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  Most popular articles (Since August 07, 2017)

 
 
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ORIGINAL ARTICLES
Impact of mid-luteal serum progesterone levels on pregnancy outcome in fresh and frozen embryo transfer cycles in women of Indian ethnicity
Jasneet Kaur, Padmaja Naidu, Rani Kumkum, Nalini Mahajan
January-June 2018, 1(1):30-35
DOI:10.4103/tofj.tofj_5_17  
Context: Luteal phase defect has been identified in all assisted reproductive technology cycles, necessitating progesterone supplementation. Aims: The aim of our study was to assess whether mid-luteal serum progesterone (P) levels' impact pregnancy outcome in fresh and frozen embryo transfer (FET) cycles. Settings and Design: A total of 145 women undergoing embryo transfer (ET) were prospectively enrolled and received standard luteal phase support. Methodology: Serum progesterone levels were assessed for all the patients in the mid-luteal phase. Patients were divided into groups based on the type of ET performed. Group A – fresh ET and Group B – FET. These groups were further subdivided based on mid-luteal serum P levels being below (Groups A1/B1) or above 15 ng/mL (Groups A2/B2). Progesterone levels were correlated with the clinical pregnancy outcome. Statistical Analysis Used: Chi-square test was used for qualitative analysis, and student's t-test was used for comparison of means. Results: Patients with mid-luteal serum P levels <15 ng/mL (Group A1) in fresh ET cycles had a statistically significant lower clinical pregnancy rate (CPR) (P = 0.049). In FET cycles, though there was no difference in the CPR, the percentage of biochemical pregnancies was significantly higher in the group with P levels <15 ng/mL (Group B1) (P = 0.024). Conclusions: This study suggests that, in Indian women, mid-luteal serum P levels <15 ng/mL have a negative impact on pregnancy outcome in both fresh (<CPR) and FET (>biochemical pregnancies) cycles. Individualizing luteal phase support by measuring serum progesterone levels might help to enhance pregnancy outcomes.
  3,589 224 -
REVIEW ARTICLES
Ovarian tissue cryopreservation and transplantation using thawed ovarian cortex for fertility preservation
Nao Suzuki
January-June 2018, 1(1):3-8
DOI:10.4103/tofj.tofj_2_17  
In the late 1990s, ovarian tissue cryopreservation was first employed clinically to preserve fertility in female children, adolescents, and young adults with cancer in Europe and the United States. In 2004, Donnez reported the first live birth after ovarian tissue cryopreservation and transplantation. Ovarian tissue cryopreservation can be employed when ova cannot be collected by intravaginal procedures, when induction of ovulation is impossible in girls before menarche, and when cancer therapy must be initiated promptly and there is insufficient time to induce ovulation. In patients with some cancers (e.g., ovarian cancer and leukemia), tumor cells can potentially infiltrate the ovaries and could be transferred by transplanting thawed ovarian tissue so ovarian tissue cryopreservation is contraindicated. Recently, live birth has been achieved up to 30% of women undergoing transplantation of cryopreserved and thawed ovarian tissue. If ovarian tissue contains more primordial follicles (as in children/adolescents), the likelihood of live birth after transplantation is higher. Therefore, the patient's age should also be considered. However, even a woman who underwent ovarian tissue cryopreservation in her late 30s has achieved live birth. Since initial clinical application of ovarian tissue cryopreservation and transplantation in 1997, approximately 100 live births have been reported, including 3 in Japan. This article reviews the current status of ovarian tissue cryopreservation and transplantation of thawed ovarian cortex for fertility preservation.
  2,357 392 -
Breast cancer and fertility: A Review - Part 1
Nalini Mahajan
January-June 2018, 1(1):9-16
DOI:10.4103/tofj.tofj_6_17  
Breast cancer (BC) treatment leads to a reduction in reproductive lifespan due to the use of gonadotoxic agents and prolonged hormonal treatment. With an increasing incidence of BC in the young and better survival rates, fertility issues have come into focus. Pregnancy does not appear to have a detrimental effect and may even improve survival rates. Fertility counseling and offering fertility preservation (FP), therefore, is the standard of care. Among the FP procedures, oocyte freezing is preferred as it allows reproductive autonomy. Ovarian stimulation required for oocyte recruitment does not worsen BC prognosis. Reproductive outcome using cryopreserved gametes gives live birth rates similar to nononcological patients though studies are limited in this aspect. Ovarian tissue cryopreservation can be safely offered if neoadjuvant therapy is required. Fertility issues are extremely relevant in BRCA mutation carriers and FP should be offered to them. Co-administration of gonadotropin-releasing hormone agonist with chemotherapy is recommended in patients wishing to preserve ovarian function.
