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AbstractBackground – Women with polycystic ovarian syndrome (PCOS) may undergo laparoscopic ovarian drilling (LOD). To find out whether endometrial scratch, at time of LOD, could improve live birth rate in subfertile women with PCOS, a randomized controlled trial was conducted.

Results –There was no evidence of a significant difference in cumulative live birth rate between women who had endometrial scratch at time of LOD and those who had LOD only (38.1% and 34.3% respectively, odds ratio 1.18, 95% CI (0.67, 2.07); p = 0.57).
Conclusion – Women undergoing laparoscopic ovarian drilling should not be subjected to endometrial scratch as it does not lead to improvement in live birth rate. The study was prospectively registered on 25 April 2014 in ClinicalTrials.gov with identifier number NCT02140398.

Background
Polycystic ovarian syndrome is the most common cause of anovulatory subfertility [1]. Weight reduction, lifestyle modification, and ovulation induction are the recommended initial management strategies [2, 3]. Laparoscopic ovarian drilling (LOD) has been suggested to induce ovulation in these women, especially those who fail to ovulate through ovulatory medications [4,5,6]. It has been suggested that the procedure is as effective as ovarian stimulation with exogenous gonadotropins [7], yet it does not increase multiple pregnancy rates or ovarian hyperstimulation syndrome (OHSS) rates. Many women may ovulate after LOD, yet they fail to conceive [8]. Those women may need to undergo IVF treatment in their pursuit for a baby.

Endometrial scratching is a procedure where the endometrium is subjected to physical trauma that caused injury to the functional layer of the endometrium mechanically [9,10,11,12]. It has been suggested that endometrial injury could improve IVF outcome in women with recurrent implantation failure after IVF [13]. Nonetheless, endometrial scratch has been also proposed to overcome subfertility in women with unexplained infertility [14]. Randomized controlled trials have also shown improvements of intrauterine insemination (IUI) results in women subjected to controlled endometrial injury prior to insemination [9, 10]. However, there were some other studies that have shown no benefit from the procedure [15, 16].

The aim of our study was to find out whether performing endometrial scratch at time of laparoscopic drilling would improve live birth rate in subfertile women with PCOS.

Patients and methods

Study design and participants – We conducted a parallel randomized controlled trial (RCT), approved by our university ethics committee. We approached all infertile women with anovulatory infertility due to PCOS referred for laparoscopic ovarian drilling in Mansoura University Teaching Hospitals in Mansoura, Egypt. Our hospital is a tertiary care center conducting between 600 and 700 laparoscopic surgeries per year for infertile women. The study was conducted during the period from April 2014 to April 2015 (last patient enrollment). Follow-up was continued for 9 months after laparoscopy. The last pregnancy was in December 2015. Last data collection was in September 2016. An informed written consent was obtained from all women who participated in the study.

Our inclusion criteria were women aged 20 and less than 39 and women with PCOS as diagnosed by Rotterdam criteria, fertile semen analysis according to WHO 2010, and bilateral tubal patency as demonstrated by hysterosalpingogram (HSG) [17, 18]. The exclusion criteria were suspected endometriosis, suspected uterine cavity anomaly or mass, associated male factor infertility, presence of endocrinopathy as thyroid dysfunction, and women subjected to endometrial curettage for any reason in the last 6 months.

Intervention

Women were admitted to our hospital 1 day before laparoscopic drilling. Women were randomized into two groups: group A (the intervention group) and group B (the control group). Randomization was through a computer-generated list of random numbers. Allocation of women to groups was through an opaque sealed envelope that had to be picked by a nurse in the operative theater. The surgeon was not blinded to the procedure while patients and data assessor were blinded to their allocation.
All women underwent a three-puncture laparoscopy procedure where laparoscopic ovarian drilling (LOD) was achieved. Ovarian drilling was performed through monopolar coagulation diathermy. Four punctures were performed. Each penetrates about 4 mm depth, using 40-W power that lasts for 4 s. In the intervention group (group A), endometrial scratching was performed at the end of laparoscopy by endometrial curette. The curette was introduced gently through the cervix up to the uterine fundus then withdrawn for 1 or 2 cm. One act of scratching was performed on the posterior wall of the uterus after the end of drilling. The obtained specimens were sent for histopathology. The control group (group B) had LOD only, and no endometrial scratch was performed.
Women in both groups were seen 3 months after laparoscopy and were asked whether they had a positive pregnancy test, still have oligomenorrhea, or had had regular periods. Women who had regular periods were subjected to folliculometry to confirm the establishment of ovulation while those with oligomenorrhea were subjected to ovulation induction with clomiphene citrate, tamoxifen, or letrozole. Women who did not respond to ovulatory oral medications were stimulated using exogenous gonadotropins using the low-dose step-up protocol with a 37.5 IU starting dose [19]. The primary outcome measure in this trial was live birth rate per woman randomized. Secondary outcome measures were clinical pregnancy rate, time to pregnancy, miscarriage rate, and multiple pregnancy rate. The study was registered in ClinicalTrials.gov with identifier number NCT02140398.

