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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 4 | Issue 2
Page Nos. 41-83

Online since Friday, December 30, 2022

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EDITORIAL  

Absolute uterine factor infertility Highly accessed article p. 41
Nalini Kaul (Mahajan)
DOI:10.4103/tofj.tofj_Editorial  
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REVIEW ARTICLES Top

In vitro maturation (IVM) procedure in oncofertility patients: A systemic review Highly accessed article p. 43
Mohd F Ahmad, Yodo Sugishita, Yuki Suzuki-Takahashi, Hideyuki Iwahata, Seido Takae, Yuki Horage-Okutsu, Nao Suzuki
DOI:10.4103/tofj.tofj_1_22  
Our review aims to evaluate the benefit of in vitro maturation (IVM) in a standard control ovarian stimulation among oncofertility patients. A thorough search for relevant studies was conducted via PubMed, Google Scholar, Scopus, Cochrane Library, and clinical.gov databases. Our primary outcome was the oocyte maturation rate (OMR), which measures the number of immature oocytes that progress to mature (MII) oocytes following IVM. Our secondary outcomes were the number of oocytes and embryo cryopreservation following IVM for future use. The initial search identified 150 studies. Eight studies were included in our review after duplication assessment, title and abstract screening, and subsequent complete text evaluation tailored to our inclusion criteria. A total of 1040 patients with cancer with a mean age of 32.68 years were included in our review, in which half of them were diagnosed with breast cancer (BC). Most of the cycles were unstimulated. Two studies compared IVM in either follicular or luteal phases, and one study compared the in vitro fertilization (IVF) cycle with or without IVM. Our review included 7711 oocytes with 4604 oocytes that progressed to MII, obtaining an overall OMR of 59.70%. Following IVM, 335 embryos and 2380 oocytes were cryopreserved for future use. The oocyte numbers and maturation were comparable among all the studies, except that prognostic and predictor BC affects the IVM outcome. Our review concluded that IVM improves the number of MII following IVF cycles with similar survival rates, meiotic resumption rates, and blastocyst formation upon fertilization. Thus, IVM is a beneficial strategy for oncofertility patients.
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COVID-19 and male fertility p. 52
Nalini Kaul
DOI:10.4103/tofj.tofj_7_22  
COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global health crisis. The virus entry into the host cell is facilitated by the coexpression of angiotensin-converting enzyme 2 (ACE2) and TMPRSS2 receptors. The male genital system is vulnerable to infection because of the presence of ACE2 and TRMPSS2 on the spermatogonial and somatic cells. Testicular damage leading to the impairment of spermatogenesis and semen parameters has been documented, though the exact mechanism of testicular injury is not confirmed. Immune response to infection, dysfunction of the steroidogenic pathway, impairment of the blood–testes barrier, and fever per se are implicated. The alteration in semen parameters has been demonstrated with COVID-19 infection leading to reproductive compromise. The recovery of semen parameters occurs within 3 months of the infection. It is recommended to wait for 3 months after infection to start infertility treatment. The possibility of sexual transmission and vertical transmission remains a concern, even though the virus has not been detected in semen in most studies. Fertility preservation procedures (semen and testicular tissue cryopreservation) must not be deferred because of their time-sensitive nature. Safety protocols to prevent crosscontamination in cryostorage and to maintain the safety of laboratory personnel should be strictly adhered to. ESHRE and ASRM recommend screening patients before initiating fertility preservation procedures. Testing semen samples for SARS-CoV-2 by RT-PCR has also been advocated to improve safety. Long-term follow-up should be considered in men and young boys exposed to infection and in children conceived during the infection. Vaccination for COVID-19 should be promoted as it does not compromise male fertility.
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ORIGINAL ARTICLES Top