  1,951 269 -
Psychosocial needs of cancer survivors in fertility preservation: A systematic review
Shayanth Manche Gowda, Harish Thippeswamy, Santosh K Chaturvedi
January-June 2018, 1(1):24-29
DOI:10.4103/tofj.tofj_4_17  
Background: There is a rise in the global incidence of cancer however, with the advancement in the available treatment options there is an increased survival rate in patients with cancer. Among cancer survivors, there are varied psychosocial challenges in the context of fertility preservation which are poorly addressed and there are limited studies on psychosocial interventions to address those psychosocial concerns. Methods: This literature review aims to study the psychosocial issues; ethical, moral and legal challenges in the context of fertility preservation in patients with cancer. PubMed and PsychINFO were systematically searched for English-language publications from the earliest available publication date of each database uptill November 2017. Among 144 unique articles concerning oncofertility and psychosocial issues; ethical, moral and legal challenges in fertility preservation in patients with cancer, 18 articles met the inclusion criteria and were included for the study. Results: In the context of fertility preservation in patients with cancer, the most common short term psychosocial concerns are dealing with double jeopardy (cancer and risk of losing fertility), fear about cancer mortality, concerns about sexuality and reproductive capacity, body image and illness related adjustment disorder or depression which all could affect the decision making and quality of life if, left unaddressed. The long term psychosocial concerns are changes in relationship, prolonged grief, internal conflicts regarding disclosing about their illness, uncertainty about fertility and devastation from the confirmed infertility, post cancer treatment regret. The ethical and legal challenges which arises with fertility preservation in cancer patients are poorly addressed by the existent practice codes and guidelines. Conclusions: To the best of the authors' knowledge, little research to date has addressed the psychosocial concerns of the patients with cancer in fertility preservation. Health care providers should take a pro-active step in identification and addressing the psychosocial concerns of the patients and to adapt a collaborative approach by involving mental health professionals. There is a need for guidelines that are culturally sensitive.
  1,934 234 -
Testicular dysfunction and cancer: The current status
Pankaj Talwar, Sapna Yadav
January-June 2018, 1(1):17-23
DOI:10.4103/tofj.tofj_3_17  
Anticancer treatments have increased the survival rates in young cancer patients in the past 15 years due to early detection. These cytotoxic therapies affect spermatogenesis temporarily or permanently because of detrimental effect they have on germ cells. Chemotherapy impairs spermatogenesis depending on the additive dose of the drugs and the combination of the drugs used for the cancer treatment. Alkytlating agents such as Cyclophosphamide has the most detrimental effect on germ cells. Radiation therapy is also associated with the risk of permanent sterility. Cryopreservation of semen and testicular tissue in the postpubertal and adult males before the cancer treatment is the only nonexperimental and efficient method to preserve future male fertility. With the advancements in cryopreservation and assisted reproductive technologies, surviving cancer patients can use their frozen sperms to raise a family.
  1,881 251 -
EDITORS CORNER
Relevance of fertility preservation in developing nations
Nalini Mahajan
January-June 2018, 1(1):1-2
DOI:10.4103/tofj.tofj_11_17  
  1,667 272 -
ORIGINAL ARTICLES
Does growth hormone supplementation improve oocyte yield and pregnancy outcome in patients with poor ovarian reserve undergoing in vitro fertilization: A prospective randomized trial
Simrandeep Kaur, Nalini Mahajan
January-June 2018, 1(1):44-50
DOI:10.4103/tofj.tofj_10_17  
Context: Poor ovarian reserve (POR) results in poor ovarian response to controlled ovarian stimulation (COS) in in vitro fertilization (IVF) cycles. Despite various strategies, clinical pregnancy rates (PRs) remain low in patients with POR. Aims: This study aims to assess if growth hormone (GH) supplementation in POR patients improves oocyte yield and PR in IVF-intracytoplasmic sperm injection (ICSI) cycles. Settings and Design: Prospective, randomized controlled study. Materials and Methods: Patients with anti-mullerian hormone ≤1.1 (ng/ml) and total antral follicle count ≤6 undergoing IVF-ICSI were enrolled in the study. Gonadotropin (GT) stimulation with GT-releasing hormone antagonist protocol was used for IVF. Patients were randomly divided into two groups: group A (n = 30) received recombinant GH 4 IU from the day of COS till the day of human chorionic gonadotropin trigger. Group B (n = 32) received COS and no GH. Statistical Analysis Used: The unpaired t-test and Mann–Whitney test was used. Categorical variables were analyzed using either the Chi-square test or Fisher's exact test. Results: Total dose of GT injections used were significantly less in GH group (Group A) compared to no GH group (Group B) (3000.89 ± 742.20), P = 0.009). There was no statistically significant difference in number of oocytes retrieved (OR), total days of stimulation, mean estradiol levels on the day of trigger and fertilization rates between the two groups. There was a nonsignificant increase in the clinical PR and chemical PR in the GH group. Conclusions: GH cotreatment with antagonist protocol decreased the amount of GTs required for COS but did not improve the oocytes yield, fertilization or PR significantly in POR patients.