Definitions – Clinical pregnancy was defined as the presence of intrauterine gestational sac 1 or 2 weeks after positive pregnancy test in blood. Live birth was defined as the delivery of living fetus after 24 weeks gestation.
Statistical analysis – We estimated that the pregnancy rate after laparoscopic ovarian drilling was around 50% [20]. The intervention was suggested to boost pregnancy rate up to 70%. We calculated that we will need to study 93 experimental subjects and 93 control subjects to be able to reject the null hypothesis that the failure rates for experimental and control subjects are equal with a study power (probability) of 80%. The type I error probability associated with this test of this null hypothesis is 0.05 [21]. To compensate for dropouts, we calculated that we needed to randomize 210 women. We used SPSS 15 program. We adopted the intention-to-treat analysis.

Source –  https://mefj.springeropen.com/articles/10.1186/s43043-019-0001-2

We at Mohak infertility center Indore provides you best quality IVF treatment with a high success rate at affordable price. Our goal is to make your parenting dreams come true.

Mohak infertility center, one of the Best Infertility Hospitals in Indore, india provides you International Standard Infertility Treatment along with assisted reproductive technologies like IUI, IVF, ICSI ,etc at affordable IVF treatment cost in indore / Test tube Baby Treatment cost along with the satisfaction of being consulted by the most renowned IVF specialist/ Doctor in Indore ,M.P. Come join best centre for IVF treatment in indore in our voyage towards better healthcare facilities for infertile couples and experience the Best Infertility Treatment in Indore. To Book an Appointment Now Call 78980-47572 / 80852-77666. For more detail visit www.mohakivf.com

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To More Post: Fallopian Tube And Its Function

Men are equally responsible for infertility.
Get consultation for fertility treatment from our experts
We at Mohak IVF Center Indore provides you best quality IVF treatment with a high success rate at affordable price. Our goal is to make your parenting dreams come true.

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“Should we be using new tool of Flageliar Analysis and Sperm Tracking ( FAST)?”

INTRODUCTION: Can flagellar analyses be scaled up to provide automated tracking of motile sperm and does knowledge of the flagellar waveform provide new insight not provided by routine head tracking? The clinical gold standard for sperm motility analysis comprises a manual analysis by a trained professional, with existing automated sperm diagnostics.

computer-aided sperm analysis (CASA)] relying on tracking the sperm head and extrapolating measures. It is not currently possible with either of these approaches to track the sperm flagellar waveform for large numbers of cells in order to unlock the potential wealth of information enclosed within.

• 

SUMMARY: Using the software tool IFlagellar Analysis and Sperm Tracking (FAST)! Gallagher et al’ analysed  176 experimental microscopy videos and have tracked the head and flagellum of 205 progressive cells in diluted semen (DSM), 119 progressive cells in a high-viscosity medium (HVM) and 42 stuck cells in a low-viscosity medium. The software tool in this manuscript has been developed to enable high-throughput, repeatable, accurate and verifiable analysis of the sperm &Filar beat. Unsc reened donors were recruited after giving informed consent. They described fully automated tracking and analysis of flagellar movement for large cell numbers. The analysis is demonstrated on freely motile cells in low- and high•-viscosity fluids and validated on published data of tethered cells undergoing pharmacological hyperactivation. Direct analysis of the flagella,- beat reveals that the CASA measure ‘beat cross frequency’ does not measure beat frequency; attempting to fit a straight line between the two measures gives R2R2 values of 0.042 and 0_00054 for cells in DSM and I-IVM, respectively. A new measurement, track centroid speed, is validated as an accurate differentiator or progressive motility. Coupled with fluid mechanics codes, waveform data enable extraction of experimentally intractable quantities such as energy dissipation, disturbance of the surrounding medium and viscous stresses. They provide a powerful and accessible research tool, enabling connection of the mechanical activity of the sperm to its motility and effect on its environment. The FAST software package has only been tested for use with negative phase contrast microscopy. Other imaging modalities, with bright cells on a dark background, have not been tested but may work. FAST is not designed to analyse raw semen; it is specifically for precise analysis of flagellar kinematics, as that is the promising area for computer use. flagellar capture will always require that cells are at a dilution where their paths do not frequently cross.

