic pregnancy: double management. BMJ Case Rep 2021; 14:e244417. [PMID: 34764105 PMCID: PMC8587342 DOI: 10.1136/bcr-2021-244417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle.
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Affiliation(s)
- Chandana S Bhat
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - N Sanjeeva Reddy
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Radha Vembu
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Monna Pandurangi
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Agrawal H, Reddy NS, Vembu R, Pandurangi M, Nagireddy S. EFFECT OF ANTIBIOTIC TREATMENT FOR CHRONIC ENDOMETRITIS ON ART CYCLE OUTCOME. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nagireddy S, Daniel G M, Srinivasan SN, Damavarapu E, Yuvaraj S, Rakesh S, Raman G, Vembu R, Pandurangi M, Reddy NS. DOES THE LOW SPERM CONCENTRATION ON THE DAY OF INTRAUTERINE INSEMINATION (IUI) AFFECT THE REPRODUCTIVE OUTCOME OF IUI CYCLES. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nagireddy S, Nellepalli SR, Vembu R, Pandurangi M, Gopal. Krishnan M, Namboor. Srinivasan S, Raja N. P–301 Intrauterine instillation of autologous platelet rich plasma for thin endometrium improves the outcome of frozen embryo transfer cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
How does the intrauterine instillation of autologous platelet rich plasma (PRP) affect the endometrial thickness and live birth rate in frozen embryo transfer cycles?
Summary answer
Intrauterine instillation of autologous PRP resulted in significant improvement in endometrial thickness. The live birth rates were satisfactory post-PRP instillation.
What is known already
Autologous Platelet rich plasma (PRP) had resulted in significant improvement in endometrial thickness, when instilled intrauterine in women with thin endometrium in FET cycles.
Study design, size, duration
A retrospective observational study was performed at a tertiary care university teaching hospital in South India. 35 women who received intrauterine autologous PRP during endometrial preparation for frozen embryo transfer from June 2017 to December 2020, were included. Patients who underwent donor oocyte recipent cycles, those with a history of tubercular endometritis, Asherman syndrome, previous intrauterine manipulations such as manual removal of placenta, and uterine anomalies were excluded.
Participants/materials, setting, methods
All the women underwent endometrial preparation in artificial cycles by depot GnRH agonist suppression and HRT (Hormone replacement therapy) was initiated by 4–6 mg of estradiol valerate and stepped up as required. Autologous PRP was offered to all women who had endometrial thickness < 7 mm on day 16 of HRT. PRP was prepared by the two-step centrifugation method and administered intrauterine by IUI catheter. The patients underwent repeat evaluation after 5 days post-PRP instillation.
Main results and the role of chance
Optimal response to PRP was considered as the attainment of an endometrial thickness (ET) ≥ 7mm after 5 days of post-PRP. 25 (71.4%) had an optimal response to PRP. There was a significant improvement in the endometrial thickness(mm) in the study participants following PRP instillation: 6.3 ± 0.6 vs. 7.1 ± 1.2; P = 0.0001.The study participants were divided into two groups based on their response to intrauterine PRP instillation. Those who optimally responded to PRP were categorized as Group A and those who didn’t were categorized as Group B. The study participants of both the groups were comparable by their demographic characteristics such as age, cause of infertility, indications for ART, and the dose of estradiol valerate before PRP. The dose of estradiol valerate (mg) after PRP was significantly higher in Group B compared to Group A: 19.9 ± 4.9 vs. 15.6 ± 3.9; P = 0.014. A total of 26 women underwent embryo transfer and 9 (25.7%) women had cycle cancellation. Of these 22 were from Group A and 4 from Group B. The pregnancy, clinical pregnancy, miscarriage and live birth rates were 36.3%(8/22) and 25% (1/4); 31.8% (7/22) and 25% (1/4); and 31.8% (7/22) and 25% (1/4), respectively.
Limitations, reasons for caution
As the study was retrospective in nature and the PRP was offered only in patients who had consented, there was a significant bias. Hence the results of the study should be interpreted with caution. Further large prospective RCTs (Randomised controlled trials) are required to confirm our findings.
Wider implications of the findings: Autologous PRP may enhance the response to the estrogen preparations. It may produce satisfactory live birth rates and reduce cycle cancellations in a reasonable proportion of patients with thin endometrium in FET cycles. However, these findings should be confirmed by dose finding clinical trials, and studies involving a comparison group.
