Frozen embryo transfer: the present practice and beyond

Anjana Ray Chaudhuri and Siddhartha Chatterjee

Abstract
Background: With the success of oocyte donation in vitro fertilization (IVF) in postmenopausal women, the importance of endometrial preparation became obvious. This appears also very crucial for achieving pregnancy after frozen embryo transfer (FET) after failed fresh IVF cycles and FET in subsequent natural cycles. Although there are different methods of preparing endometrium, in this study, another method of preparing the implantation bed using letrozole was scrutinized for its usefulness.

Methods: Two hundred and seventy patients between 28 and 40 years of age undergoing IVF due to bilateral tubal blocks were chosen for FET. They had a previous unsuccessful single IVF attempt or had postponed embryo ...

PREGNANCY OUTCOME IN PRE-OPERATIVE DANAZOL TREATMENT FOLLOWED BY LAPAROSCOPIC CORRECTION IN INFERTILITY ASSOCIATED

The Journal of Indian Medical Association (JIMA); October 2012; Volume 110; Number 10 issue; pgs. - 694-699.
Chatterjee Siddhartha DNB, FRCOG Director & Chief Consultant
Dey Sandip MS, DGO - Clinical Associate
Gon Chowdhury Rajib DGO, FICMCH, PH.D. Fellow - Clinical Associate
Ganguly Debi Das MD, DA - Clinical Associate
Corresponding Author:  Dr. Siddhartha Chatterjee

ABSTRACT
Probably, more has been written and less has been agreed upon, regarding the pathogenesis of the enigmatic disorder – Endometriosis, which is the leading cause of disability in women of reproductive age group, resulting in infertility and pelvic pain. It is an accepted fact that the medical treatment of endometriosis does not help in infertility management, except certain situations like pain, limiting the attempt of pregnancy, or endometriosis presenting with cornual block, due to endosalpingiosis. The usual treatment of infertility being either surgical correction, or Assisted Reproductive Technology (ART) procedures. In our patient population, the acceptance of In-vitro Fertilization (IVF) or Embryo Transfer (ET) is much less, because of its ...

Why IUI Fails?

Published in the book - "Intrauterine Insemination" by Dr. Gita Ganguly Mukherjee & Dr. B. N. Chakravarty; 2012; pg. 358-369

Artificial insemination (AI) had been performed for many decades. Almost 200 years ago, John Hunter advised a man with hypospadias, to inject his own semen into his wife’s vagina with a syringe, which produced a normal pregnancy [1]. Sims in the 19th century artificially inseminated 6 women with their husband’s semen obtained from the vagina after intercourse, and one pregnancy was achieved [2]. Intra-uterine Insemination (IUI) is one of the techniques of AI where a bolus of concentrated, motile and morphologically normal spermatozoa is placed inside the uterine cavity close to the oocytes. The frozen sperm for AI in 1953 was first successfully used by Bunge and Sherman [3], but widespread use started in the 1970s, and at present, is a must for donor insemination. ...

Medical Treatment Of Endometriosis

Published in "Endo Insight" – the Quarterly Newsletter of Endometriosis Society India; August 2012; Issue 1

The medical treatment of endometriosis is related to pathogenesis of the disease. Endometriosis is caused primarily as a result of retrograde menstruation. The regurgitated endometrial cells (REC) are normally scavenged by innate immune system, failing which these cells adhere and proliferate on the peritoneal wall. Hormones namely estrogen (E) stimulates this process. The REC escape destruction due to reduced apoptosis and diminution of NK cell activity alongwith infiltration of cytokines like IL1 and IL8, growth factors like VEGF, TNFά and increased Th1 response. The adhesiveness of these cells increases due to integrins, cell adhesive molecules (CAM) and Hyaluronic Acid etc. The proliferation occurs due to increased matrix metalloprteinases (MMP), TNF β, estradiol (E2) and ...

Screening of Endometriosis at an Early Stage

Published in Journal of the Indian Medical Association (indexed journal); July 2000; Volume 98; No. 7; p. 387, 388 & 393

Endometriosis is probably the most focused problem in female infertility. The close association of endometriosis with infertility either as a cause or an effect is an accepted fact. The main problem of endometriosis is that it is progressive disease, which brings anatomical as well as biochemical changes in the reproductive system. Prolonged treatment with ovulation inducing drugs, particularly in high doses, may aggravate the disease in a very short period of time.

