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   Table of Contents - Current issue
Coverpage
September 2022
Volume 11 | Issue 5
Page Nos. 201-246

Online since Friday, September 30, 2022

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REVIEW ARTICLE  

Impact of gamete health on fertilization and embryo development: An overview p. 201
Jaypalsinh B Chorya, Tarunkumar V Sutaria, Ravjibhai K Chaudhari, Chandrakant F Chaudhari
DOI:10.4103/2305-0500.356838  
A genetically and functionally proficient gamete is essential for normal fertilization and embryonic development. Any change in gamete health affects fertilization and subsequent events, including embryonic development, implantation, and successful pregnancy. This present review focuses on the role of gamete health on fertilization and embryo development. Several conventional and advanced methods are used to evaluate the morphology and functions of gametes. The abnormal spermatozoa adversely affect fertilization events, which results in reduced cleavage/blastocyst/ implantation and pregnancy rate during assisted reproductive techniques. Poor oocyte quality is also one of the reasons for infertility, although the oocyte has an innate capacity to repair a certain amount of abnormality of both oocyte and spermatozoa. Therefore, oocyte health carries more responsibilities during fertilization events. The gamete, either spermatozoa or oocyte, should have optimum morphological and functional health to fertilize and develop a competent embryo successfully. Thus, it is of prime importance to consider the gamete health parameters while dealing with infertility.
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ORIGINAL ARTICLES Top