Trial registration number
Not applicable
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Affiliation(s)
- S Nagireddy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
| | - S R Nellepalli
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
| | - R Vembu
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
| | - M Pandurangi
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
| | - M Gopal. Krishnan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
| | - S Namboor. Srinivasan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
| | - N Raja
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery, CHENNAI, India
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Gundewar T, Pandurangi M, Reddy NS, Vembu R, Andrews C, Nagireddy S, Soni A, Kakkad V. Exclusive use of intrasac potassium chloride and methotrexate for treating cesarean scar pregnancy: effectiveness and subsequent fecundity. Hum Reprod Open 2020; 2020:hoaa025. [PMID: 32685702 PMCID: PMC7359909 DOI: 10.1093/hropen/hoaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Is exclusive use of intragestational sac potassium chloride (KCl) and methotrexate
(MTX) effective in the management of viable cesarean scar pregnancy (CSP)? SUMMARY ANSWER Exclusive use of intragestational sac KCl and MTX was effective in the management of
viable CSP. WHAT IS KNOWN ALREADY Owing to a paucity of randomized studies on management of CSP, evidence-based
management remains unclear. Intragestational sac KCl or MTX along with either systemic
MTX or surgical intervention, such as uterine artery embolization or dilation and
curettage, has proved to be effective in the management of CSP. Furthermore, there are
limited data in the literature on the use of exclusive intragestational sac KCl and MTX
for management of CSP and subsequent fecundity. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted from June 2017 to September 2019. We recruited
nine CSP patients referred to our unit. There was no lost to follow-up noted. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients with an ultrasound diagnosis of CSP who fulfilled the inclusion criteria were
recruited. The study was conducted in a tertiary care center. Clinical symptoms,
pregnancy viability, gestational age and human chorionic gonadotrophin (HCG) values
determined the management in each individual case. Accordingly, patients were grouped
into the expectant management (Group I, n = 3) and intragestational sac
KCl with MTX (Group II, n = 6) groups. Demographic details, clinical
characteristics, ultrasound details at diagnosis, post-treatment HCG normalization time,
menses resumption, mass resolution and subsequent fecundity were noted. Descriptive
statistics were used for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Of the nine patients with CSP, six patients had viable CSP and required intervention.
Out of these, four patients expressed a desire for future fertility. Mean gestational
age at treatment among patients in Group II was 54.33 ± 7.51 days (range 46–65). Mean
HCG value at the time of diagnosis was 84 110 ± 38 679.39 IU/l in Group II patients as
compared with 2512 ± 709.36 in Group I. HCG had decreased by 92.7 ± 3.78% 2 weeks after
intervention and normalized (<5 IU/l) by 53.5 ± 14.97 days. No major complications
occurred and additional treatment was not required in these patients. Menstruation had
resumed by 26 ± 6.6 days after treatment in Group II. On follow up, a small unresolved
mass was present in two patients and the cesarean scar niche was visible in the
remaining four patients. Out of the four patients desirous of future conception, three
conceived naturally and one delivered a term baby via repeat lower segment cesarean
section. LIMITATIONS, REASONS FOR CAUTION The main limitation of our study was small sample size. All the patients were
asymptomatic at presentation and hence we cannot comment on use of this method in those
presenting with active vaginal bleeding. WIDER IMPLICATIONS OF THE FINDINGS Intragestational sac KCl plus MTX may be a highly effective approach for the management
of viable CSP despite high initial HCG values. There seems to be no need for any further
intervention. It can be considered as the first line minimally invasive treatment option
in patients desirous of future fertility. Nevertheless, accumulation of further cases is
required to validate this treatment modality. STUDY FUNDING/COMPETING INTERESTS No specific funding was received to undertake this study. The authors report no
conflict of interest. TRIAL REGISTRATION NUMBER N/A
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Affiliation(s)
- Tejas Gundewar
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - Monna Pandurangi
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - N Sanjeeva Reddy
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - Radha Vembu
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - Chitra Andrews
- Department of Obstetrics & Gynecology, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - Siddharth Nagireddy
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - Ashish Soni
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
| | - Vivek Kakkad
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Chennai 600116, India
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Vembu R, Devi N, Sanjeeva Reddy N, Pandurangi M, Nagireddy5 S. Prevalence of Metabolic Syndrome in infertile women. Indian J Community Health 2019. [DOI: 10.47203/ijch.2019.v31i04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Prevalence of Metabolic syndrome is increasing rapidly among the infertile women over the last few years Objective: to evaluate the prevalence of metabolic syndrome (MBS) among the infertile women. Methods: A prospective cross-sectional study was conducted of all infertile women in a tertiary care centre in southern India. These women underwent screening for MBS according to the modified AHA/NHLBI (ATP III 2005) definition. These women were categorized as PCOS and Non PCOS based on Rotterdam criteria (2003). Results: Among 1030 infertile women. The prevalence of MBS among the infertile women was 35.3% and among PCOS and Non PCOS women were 44.7% and 28.9% respectively. Conclusions: The prevalence of MBS among infertile women was 35.3%. It is showing an upward trend among infertile PCOS and Non PCOS women. So early screening for MBS can reduce the long term sequale.