  1,583 154 -
Intrauterine autologous platelet-rich plasma therapy to improve implantation rates in patients undergoing frozen embryo transfer: A pilot study
Anju Madhavan, Padmaja Naidu, Kum Kum Rani, Jasneet Kaur, Nalini Mahajan
July-December 2018, 1(2):81-85
DOI:10.4103/tofj.tofj_11_18  
Background: Successful implantation is a well-orchestrated event requiring the presence of a healthy embryo, a receptive endometrium, appropriate embryo endometrial cross-talk, and adequate maternal immune protection. Despite advances in assisted reproductive technology, there are insignificant improvements in the implantation and pregnancy rates. Intrauterine infusion of platelet-rich plasma (PRP) might improve implantation rates through its paracrine effects by recruiting growth factors and cytokines that favor decidualization and implantation. Objectives: The objective of the study is to study whether intrauterine PRP improves implantation rates in patients undergoing frozen embryo transfer (FET). Subjects and Methods: In this retrospective study, we collected data of patients who underwent FET in Mother and Child Hospital for 11 months from January 2018 to November 2018. We screened data of 98 patients who had at least one previous failed FET and underwent subsequent FET. The patients were divided into a study and control group. The study group received Intrauterine PRP before FET, while the control group did not. All patients underwent the same hormone replacement therapy regimen for endometrial preparation. Main Outcome Measure: The main outcomes studied were the implantation rates and clinical pregnancy rates (CPR) after embryo transfer. Results: Patient demographics such as mean age, body mass index, and anti-mullerian hormone of both groups were comparable. Overall, the CPR was 42.8% in the control group and 47.6% in the intervention group, and the difference was not statistically significant. Conclusion: Intrauterine PRP does not increase the implantation rates/CPR significantly in patients who have had one previous FET failure.
  1,479 184 -
Fertility preservation in endometrial carcinoma: Case series of 11 patients
Madhuri Patil, Nalini Mahajan
January-June 2018, 1(1):36-43
DOI:10.4103/tofj.tofj_7_17  
Introduction: Endometrial cancer comprises 7.1% of all new cancer cases in females. Carcinoma of the endometrium is one of the long-term complications of polycystic ovarian syndrome (PCOS) due to unopposed estrogen action due to chronic anovulation. The standard treatment involves hysterectomy and bilateral salpingo-oophorectomy, due to its hormonal sensitivity. In endometrial cancer without infiltration to the myometrium and no extrauterine involvement, conservative treatment can be offered to women who wish to preserve fertility. Results: We report 11 cases of endometrial carcinoma either diagnosed during workup for infertility or referred for fertility preservation (FP) before definitive treatment. About 72.7% (7/11) of patients had PCOS, it becomes important for clinicians to suspect and rule out endometrial carcinoma by regular endometrial surveillance which, includes transvaginal ultrasound and/or endometrial biopsy in all PCOS women who have abnormal uterine bleeding, prolonged amenorrhea, unopposed estrogen exposure, and thick endometrium especially on day 3 of the menstrual cycle. About 36.36% (4/11) of our patients were not convinced for FP and were either lost to follow-up or underwent definitive therapy. Thus, it is important that all patients with endometrial carcinoma should be counseled not only by the oncologist but also by a reproductive endocrinologist and a psychosocial counselor, both together and separately. This will enable the patient to make a right choice of the treatment modality. Conclusion: Conservative treatment with progestogen therapy in selected young patients with well-differentiated carcinoma limited to the endometrium helps in preserving fertility. If they fail to conceive in the first attempt of in vitro fertilization, it is mandatory to monitor them for recurrence till a definitive treatment is planned. If definitive treatment is required fertility can be preserved either by oocyte or embryo freezing. Some women with low risk of ovarian involvement can benefit by ovarian tissue cryopreservation.