To avoid such problem it is important to detect the disease at the earliest opportunity. Endometriosis at an early stage is most often silent or produces negligible symptoms. The diagnostic tool till today is laparoscopy. Laparoscopy being an invasive procedure requiring general anaesthesia, cannot ...

Role of Cryopreservation in the Treatment of Male Subfertility

Published in Journal of the Indian Medical Association (indexed journal); April 2000; Volume 98; No. 4

Cryopreservation or low tempature () storage of sprematozoa is believed to resuld in considerable impairment of pos that sperm quality in terms of motility and viabality when compared to fresh ejaculates, the condition led mainly by determental effect of freezing on the ascrosomal structure and acrosin acivity'. Since optimum sprem motility correlates with improved fertilisation capacity and subsequent pregnancy rate2, the role of cryopreservation in the respect is highly controversial.numerous investigations are being carried out worldwide towards improving the existing the condition in alleviating the afore mentioned shortcoming of sperm cryoipreservation in general., but no rational approach has till date been adopted to find out the metirs and demerits of the technique ...

Recurrent Spontaneous Abortion and Implantation Failure - Immunological Factor and Social clinical Implications

Published as Editorial in “Your Health” (An Indian Medical Association Publication for The People) Doctor’s Day Issue; July 2005; Volume 54; No. 7

Recurrent spontaneous abortion (RSA) is a devastating reproductive problem that affects as many as 5-l0% of couples trying to establish a family. This is a challenging problem to both the clinicians and the scientists. As many as 40% of the couple suffering from recurrent pregnancy loss (RPL) are left without answers, effective therapy and often without a child. The main causes of RPL can be subdivided into genetic, hormonal, anatomical, infective and immunological factors. In this editorial we have highlighted immunological factors and implantation failures.

Substantial evidence now exists to support the concept of suboptimal implantation as being the end result of embryonic, endometrial or immune associated recurrent miscarriages. Early embryonic mortality is very ...

Third party Reproduction in Recent Scenario

Published as Editorial in the Indian Medical Association (indexed journal); May 2007; Volume 105; No. 5

Present day advancement in assisted reproductive technology (ART) procedures has opened a new area known as surrogacy which can otherwise be called third party reproduction. Third party reproduction made it possible for a child to have 5 parents as following genetic mother, genetic father, gestational mother, rearing mother, rearing father. As the procedure is becoming popular now-a-days, the necessity of detailed information about social, psychological and legal aspects are of immense importance A surrogate mother (SM) is a woman who carries pregnancy for another woman. The ethical, moral and legal issues have far lagged behind the technical development in the process of third party reproduction. The first in-vitro fertilization (IVF) surrogate pregnancy occurred in the ...

Postcoital Intra-uterine Aspirate - A Unique Criterion for Selecting Patients for Natural or Assisted Conception

Published in Journal of the Indian Medical Association (indexed journal); May 2007; Volume 105; No. 5; p. 252-258 & 262

The success of any infertility management programme is reflected in its efficacy to achieve a pregnancy either spontaneously or through assistance. For this purpose some routine investigations are carried out to pinpoint the nature of problem(s) which an infertile couple is trouble with. As the basic requisite for conception to occur is the accumulation of motile spermatozoa around the egg at the site of fertilisation, proper assessment of sperm transit from the vagina to the tubal ampulla becomes a very important criterion to predict the possibility of spontaneous pregnancy. Till date postcoital test was the sole investigative tool available to serve this purpose but unfortunately it fails to furnish any information about the concentration and nature of quality of ...

PLACE OF INTRA-UTERINE INSEMINATION IN MALE INFERTILITY AND ENDOMETRIOSIS

Presented in Symposium on Advances in Reproductive Medicine on 27th August 2006 at Indian Institute of Chemical Biology

Intra-uterine Insemination (IUI) is the least invasive technological assistance to promote conception in the field of reproductive medicine. Though it was applied initially for poor seminal parameter, its indications in present day are varied, like unexplained infertility, ovulatory dysfunction with controlled ovarian hyperstimulation (COH), and endometriosis. IUI in male factor though perform very open, does not give good result when seminopathy is severe (sperm count <10 million; motility <20%).