Anti–Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple–dose protocol p. 208
Mohammed M. Laqqan, Maged M. Yassin
DOI:10.4103/2305-0500.356839  
Objective: To speculate which of the following parameters: antral follicle count (AFC), anti-Müllerian hormone (AMH), follicle- stimulating hormone (FSH) and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone (GnRH) antagonist stimulation multiple-dose protocol in women under 45 years, and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response. Methods: This prospective study included 462 women with the mean age of (29.3±6.5) years. All women were subjected to the GnRH antagonist stimulation multiple-dose protocol. On the second day of the menstrual cycle, ultrasonography was conducted to determine AFC in both ovaries. Peripheral blood samples were collected to evaluate the level of estradiol, FSH, luteinizing hormone, prolactin, thyroid-stimulating hormone, and AMH. The women were divided into three groups: low response (AHH<1 ng/mL, n=173), normal response (AMH=1.0-3.5 ng/mL, n=175), and high response (AMH >3.5 ng/mL, n=114). Results: A significant decrease was found in the age and FSH level in the high response group compared to other groups (P<0.001). Conversely, a significant increase was shown in AMH, estradiol on human chorionic gonadotropin (hCG) day, AFC, mature oocytes, fertilized oocytes, and embryos transferred in the high response group compared to the other two groups (P<0.001). The receiver operating characteristic (ROC) curves demonstrated that AFC and AMH had the highest accuracy, followed by basal FSH level and age in the prediction of low ovarian reserves (P<0.001) with cutoff values of ≤4.50 and ≤0.95 for AFC and AMH, respectively. Moreover, the ROC analysis showed that AFC had the highest accuracy, followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of ≥14.50, ≥3.63, and ≤27.50 years, respectively (P<0.01). A significant decrease was observed in women's age, estradiol level, and oocyte fertilization rate in pregnant women compared to non-pregnant women (P<0.001). Additionally, significant negative correlations were found between the AFC, the number of mature oocytes, fertilized oocytes, embryos transferred, and the age of pregnant women (P<0.001). Conclusions: AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.
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Association of the microbial culture of follicular fluid, vaginal swab and catheter tip with β–hCG IVF positive and negative p. 217
Manoj Chellani, Manju Chellani, Sandeep Rahangdale
DOI:10.4103/2305-0500.356840  
Objective: To find out the association of microbial contamination with β-human chorionic gonadotropin ( β-hCG) in-vitro fertilization (IVF) positive and negative. Methods: A total of 73 fresh IVF cycle women were included in the retrospective study. Vaginal swab culture samples were collected prior to ovum pick-up and embryo transfer. The follicular fluids were collected during ovum pick-up and catheter tip culture samples were collected after successful embryo transfer. After 14 days of the embryo transfer, women were classified into β-hCG IVF positive and negative. The comparative statistical analyses of aerobic microbial culture reports were done between β-hCG IVF positive and negative women. Results: Out of 73 women, 42(57.5%) were found to be β-hCG IVF positive and 31(43.5%) were negative. In the aerobic culture of ovum pick-up vaginal swab, follicular fluid, embryo transplantation vaginal swab and catheter tip, Enterococcus faecalis was found to be higher compared to other bacteria (Streptococcus spp., Candida, Escherichia coli and Klebsiella). Regarding the comparison between IVF positive and negative, the overall microbial infection rate of vaginal swab culture during ovum pick-up and embryo transplantation was found to be higher in IVF negative women than in IVF positive women (38.71% vs. 28.57%); however, it was not statistically significant (P>0.05). The follicular fluid and catheter tip culture microbial infection rate was found to slightly higher in IVF positive women than in IVF negative women (54.76% vs. 41.94% and 19.05% vs. 9.68%, respectively), but there were not significant differences (P>0.05). Conclusions: The aerobic microbial culture reports of follicular fluid, vaginal swab culture, and catheter tip culture are not statistically significantly with β-hCG IVF positive.
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Oxytocin improves testicular blood flow without enhancing the steroidogenic activity in Baladi goats p. 223
Mohamed G. Hedia, Amr S. El-Shalofy
DOI:10.4103/2305-0500.356841  
Objective: To investigate the effects of a single oxytocin injection on plasma steroid concentrations, testicular blood flow measures (resistive and pulsatility indexes), and testicular echogenicity in Baladi goats. Methods: Twelve Baladi goat bucks were randomly allocated into 2 groups and received an intravenous injection of either 0.7 IU/kg oxytocin or normal saline 0.9%. Venous blood samples were collected, and testicular blood flow Doppler parameters (i.e, peak systolic velocity, end-diastolic velocity, time average maximum velocity, resistive index, and pulsatility index) were assessed for supratesticular arteries in the left and right testes immediately before (0), and at 5, 30, 60, and 120 min after injection. Results: Plasma concentrations of testosterone significantly decreased in the oxytocin group at 60 min post-treatment compared to the control group, whereas plasma concentrations of estradiol-17 β were not affected (P>0.05). Both resistive index and pulsatility index declined in the oxytocin group at 60 min post­treatment compared to the control group (P<0.05). Testicular pixel intensity increased at 30 min post-treatment in the oxytocin group compared to the control group (P<0.05). Conclusions: Oxytocin treatment significantly increases testicular blood flow and decreases plasma testosterone concentrations in male Baladi goats.
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Evaluation of intratesticular chlorhexidine gluconate for chemical contraception in dogs p. 231
Aeknath Virendra, Om Prakash Shrivastava, Satya Nidhi Shukla, Manish Kumar Shukla, Nitin Kumar Bajaj, Afroza Khanam, Firdous Ahmad Khan
DOI:10.4103/2305-0500.356842  
Objective: To investigate the contraceptive effect of intratesticular injection of chlorhexidine gluconate in dogs and compare it with that of zinc gluconate neutralized with arginine. Methods: Twenty-four sexually mature male mongrel dogs were randomly divided by replicate into four groups (n=6 per group). Group I received intra-testicular injection of 2 mL zinc gluconate (10 mg/mL) neutralized with arginine. Group II received intratesticular injection of 2 mL chlorhexidine gluconate (5% w/v). Group Ⅲ received intratesticular injection of 2 mL chlorhexidine gluconate (4% w/v). Group Ⅳ did not receive any treatment and served as the control group. Testicular morphometry was conducted on day 0, 7, 15 and 30 after treatment. Semen was collected and evaluated on day 0 and 30. Data were analyzed using repeated measures analysis of variance. Results: There was no difference in the mean values of various parameters between dogs treated with zinc gluconate and those treated with chlorhexidine gluconate at any of the time points. In dogs treated with zinc gluconate or chlorhexidine gluconate, there was a significant increase in the testicular morphometric parameters on day 7 followed by a significant reduction thereafter (day 15 and 30). In contrast, there was no change in any of the parameters in the control untreated dogs during the course of the study. Compared to the pre-treatment values, the mean scrotal circumference and the mean paired testicular volume and testicular weight on day 30 were significantly lower in the treated dogs. Semen samples collected on day 30 from treated dogs were found to be azoospermic, whereas no change in semen quality was observed in the control untreated dogs. Conclusions: Intratesticular injection of chlorhexidine gluconate (5% w/v and 4% w/v) is equally as effective as zinc gluconate neutralized with arginine for chemical contraception in dogs.
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L–carnitine improves developmental competence of buffalo oocytes in vitro p. 236
Avijit Kumar Modak, Md Nuronnabi Islam, Asma Khatun, Md Hasanur Alam, Ireen Akter, AKM Ahsan Kabir, Md Abul Hashem, Mohammad Moniruzzaman
DOI:10.4103/2305-0500.356843  
Objective: To investigate the effect of L-carnitine on in vitro maturation and subsequent in vitro embryo production of buffalo oocytes. Methods: Cumulus oocyte complexes (COCs) were aspirated from ovaries of slaughtered buffaloes. COCs were classified into good and fair qualities based on morphological observation of numbers and integrity of cumulus cells surrounding the oocyte. Both categories of COCs were placed in in vitro maturation medium with supplementation of different concentrations (0, 0.250, 0.375 or 0.500 mg/mL) of L-carnitine. Oocytes from both qualities were in vitro fertilized and in vitro cultured for 7 days, to examine the developmental competence. Results: Supplementation of L-carnitine to in vitro maturation medium increased the cumulus cell expansion rate of COCs to grade A, and reduced the cumulus cell expansion of COCs to grade B and grade C in both good and fair quality oocytes. Similarly, L-carnitine induced the in vitro meiotic progression of buffalo oocytes to metaphase Π in both good and fair quality oocytes. Additionally, L-carnitine reduced the rate of oocyte degeneration in both good and fair quality oocytes. L-carnitine increased the rate of cleaved formation at day 2 and blastocyst formation at day 7 during in vitro culture in both qualities of oocytes. Moreover, a higher rate of blastocyst production was observed in L-carnitine-treated fair quality oocytes, which was higher than the results in the untreated good quality oocytes. Conclusions: L-carnitine enhances meiotic maturation and subsequent embryo development from both good and fair quality buffalo oocytes.
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CASE REPORT Top