  1,441 157 -
CASE REPORTS
Outcome of fertility-preserving surgery for ovarian malignancy in young women
M Ali Ashraf, Paapa Dasari
January-June 2018, 1(1):51-54
DOI:10.4103/tofj.tofj_8_17  
Ovarian cancer is considered to be one of the most lethal gynecological malignancies. It is estimated that 10% of ovarian cancer cases will be diagnosed in women of reproductive age and >80% would be in advanced stage. Conservative treatment can be carried out for Stage IA, B, C1, C2, C3 (International Federation of Gynecology and Obstetrics) to preserve fertility. However, accurate staging prior to surgery is difficult and some of these women require chemotherapy after fertility-preserving surgery which affects ovarian reserve, and there are a lot of anxieties regarding the aftereffects of chemotherapy on conception. In this article, cases of three young women who underwent conservative surgery for ovarian cancer followed by chemotherapy and subsequent treatment for infertility are presented. These are immature teratoma, juvenile granulosa cell tumor, and dysgerminoma. There was tumor spill in case of immature teratoma and capsule rupture in case of juvenile granulosa cell tumor. All the three women received chemotherapy and could achieve pregnancy after infertility treatment and had normal children. Tumor spill or rupture did not result in adverse outcomes and hence it should not prompt the surgeon to undertake radical procedure in women desirous of pregnancy. Undergoing chemotherapy subsequently did not result in adverse fetal outcome and there was no recurrence of malignancy among these women.
  1,260 152 -
ORIGINAL ARTICLES
Comparison of ovarian reserve and response to gonadotropin stimulation in fertile and infertile Indian women based on ovarian reserve markers, anti-Mullerian hormone and antral follicle count
Jasneet Kaur, Nalini Mahajan
July-December 2018, 1(2):74-80
DOI:10.4103/tofj.tofj_9_18  
Background: Poor ovarian response to gonadotropin (GT) stimulation during assisted reproductive technology cycles is often encountered in infertile women and is considered to be a cause of their infertility. Poor ovarian response is mostly a result of a low ovarian reserve (OR), implying that there may be an earlier depletion of the oocyte pool in infertile women. Aim of the Study: To evaluate whether infertile Indian women below the age of 35 years have an earlier depletion of their OR and a lower ovarian response to GT in comparison to age-matched fertile controls. Materials and Methodology: A total of 146 women undergoing in vitro fertilization-intracytoplasmic sperm injection at our fertility center between March 2017 and August 2017 were prospectively enrolled in this study. Anti-Mullerian hormone and antral follicle count (AMH and AFC) assessment was done for women enrolled in the study in the early follicular phase. Flexible GnRH antagonist protocol was followed. Age, AMH, AFC, body mass index, and response to ovarian stimulation (OS) were compared between the fertile and infertile groups. We also sought to determine which among these had the best prediction for ovarian response to controlled OS. Statistical Analysis: Chi-square test was used for comparisons between study groups with respect to percentages. P < 0.05 was considered to be statistically significant. Results: When adjusted for the differences in the demographic variables, we found no difference in the AMH (P = 0.298) and AFC (P = 0.302) between the fertile and infertile women. In addition, there was no difference in the ovarian response; the mean number of oocytes retrieved was 15.8 ± 7.5 in the fertile group and 14.3 ± 7.5 in the infertile group (P = 0.510). AMH had the strongest correlation with the number of oocytes retrieved (r = 2.11) in comparison to AFC (r = 0.08) and age (r = −0.45) Conclusion: There is no difference in OR and response in fertile and infertile Indian having similar demographics and basal characteristics.
  1,093 124 -
CASE REPORTS
Oocyte cryopreservation in carcinoma breast
Richa Bansal Jagtap, Avantika Vaze
January-June 2018, 1(1):55-58
DOI:10.4103/tofj.tofj_9_17  
This is a case of fertility preservation attempted at the crucial time through mature oocyte cryopreservation in a patient of breast cancer.