CONCLUSION: High-throughput flagellar waveform tracking and analysis enable measurement of experimentally intractable quantities such as energy dissipation, disturbance of the surrounding medium and viscous stresses, which are not possible by tracking the sperm head alone. Combining tracked flagella with mathematical modelling has the potential to reveal new mechanistic insight. By providing the capability as a free-to-use software package, ability to accurately quantify the flagellar waveform in large populations of motile cells will enable an abundant array of diagnostic, toxicological and therapeutic possibilities, as well as creating new opportunities for assessing and treating male subfertility.

SOURCE: https://www.indianfertilitysociety.org/fertility-news-august-2019-volume-11/

Mohak infertility center Indore provides a reasonably priced IVF treatment and Test Tube Baby treatment to achieving pregnancy. Call +917898047572 to schedule a meeting from best IVF Centre in Indore, Test Tube Baby Centre in Indore from qualified IVF specialist in Indore. book an appointment : https://www.mohakivf.com

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To More Post: IVF and chances of Twins

Studies say that one out of five pregnancies due to IVF may result in multiple births. Usually, it is seen because during IVF, sometimes multiple embryos might be inserted into the uterus in order to increase the chances of giving birth to twins. Because of this, sometimes more than one embryo gets implanted in the uterine lining and result in twin pregnancy.

Although, even a single embryo can lead to a twin pregnancy in case of IVF when one egg may split and lead to the formation of two zygotes. These are termed as monozygotic twins. While in the case of twins as a result of two separate eggs are called Dizygotic twins. This is a result of transferring two or more embryos in the uterus.

IVF treatment proved to be a blessing for the women who are unable to conceive normally or in other words, are infertile. This medical procedure increases the chances of a woman to get pregnant after trying naturally for long.

Why sometimes IVF results in multiple births?

The prime reason for multiple pregnancies as a result of IVF is because of transferring many embryos at the same time. In the hope of achieving a better possibility of success, doctors sometimes routinely transferred multiple embryos. The main reason behind this is that most of the embryos can have chromosomal abnormalities, i.e., they are not actually viable. This is applicable in both the cases whether the embryo is conceived naturally or through the assistance process, IVF. With the increase in women’s age, the proportion of abnormal eggs increases as well. The reason behind this is that the quality of eggs tends to decline over the years. With the hope that at least one of the embryos would survive, doctors place two or more embryos inside the uterus simultaneously thinking that it would increase the rate of pregnancy. This lead to cases of multiple pregnancies as most of the times, more than one embryo get successfully implanted.

How can we avoid the chances of twins because of IVF?

Most of the leading experts in the field of fertility now go for eSET (elective single embryo transfer) and consider it to be the best practice for most of the IVF cycles. During the ovarian stimulation process, sometimes the woman may produce a large number of eggs and also can have a considerable number of viable embryos available. And the doctor still may suggest transferring only one embryo.

Every IVF cycle is one of a kind and never can we have a single answer that it is right for all. The women going through IVF cycle and her doctor can assess the risks and analyse the benefits of eSET in comparison to multiple transfers in her case. In some of the cases, fertility doctors can still go for transferring more than one embryo. This is mostly seen in the cases of older patients who already had multiple failed attempts.

Becoming a mother is like a dream come true but for some mothers the dreams often start as scary nightmares like Infertility problems. Mohak infertility center is one of the best infertility treatment and Best infertility hospital in indore. provides an all round approach to infertility and advises you with the best available treatment options. We provide affordable IVF treatment cost in Indore, ICSI treatment in Indore along with various other remedies. With a large number of satisfied patients and families Mohak IVF centre is now being recognized as one the best IVF centre and Best fertility hospital in India. visit for more details : https://www.mohakivf.com  and call us 78980-47572 / 80852-77666.