Can the pregnancy outcome be improved by incrementing progesterone supplementation on the day of embryo transfer in women undergoing fresh and frozen embryo transfer cycles? p. 58
Jasneet Kaur, Nalini Mahajan
DOI:10.4103/tofj.tofj_6_21  
Context: Luteal phase defect has been identified in all assisted reproductive technology cycles, necessitating optimal progesterone levels during the window of implantation (WOI) to improve reproductive outcomes. Aims: The aim of this study was to determine if incrementing progesterone supplementation based on the levels of serum progesterone(P) measured on the day of embryo transfer (ET) has an impact on the pregnancy outcome in fresh and frozen ET cycles. Settings and Design: A total of 220 women undergoing fresh and frozen ET were prospectively enrolled and received standard luteal phase support, an increment in P supplementation made if serum P levels were less than 15 ng/mL. Materials and Methods: Serum progesterone levels were assessed for all the patients on the day of ET. Patients undergoing fresh and frozen ETs were divided into two groups based on serum progesterone levels on the day of ET. If serum progesterone levels were found to be less than 15 ng/mL on the day of ET, the dose of progesterone supplementation was incremented. A correlation between the groups with serum progesterone less than and more than 15 ng/mL on the day of ET with the pregnancy outcome was then made. Results: No statistically significant difference was observed in the clinical pregnancy rate and biochemical pregnancies in the groups with serum progesterone levels less than or more than 15 ng/mL on the day of ET when an increment in the progesterone supplementation was performed (both fresh, P = 0.35 and frozen cycles, P = 0.056). Statistical Analysis Used: Chi-square test was used for qualitative analysis, and the Student’s t test was used for comparison of means. Conclusions: Measuring serum progesterone levels on the day of ET and incrementing P supplementation if serum levels of progesterone are less than 15 ng/mL to obtain optimal progesterone levels during the WOI in both fresh and frozen ET cycles might help in improving our pregnancy outcomes.
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Effectiveness of health education on knowledge, attitude, and practice of fertility preservation among parents of adolescents, young adults and among young adults with malignancies at a tertiary care centre in South India p. 65
DJ Harshit, Papa Dasari, Bishwajit Dubashi
DOI:10.4103/tofj.tofj_2_22  
Background: The incidence of cancer among children, adolescents and young adults is on the rise and 80% survive. Fertility preservation is not practiced due to lack of knowledge of affects of cancer and its therapy on fertility and the availability of fertility preservation methods. The objective of this study was to assess Knowledge, Attitude and Practice (KAP) of Fertility preservation among parents of adolescents, young adults and among young adults at base line and after intervention of a dedicated health education programme. Materials and Methods: Prospective interventional study undertaken in a tertiary care set up. Assuming baseline knowledge of fertility preservation as10% with absolute precision of 5%, 67 parents of adolescents and 75 young adults with cancer were included. Preformed questionnaire was used to assess the KAP at base line and after health education programme. The pre-test and post- test values were expressed as proportions and were compared by using McNemar test. SPSS version 20 was usedResults: Baseline knowledge about affect of cancer and its treatment on fertility and availability of fertility preservation methods was 26.7% and16.4%. After health education it was improved to 97.2% and 93.8%. Baseline knowledge about awareness of starting Fertility preservation prior to cancer, types of fertility preservation methods available was 8.9%, and 3.4%, and it was increased to 93.1% and 62.4%. Willingness to practice FP methods increased from 44.7% to 70.2% among parents and 40.5% to 59.5% among young adults. Conclusion: Baseline knowledge regarding fertility preservation and methods available was very poor. The health education programme is the need of the hour as it significantly improved their knowledge and attitude to practice fertility preservation.
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CASE REPORTS Top

Therapeutic ART for borderline ovarian tumor p. 74
Pondicherry M Gopinath, Anusha Raaj, Sahityalakshmi Manoharan
DOI:10.4103/tofj.tofj_6_22  
Borderline ovarian tumors occur in about 10–16% of all epithelial ovarian tumors. However, it has a good prognosis when compared with other epithelial malignant tumors. Out of all the types, serous borderline tumor is the most common type, found bilateral in 30% of the cases. Management is tailored based on physical examination, radiological findings, and histopathology report. Even though the diagnosis is based on histopathological findings, pre-operative evaluation, especially in younger women, plays an important role in selecting less radical treatment. Here is a case of a borderline ovarian tumor, which was managed considering her age, marital, and fertility status.
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Motherhood after hysterectomy: A case report p. 76
Pondicherry M Gopinath
DOI:10.4103/tofj.tofj_3_22  
Uterine rupture in pregnancy is rare and life-threatening. Myomectomy is one of the common procedures done to enhance success rates in the treatment of subfertile patients. The risk of scar rupture is very high during the third trimester. The rate of total uterine rupture has been reported about 0.07%. This patient was a 33-years-old, seeking motherhood after hysterectomy following a ruptured uterus in the third trimester. Invitro fertilisation stimulation was done, and the embryo transferred to a surrogate mother.
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A case of colorectal cancer in pregnancy p. 78
PM Gopinath, Susan Mathen, E Esther Rani Stella Bhakiyathai
DOI:10.4103/tofj.tofj_5_22  
Colorectal cancer in pregnancy is a rare pathology with limited high-grade evidence available. The diagnosis of colorectal cancer in pregnancy is delayed and has a varied presentation, which may mimic pregnancy. Challenges exist as the treatment options are delayed and a decision needs to be made encompassing both mother and fetus.
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Abdominal oocyte pickup in patient with uterine factor infertility: A case report p. 81
PM Gopinath, Sahityalakshmi Manoharan
DOI:10.4103/tofj.tofj_4_22  
During infertility treatment, ultrasound was required for both diagnostic and therapeutic procedures. Transvaginal route of oocyte retrieval was preferred due to its better visualization, easy accessibility, decreased intestinal trauma, and high pickup rate. Here we have a rare case scenario where abdominal oocyte retrieval was done in a patient with fibroid uterus due to the inaccessibility of both ovaries by the transvaginal method.
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