  940 108 -
REVIEW ARTICLE
Breast cancer and Fertility Part 2- Pregnancy Associated Breast Cancer
Nalini Mahajan
July-December 2018, 1(2):61-70
DOI:10.4103/tofj.tofj_8_18  
Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy or within the first postpartum year. The increasing incidence follows the increase in age at first childbirth. Diagnostic delay due to physiological breast changes of pregnancy leads to the tumor being diagnosed at a more advanced stage. Since the termination of pregnancy does not alter the course of disease, patients can be offered BC management during pregnancy with a good outcome. Chemotherapy (CT) can be given safely during the second and third trimester of pregnancy. In the first trimester, the option of surgery is available while during puerperium, radiotherapy can be safely administered in addition to CT. Prognosis is related to the stage and grade of the tumor. Neonatal outcomes are reassuring. This article gives an overview of the diagnosis, management, and prognosis of PABC.
  904 130 -
EDITORS CORNER
Ethical concerns in fertility preservation in the young
Nalini Mahajan
July-December 2018, 1(2):59-60
DOI:10.4103/tofj.tofj_10_18  
  838 117 -
ORIGINAL ARTICLES
Fertility preservation surgeries in gynecological malignancies at a tertiary care institute in South India
Paapa Dasari, Sonal Garg
January-June 2019, 2(1):16-19
DOI:10.4103/tofj.tofj_3_19  
Background: Fertility preservation surgery is a method to preserve the fertility potential of women without affecting the management of Gynecological cancer. It is important to know the type of malignancies and age group at which these are diagnosed and managed as this differs from centre to centre. Aims and Objectives: The aim was to find out the spectrum of Gynaecological malignancies in young women and to find out the type of malignancies in which Fertility sparing surgery was feasible. Materials and Methods: This is a retrospective analysis of young women (≤ 40 years of age) with Gynaecological malignancies who underwent fertility sparing surgeries from January 2017 to December 2018 in the department of Obstetrics and Gynaecology, JIPMER, Puducherry, South India Results: Out of 558 women with Gynecological malignancies admitted for management, 127 were ≤ 40 years of age. The most common malignancy was Ovarian (58%) followed by Cervix (24%) and Endometrium (14%). In Ovarian carcinoma, surface epithelial tumors were the commonest (62%) followed by Germ cell tumors (31%). Fertility sparing surgery was feasible in all germ cell tumors and only 30 % of surface epithelial tumors as the mean age at presentation was 25 years. In women with carcinoma cervix and carcinoma endometrium the mean age was 37 and 35 years respectively and all of them completed their family. Conclusion: In this retrospective cohort, fertility sparing surgery was needed only in Ovarian malignancies.
  858 93 -
REVIEW ARTICLES
Breast Cancer and Fertility Part 3: Pregnancy after breast cancer
Nalini Mahajan, Madhuri Patil
January-June 2019, 2(1):9-15
DOI:10.4103/tofj.tofj_5_19  
The incidence of breast cancer (BC) in young nulliparous women is on the rise globally. Early diagnosis and improved multimodality treatment have given survivors an opportunity to fulfill their reproductive needs. Concerns of disease recurrence, increased risk of antenatal and neonatal complications, and possibility of cancer inheritance in the baby influence decision making on pregnancy after BC (PAFBC). Fertility itself may be an issue as ovarian reserve is compromised by chemotherapy, and patient may need the help of assisted reproductive technique's. Fortunately, PAFBC treatment does not jeopardize disease outcome. However, the optimal time for conception after completion of treatment needs to be determined. Safety of pregnancy in women with a history of hormone (estrogen and progesterone) receptor positive BC, also remains controversial. Advice on going through with pregnancy should be individualized after evaluating the status of the women, keeping in mind safety of both fetus and the mother. Wishes of the patient need to be respected and the final decision rests with her.
  806 102 -
MINI REVIEW
Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan
Yasushi Takai
July-December 2018, 1(2):71-73
DOI:10.4103/tofj.tofj_5_18  
Fertility preservation (FP)/oncofertility is a crucial facet of cancer supportive care. The publication of FP guidelines is becoming increasingly prevalent in Japan. However, the viability of the guidelines is predicted on a well-developed FP network comprising of cancer hospitals, assisted reproductive technology (ART) hospitals/clinics, and oncofertility center, and the quality of the FP network in Japan varies greatly based on the region. Oncofertility care availability is influenced by the sustainability of each network and public financial support which may be facilitated by oncofertility registry system which recently launched in Japan.