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It is the priceless moment for a woman to give birth to a new life from her womb. During the period of pregnancy, she dreams of so many things in this period. The feeling in the mind of the woman about how the fetus is developing, what she is doing and how big is the baby in the womb. Other family members also take care of women during this time.

Which time is better for pregnancy? 

Time of ovulation (egg in fallopian tube) is beneficial to have sexual intercourse. It is most likely to have the chance of fertilization of sperm and egg. Within 5-6 days of fertilization in the tube, the embryo sticks to the surface by entering the uterus which is called as transplant, during which women may experience light bleeding or spotting, which is normal. The womb is born in the uterus and is fully prepared to develop itself.

How to know that you are pregnant?

Generally the woman does not get to know that she has conceived in the beginning, after the fourth week of the previous period, if there is no menstruation, then the pregnancy test should be done. If test comes positive, then it may cause some weakness, fatigue, sudden mood swings and vomiting.
As the embryo develops, the water sac (amniotic sac) starts to form around it, which works as pillows for it. During this time, placenta (organs similar to a round disk) begins to form and it connects the mother and infant (embryo) through which the nutrients pass from mother to the baby.

How Baby grows?

First month– The face of the baby starts to shape, mouth, eyes, lower jaw and throat are also form and blood cells begin to form to start blood flow. By the end of the first month, the size of the embryo is smaller than rice grain.

• Second month – The face develops more, gradually the two ears begin to form, both hands – legs and their fingers, the dietary tubes and bones are also starts. The baby’s beating can be seen through sonography in the sixth week. A neural tube forming the brain and spinal cord, the ability to feel develops in fetus. By the end of this month the infant develops to 1.5 cm and weighs around 1 gram.

Third month– Important for the development of infant, also called period of organogenesis. By this time, the face of the infant, ears, hands and feet will have been completely formed. Nails begin to form and genitalia begin to grow. By the end of this month the heart, arteries, liver and urinary systems start working. The length of the baby is 5.4 centimeters and the weight is 4 grams.Woman has to take special care of her as this is the critical period of development. If there is any problem, then you should not take medicines without a doctor’s consult. The woman begins to have emotional attachment to the baby by this period.

• Fourth month– Eyes, eyebrow, nails and reproductive organs develop. Tooth and bones begin to grow stronger. Now the baby starts swirling, turning the thumb etc. This month, the Fetal Doppler machine can hear baby’s beating for the first time. Generally, the doctors give you the date of delivery, the weight of the baby is 100 grams and the length is 11.5 centimeters.

Fifth month– Head hair starts forming, shoulder, waist and ears are covered with hair. These hairs are very soft and brown. These hairs fall by the first week after birth. By this time the infant’s muscles develop and start the stir which the mother can feel. By the end of the month weight weighs 300 grams and length 16.5 centimeters.

• Sixth month– The baby’s color is red from which the arteries can be seen. At this time, the ability of the baby to feel is increases and he feels the sound of music and gives feedback on it. By the end of this month, it weighs 600 grams and lengths to 30 centimeters.

• Seventh month – Fat increases in the baby, its ability to hear his voice increases further, gives his reaction to the light and keeps changing his position as quickly as possible. By this time the infant has developed so much that if there is a pre-maturity delivery for some reason then he can survive.

• Eighth month – The movement of the baby increases more and the mother can feel very well. At this time, the brain develops rapidly and it can also see with the hearing. The development of all other physical organs except the lungs has been completed. In this month the baby weighs 1700 grams and the length is 42 cm.

Ninth month – Baby’s lungs are also completely formed. The movement increases, the blinking of the eyelids, the eyes closed and head rotates and the ability to catch is also developed. By the end of this month, the movement of the baby starts decreasing due to less space in the uterus. At this time, the baby weighs 2600 grams and length 47.6 centimeters.

Now the baby is ready to come into the world and starts coming down slowly. Normally the baby’s head comes out first at birth. Traveling from a woman’s pregnancy to a child’s world is unique and has many types of experiences.

Mohak infertility center is one of the Best infertility treatment in Indore that offers low cost IVF Treatment. The infertility treatment center is located near Indore-Ujjain state highway,  MR-10 crossing with peaceful surrounding making it an ideal location for IVF center in Indore. Book an Appointment Now Call 78980–47572 / 80852–77666 For more detail visit www.mohakivf.com

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To More Post: Sleep disturbances may be associated with impaired fertility