Ectopic Pregnancy In Previously Infertile Women Subsequent Pregnancy Outcome After Laparoscopic Management

Published in Al Ameen Journal of Medical Sciences (indexed journal); January-June 2009; Volume 02; No. 1; p. 67-72

Abstract

Ectopic tubal pregnancy (ETP) is a major event in a woman's reproductive life particularly if it happens after treatment of infertility. It complicates infertility treatment and must be recognized early to simplify the treatment strategy, which must always be directed towards optimizing subsequent fertility. All the treatment trials and the Cochrane database meta-analysis show that medical treatment with methotrexate, preferably multi-dose, is equivalent in efficacy to conservative treatment with laparoscopy in the populations studied. The prolonged follow up and repeated estimation of costly beta subunit of human chorionic gonadotropin (hCG) hormone required in medical treatment become inconvenient for patients in this country. Hence people ...

INFESTATION OF ENDOMETRIUM BY MYCOBACTERIUM TUBERCULOSIS BACILLI - CAUSE OF REPRODUCTIVE FAILURE

Published in Al Ameen Journal of Medical Sciences (indexed journal); October-December 2010; Volume 3; No. 4

Abstract

Tuberculosis is known to be one of the major diseases, causing infertility in India. The prevalence of tuberculosis causing infertility is different in different countries. Established tubercle infection may cause irreversible infertility, on many occasions as it may affect all the reproductive organs. It also produces lower pregnancy rate in Assisted Reproductive Technology program as well. Tubercular bacillary infestation of the endometrium that is mere presence of Mycobacterium Tuberculosis (MTB) bacilli on the endometrial surface has been found to affect fertility as well. In this study, we have detected Mycobacterium Tuberculosis (MTB) infestation of endometrium, causing implantation failure or early embryonic rejection. In many cases ...

Selecting Age-Specific Protocol For Controlled Ovarian Hyperstimulation In IVF Program With Particular Reference To Advanced Age Group

Published In Al Ameen Journal of Medical Sciences (AJMS) April 2012
Ray Chaudhuri Anjana        Ph. D.
Chatterjee Siddhartha         M.B.B.S., D.G.O., D.N.B., F.R.C.O.G., F.I.C.O.G.

Abstract

Aim: The present study was aimed at finding out the age specific best protocol for ovarian stimulation, particularly for advanced age group.

Materials and Methods: This retrospective analysis was carried out from July 2005 to June 2009 in 617 cycles of In-vitro Fertilization (IVF) in different age group patients, performed at our centre. 617 patients having indications for female factor infertility were randomly divided into 3 age groups, as 26 to 30 years (younger age group); 31 to 35 years (middle age group) and 36 to 40 years (advanced age group). They were selected for IVF program, after routine investigations. 4 different stimulation protocols, e.g., Long Down Regulation (LDR), Ultra Long Down Regulation ...

Fertility Promoting Laparoscopic Surgery - Our Experience

Journal of the Indian Medical Association (JIMA); July 2000; Vol. 98; No. 7; pp. 387, 388 & 393
Chatterjee Siddhartha DGO, DNB (MNAMS), FRCOG (ENG)
Chatterjee Alokendu MBBS, DGO, FRCOG
Gon Chowdhury Rajib DGO, FICMCH
Dey Sandip MS, DGO
Ganguly Debidas MD, DA

Abstract

Aim and Objective: This study was to find out optimal laparoscopic surgical procedures for fertility promotion and to compare its pregnancy outcome with in-vitro fertilization (IVF) procedure.

Design and Setting: Laparoscopic surgical procedures were performed under one consultant in a tertiary fertility set-up.

Material and Methods: Between January 1994 and December 2008, 3982 cases of fertility promoting laparoscopic surgery (FPLS) were performed in our center. The procedures were related to uterus and appendages and especially endometriosis.

Results: The pregnancy rate following the surgical correction of minor tubal defects, ovarian cyst and uterine ...

INFERTILITY and ENVIRONMENT

Online Publication in JKIMSU 2012 (Volume-1-No-1-P-24-29)

Abstract:

Environment is coming up as one of the causative factors for many physical and mental diseases. Infertility is not only a medical problem; it is a social and psychological problem as well. Air and soil pollutions are disturbing the male and female reproductive processes in various ways. Endocrine disruptors otherwise called Estrogen Mimics not only induce endometriosis, but can influence the reproductive process by competing with estrogen receptors. Insecticides and environmental toxicants also disrupt the reproductive process. Psychological stress is an important factor for infertility. This is also a stimulating factor for many gynecological conditions like Polycystic Ovary Syndrome (PCOS). In treating the infertile couples, psychological treatment ...