  787 119 -
REVIEW ARTICLES
Role of ovarian reserve testing in cancer survivors
Padma Rekha Jirge
January-June 2019, 2(1):3-8
DOI:10.4103/tofj.tofj_1_19  
Improved survival in children and young women affected with malignancies bring forth the impact of gonadotoxic chemotherapy and radiotherapy on future fertility. This review looks at the understanding of mechanisms of damage to ovarian follicular pool and the evolution of assessment of ovarian reserve. The search for articles was done through PubMed. The review summarizes the current evidence on the value of ovarian reserve testing in young cancer survivors.
  647 92 -
ORIGINAL ARTICLES
Distribution of anthropometric, clinical, and metabolic profiles of women with polycystic ovary syndrome across the four regions of India
Jasneet Kaur, Madhuri Patil, Sujata Kar, Padma Rekha Jirge, Nalini Mahajan
January-June 2019, 2(1):20-26
DOI:10.4103/tofj.tofj_7_19  
Context: Polycystic ovary syndrome (PCOS), one of the most common endocrine disorders encountered in women of reproductive age, is associated with an increased prevalence of metabolic syndrome (MetS). Development of PCOS and its phenotypic expressions is influenced by genetic, ethnic and environmental factors. Due to the vast cultural diversity in our country, differences in the prevalence of MetS may exist across different regions. Aims and Objectives: To study the distribution of anthropometric, clinical, and metabolic profiles of women with PCOS across the four regions of India. Materials and Methods: A multicentric prospective study using data collected from four tertiary Assisted Reproductive Centres across four different regions of India was carried out between January 2017 and December 2017. A total of 651 women were diagnosed with PCOS, with 178 belonging to North, 209 to East, 115 to West and 149 to South India. A comparison of the metabolic and anthropometric profiles of women with PCOS was made across the four different ethnic regions of India. Statistical Analysis: Quantitative variables were compared using the Mann–Whitney test and qualitative variables using the Chi-square test.P < 0.05 was considered statistically significant. Results: North Indian women had the highest mean body mass index (BMI) – 27.53 ± 4.55 kg/m2 and a higher waist circumference (89.93 ± 14.53 cm) compared to women from South and West India (P = 0.0001). The prevalence of MetS (41.98%) and impaired glucose tolerance (IGT) (37.04%) was also highest in North India followed by East India. PCOS women from East India were lean but had the highest waist-to-hip ratio (WHR) 0.9 ± 0.05 (P = 0.0001) and dyslipidemia. Using multivariate logistical regression analysis, age >25 years, BMI >25 kg/m2, and WHR >0.8 had a strong association with MetS. Conclusion: Prevalence of MetS is high among Indian PCOS women, with women from the North and East India having the worst metabolic profiles. IGT is the main driver for MetS.
  556 107 -
EDITORíS CORNER
Sexual health of breast cancer survivors
Nalini Mahajan
January-June 2019, 2(1):1-2
DOI:10.4103/tofj.tofj_11_19  
  477 112 -
CASE REPORTS
Fertility preservation in testicular seminoma
Madhuri Patil, Priyanka Reddy
July-December 2018, 1(2):89-95
DOI:10.4103/tofj.tofj_3_18  
Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1% of all cancers in men. Germ cell tumors (GCTs) account for 95% of testicular cancers. Two broad categories of testicular tumors have been described, one pure seminoma (no nonseminomatous elements present) and the other is nonseminomatous GCTs. It is one the most curable neoplasm with 5 years survival rate of 98%–99% when diagnosed at an early stage. We present here one such case of metastatic seminoma, where the semen was cryopreserved for fertility preservation. Although the sample was oligoasthenospermic, a successful pregnancy and live birth was obtained with intrauterine insemination of the frozen sample in an controlled ovarian stimulation cycle. Testicular tumors can impair fertility after treatment in majority of patients. Fertility preservation methods such as semen freezing, sperm freezing using epididymal or testicular sperm extraction (TESE) or testicular tissue freezing provides hope for those who wish to father a child latter.