An incidental presentation of Herlyn–Werner-Wunderlich syndrome with secondary infertility: A case report p. 243
Abiola Omobonike Adekoya, Adeniyi Kazeem Akiseku, Ayodeji Anike Olatunji, Mojisola Adejoke Olusola-Bello
DOI:10.4103/2305-0500.356844  
Rationale: Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemi-vagina with ipsilateral renal agenesis (OHVIRA) syndrome, is a rare congenital anomaly of the Müllerian and Wolffian ducts. It is often asymptomatic until puberty and is usually misdiagnosed as infertility. Patient concerns: A 39-year-old woman desirous of pregnancy was referred to our radiodiagnosis unit for imaging evaluation on account of secondary infertility. Diagnosis: Incidental discovery of uterine bicornis bicollis and blind-ending hemivagina was noted at hysterosalpingography. Interventions: This necessitated the search for other genitourinary tract anomalies, and ipsilateral renal agenesis was also discovered. Outcomes: A diagnosis of Herlyn-Werner-Wunderlich syndrome was made. Lessons: Magnetic resonance imaging (MRI) is considered the gold standard imaging modality for the assessment of uterine malformations. However, in resource-poor centers where MRI is unavailable, a heightened clinical suspicion with the combination of available imaging modalities is important and reliable in making an accurate diagnosis, hence, successful management.
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