Minor Tubal Defects - The Unnoticed Causes of Unexplained Infertility

Published in The Journal of Obstetrics and Gynecology of India (JOGI - Official Journal of FOGSI); July-August 2010; Volume 60; No. 4; p. 331-336

Abstract:

Objective: To review whether detailed videolaparoscopic evaluation of so called unexplained infertility can find out certain causes and laparoscopic corrective techniques can alleviate them.

Methods: From 1998 to 2007, 1726 cases of unexplained infertility were investigated by laparoscopy at Repose Fertility Clinic, Kolkata. 846 minor tubal defects were detected.

Results: According to our observation tubal defects were classified in six categories. Most of them belong to combined aeteology.

Conclusion: Different laparoscopic surgical techniques to restore structural and functional integrity of fallopian tubes may be useful in achieving pregnancy ...

Prof. Robert Edwards, Nobel Laureate in Medicine 2010 - Tribute of an Indian with Joy and Sorrow

Published as Editorial in Al Ameen Journal of Medical Sciences (indexed journal); 2011; Volume 4; No. 1; p. 1-2

The Nobel Prize award in medicine for 2010 to Prof. Robert Edwards, the Pioneer of Modern In-vitro Fertilization (IVF), has made us proud. This was long awaited, and took 32 years for IVF technology to get the highest international scientific recognition. Prof. Edwards, who is now 85, worked since 1950, to develop this programme, and ultimately became successful, when Louise Brown, world's first test tube baby was born on July 25, 1978. In the process of development, Edwards could determine the fertilizing potential of sperm, and in 1969, a human egg was fertilized in a test tube for the first time. Till date, about 4 million babies are born ...

Male Infertility: Whom to treat - person or his sperm

Published on the occasion of 21st AICC RCOG Conference, Kolkata 3rd to 5th March, 2006

Infertility per se is a unique condition to the physicians as it itself is not a disease state. Infertility may be caused by some disease or it may prevail in perfectly healthy couple. Primarily it is a social problem followed by psychological and medical disorder. While 85% of couples are able to conceive after one year of unprotected intercourse, approximately 15% of couples are unable to initiate a pregnancy without some form of assistance or therapy. These patients are said to be "primarily infertile." In approximately one-third of these couples, a male factor appears to be singularly responsible, and in an additional 20% both a male and a female factor can be identified. Therefore, a male factor is at least partly responsible for difficulties in conception in ...

Is Test - Tube Baby is Really Test-tube

Published in "Your Health" (An Indian Medical Association Publication for The People) Doctor's Day Issue; July 2005; Volume 54; No. 7

Test-tube baby- the particular term makes common people curious enough to find out whether the baby or its precursor formed in this process remains in a test-tube. Hence, the Infertility practitioners are frequently asked this question by their patients. Actually, it is the popular term used to designate a baby born out of the process of 'in vitro fertilization' (IVF), ie, fertilization of male and female gametes 'outside' the body,- in the incubator instead of being in the fallopian tube that occurs in vivo fertilization. In Latin 'vitro' means glass and in the beginning the laboratory part of the IVF procedure used to be carried out in a test-tube. This is how the name was originated. The procedure which was confined mostly to the laboratory and known to the scientists and ...

Laparoscopic Management of Ovarian Cyst in Infertile Women

Published in The Journal of Obstetrics and Gynecology of India (JOGI - Official Journal of FOGSI) 1999; 49(2); 68-70

Ovarian cysts due to high possibility of complications, demand surgical intervention at the earliest. The infertologists are more worried about endometriotic ovarian cysts or chocolate cysts which are not only progressive themselves but invite severe pelvic adhesion and sometimes infection in the form of ovarian abscess. The pressure effect of gradually enlarging cyst destroys the ovarian tissue and sometimes invites ovulatory dysfunction. The available ways of managing these ovarian cysts are laparotomy, laparoscopic surgery and transvaginal ultrasound guided cyst aspiration. (Dordoni 1993).

Laparoscopic surgery, on the other hand has emerged as an acceptable surgical procedure for dealing the ovarian cysts, particularly in infertile women. The low incidence of post ...