  507 69 -
Idiopathic hyperprolactinemia with tumoral prolactin levels
Nadia Belmahi, Houda Salhi, Said Boujraf, Hanan El Ouahabi
July-December 2018, 1(2):107-110
DOI:10.4103/tofj.tofj_1_18  
The causes of hyperprolactinemia are varying, from physiological to pharmacological and pathological causes; but some cases are classified as “idiopathic” because of unknown causes. We describe a 29-year-old woman who presented to our department with galactorrhea and secondary amenorrhea. She had no clinical features of hypopituitarism and was not taking any medication. On physical examination, she had bilateral galactorrhea. Prolactin (PRL) level was high, up to 200 ng/ml, and other pituitary and thyroid indices were normal, including testing for macroprolactinemia. Pituitary magnetic resonance imaging was normal; and thoraco-abdominopelvic tomography was performed with no abnormalities detected. Cabergoline was started at the dose 0.5 mg/week. Galactorrhea disappeared, the menstrual cycle had become regular, and PRL level decreased to 26 ng/ml. Should all causes of hyperprolactinemia be ruled out and pituitary imaging revealed as negative, idiopathic hyperprolactinemia is therefore diagnosed. In symptomatic patients, treatment with dopaminergic agonists is indicated.
  503 53 -
ORIGINAL ARTICLES
Strategies for fertility preservation in young patients with cancer
Devika Gunasheela, Jyothi Menon, N Ashwin
July-December 2018, 1(2):86-88
DOI:10.4103/tofj.tofj_4_18  
Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.
  433 90 1
CASE REPORTS
Beware of bleomycin toxicity: Fertility preservation for dysgerminoma
Ashraf M Ali, Paapa Dasari
July-December 2018, 1(2):103-106
DOI:10.4103/tofj.tofj_6_18  
An 18-year-old female who underwent fertility preservation surgery for dysgerminoma Stage IIa received adjuvant chemotherapy and bleomycin, etoposide and cisplatin of four cycles. She presented with cough and breathlessness after 45 days of the last cycle of chemotherapy. She was tachypneic and had decreased SpO2 and was managed by supportive therapy. Her X-ray chest revealed bilateral ground-glass nodular opacity and computed tomography thorax showed evidence of pulmonary fibrosis in the form of intra- and inter-lobular septal fibrosis with surrounding ground-glass opacity. She ultimately died after 5 days of admission due to respiratory failure. Her body weight was 37 kg and she received standard dose of bleomycin and the cumulative dose was 360 U. Bleomycin dose recommendation is not per kg bodyweight, and the complication of pulmonary fibrosis could have been prevented if the dosage schedule as per bodyweight (0.25–0.5 U/kg) is advocated.
  457 55 -
A case report on severe ovarian hyperstimulation syndrome in a pregnancy with torsion of bilateral enlarged ovaries with acute abdomen
Sankar Kumar Das, Priyanka Roy
July-December 2018, 1(2):99-102
DOI:10.4103/tofj.tofj_2_18  
Ovarian hyperstimulation syndrome is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology. Ovarian hyperstimulation syndrome is invariably associated with increased volume of ovaries which is itself a threat to undergo torsion, and it may cause an additional threat requiring prompt surgical intervention in many situations. Simple release of torsion, sacrificing the devitalized ovarian tissue in part and complete can have effect in continuation of pregnancy; and something like this happened in our case. The patient, 29-year-old, a known case of polycystic ovary syndrome (PCOS), conceived through ovulation induction; came with an episode of acute pain abdomen with abdominal distension toward the later part of her first trimester. Ultrasonography was done. Bilateral enlarged ovaries of around 23 cm × 11.8 cm each were seen meeting at the pouch of Douglas with ascites. It was a case of ovarian hyperstimulation syndrome, more specifically, a case of late ovarian hyperstimulation syndrome. Serum E2 level was 3263 pg/ml. Laparotomy was then done. Intraperitoneally bilateral ovarian torsion was seen with areas of necrosis. The right oophorectomy was done, while on the left side some portion of normal ovarian tissue was preserved. Following the operation, her symptoms were improved. The pregnancy continued uneventfully. Exposure of ovaries to human chorionic gonadotropin or luteinizing hormone following controlled ovarian stimulation by follicle-stimulating hormone underlies most cases of ovarian hyperstimulation syndrome. The risk of ovarian hyperstimulation syndrome is smaller when using gonadotropin-releasing hormone antagonist (GnRH) antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. To avoid ovarian hyperstimulation syndrome, the best trigger is GnRH agonists. In PCOS patients, metformin is an important aid in reducing ovarian hyperstimulation syndrome.
  433 62 -