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Kakkad VP, Reddy NS, Pandurangi M, Vembu R, Nagireddy S, Soni AK, Nakum RN. Serum progesterone level: a predictor of pregnancy in vitrified-warmed blastocyst transfer. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Siddhartha N, Reddy NS, Pandurangi M, Muthusamy T, Vembu R, Kasinathan K. The Effect of Sperm DNA Fragmentation Index on the Outcome of Intrauterine Insemination and Intracytoplasmic Sperm Injection. J Hum Reprod Sci 2019; 12:189-198. [PMID: 31576075 PMCID: PMC6764233 DOI: 10.4103/jhrs.jhrs_22_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CONTEXT Elevated sperm DNA fragmentation index (DFI) is found to affect normal embryonic development, implantation and fetal development after intrauterine insemination (IUI), in vitro fertilization and intracytoplasmic sperm injection (ICSI). Estimation of DFI by terminal deoxynucleotidyl transferase-mediated fluorescent deoxy uridine nucleotide nick end labeling (TUNEL) assay was found to have a high predictive value for pregnancy after fertility treatments. AIM This study aims to find the effect of increased sperm DNA fragmentation by TUNEL assay on reproductive outcome after IUI and ICSI. PRIMARY OBJECTIVE To find the association of DFI and pregnancy rate in IUI and ICSI. SECONDARY OBJECTIVES To find the association of DFI with fertilization and implantation in ICSI. To find the association of DFI with miscarriage rate. SETTINGS AND DESIGN A prospective observational study performed at a tertiary care university teaching hospital. SUBJECTS AND METHODS 105 male partners of infertile couple planned for IUI and ICSI underwent estimation of sperm-DFI by TUNEL assay. The treatment outcomes were compared between the DFI-positive (≥20%) and DFI-negative (<20%) groups. STATISTICAL ANALYSIS USED Statistical analysis was performed by SPSS version 17, Software. P < 0.05 was considered statistically significant. RESULTS The men with abnormal semen analysis were significantly higher in the DFI-positive group (77.15% vs. 22.85%). There was no significant difference in the pregnancy rate in IUI cycles (17.6% vs. 11.8%); but in the ICSI, the pregnancy rate was significantly reduced in the DFI-positive group (16.7% vs. 47.4%). CONCLUSIONS Elevated DFI significantly affects the pregnancy rate in ICSI cycles.
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Affiliation(s)
- Nagireddy Siddhartha
- Department of Reproductive Medicine and Surgery, SRIHER, Chennai, Tamil Nadu, India
| | | | - Monna Pandurangi
- Department of Reproductive Medicine and Surgery, SRIHER, Chennai, Tamil Nadu, India
| | | | - Radha Vembu
- Department of Reproductive Medicine and Surgery, SRIHER, Chennai, Tamil Nadu, India
| | - Kanimozhi Kasinathan
- Department of Reproductive Medicine and Surgery, SRIHER, Chennai, Tamil Nadu, India
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Nellepalli S, Nagireddy S, Vembu R, Pandurangi M, Daniel M. Estimation of sperm DNA fragmentation index in ICSI cycles: does it affect the outcome? Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Background: It is essential to determine the cut-off value of serum anti-Mullerian hormone (AMH) to predict the hyper response in assisted reproductive technology (ART). There are few studies mentioning the cut-off value for the hyper response in infertile women but not specifically for polycystic ovary syndrome (PCOS) and non-PCOS groups. With this in background, this study was conducted. Aim: To determine the cut-off value of serum AMH to predict the hyper response in women with PCOS and non-PCOS undergoing a controlled ovarian stimulation (COS) in ART. Objective: To compare the outcome of stimulation in PCOS and non-PCOS groups. Materials and Methods: All 246 women enrolled for Intra Cytoplasmic Sperm Injection (ICSI) fulfilling the selection criteria were recruited. On the day 3 of the cycle, the serum AMH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol and antral follicle count (AFC) were measured. They underwent COS as per the unit protocol. They were divided into PCOS and non-PCOS groups as per the Rotterdam’s criteria. The mean age, duration of infertility, Body Mass Index (BMI), Ovarian reserve markers and outcome of stimulation were compared. Using the Statistical Package for the Social Sciences version 16.0 software, the significant difference was measured by multivariate analysis, as well as a one-way analysis of variance with Tukey’s post-hoc test was used. Results: Among 246 women, 31.3% were in PCOS group, and 68.7% were in non-PCOS group. Comparison of PCOS and non-PCOS groups showed a significant difference in the age with the mean age being 29.2 and 31.5 years, respectively. The mean AMH and AFC were 2-fold higher in PCOS group. The mean number of follicles, oocytes retrieved, MII and oocytes fertilised were significantly higher in PCOS group. The pregnancy rate was 52.6% in PCOS and 30.9% in non-PCOS group. In the PCOS group, 22.1% had ovarian hyper stimulation syndrome (OHSS), and only 4.7% had OHSS in non-PCOS group (P = 0.0005). Receiving Operator Curve (ROC) curve was plotted to predict the hyper response, which showed a cut-off value of 6.85 ng/ml with a sensitivity of 66.7% and a specificity of 68.7% for PCOS group and 4.85 ng/ml with a sensitivity of 85.7% and a specificity of 89.7% in non-PCOS group. Conclusion: The cut-off value of serum AMH to predict the hyper response in PCOS group is 6.85 ng/ml and in non-PCOS group is 4.85 ng/ml.
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Affiliation(s)
- Radha Vembu
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, Tamilnadu, India
| | - Nellepalli Sanjeeva Reddy
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, Tamilnadu, India
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