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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 3 | Issue 1
Page Nos. 1-45

Online since Saturday, January 30, 2021

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EDITORIAL  

Oncofertility and the corona pandemic Highly accessed article p. 1
Nalini Kaul
DOI:10.4103/2589-9597.308412  
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REVIEW ARTICLES Top

Managing mental health of pregnant women during COVID-19 p. 3
Harshmeet Kaur
DOI:10.4103/tofj.tofj_4_20  
There is an uptrend in mental health issues among the general population during COVID. Psychologists speculated that the psychological impact of COVID-19 on pregnant women cannot be neglected. It can have a serious and long-lasting social-emotional impact on expectant mothers. Keeping the above in view, existing review on psychological impact of COVID-19 and its consequences among pregnant women was retrieved via the search on PubMed, Medscape, and Google Scholar database. Evidence also suggested effective coping strategies to be used during this time to manage stress. Guided by research evidence and medical guidelines, a brief guide called “CARE” which focuses on key self-care elements for healthy prenatal and postnatal experience during the COVID-19 crisis, are being discussed in the article. Globally, mental health and well-being awareness among pregnant women is needed.
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Elective frozen embryo transfer – What is the evidence? p. 7
Madhuri Patil
DOI:10.4103/tofj.tofj_8_20  
Fresh embryo transfer (ET) has been the norm in Assisted reproductive technology (ART) treatment. However, there has been a concern about decreased implantation and pregnancy rates due to altered endometrial receptivity, resulting from the supra-physiological hormonal levels associated with controlled ovarian stimulation (COS). Improvement in embryo survival rates with vitrification has led to an increase in the use of elective freezing of all good quality embryos and transfer in subsequent cycles, i.e., elective frozen ET (eFET). The use of gonadotropin-releasing hormone (GnRH) agonist trigger and segmental in vitro fertilization (IVF) to prevent ovarian hyperstimulation syndrome in hyper responders, has further enhanced the use of e FET. Significantly higher pregnancy rates after frozen-thawed ET in some reports have encouraged wider use of elective freeze-all cycles in ART. Recent studies have shown that in patients with regular menstrual cycles, a freeze-all strategy with GnRH agonist triggering did not result in higher on-going pregnancy rates and live birth rates (LBRs) as compared to fresh transfers with the use of human chorionic gonadotropin for the trigger. There have been no studies comparing fresh verses eFET in poor responders. Significant benefit of e FET has been documented only in hyperresponders. Despite the potential advantages, it seems that e FET is not designed for all IVF patients and a careful patient selection is advocated to derive true benefit from this strategy.
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Oncofertility in males: A literature review p. 13
N Ashwini, Lohith Chengappa Appaneravanda, Devika Gunasheela
DOI:10.4103/tofj.tofj_9_20  
The aim of this study was to evaluate current literature on oncofertility specifically in males. We convey that malignancies on its own result in compromising semen quality in males, subsequently causing infertility or impaired fertility. Testicular cancer and Hodgkin's disease are aggressive in causing infertility compared to other malignancies. This review also aims to address the gonadotoxic nature of cancer therapy, outlining the cytotoxicity of radio and chemotherapy. We also address techniques that major fertility centers utilize for fertility preservation in males, specifically semen cryopreservation. Prepubertal males with malignancies are also assumed early care in fertility protection, experimental techniques such as spermatogonial stem cells preservation, and testicular tissue freezing has quickly become prevalent in giving patients hope of parenthood. Finally, we discuss some current oncofertility guidelines to care for male patients with cancers. We also evaluate the ethical constrains of semen cryopreservation and overall providing oncofertility care.
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ORIGINAL ARTICLES Top

Clinical outcomes of fresh versus frozen embryo transfers and its influence on mid-trimester miscarriage and fetal birth weight: A retrospective study p. 18
Priya Selvaraj, Kamala Selvaraj, S Valarmathi, Mahalakshmi Sivakumar, HP Vasundra
DOI:10.4103/tofj.tofj_2_20  
Aim: The aim of the study was to compare the clinical outcomes of fresh and frozen embryo transfer (FET) in women undergoing assisted reproductive technology and its influence on mid-trimester miscarriage and fetal birth weight. Materials and Methods: The study was conducted between June 2016 and June 2019. The study group comprised 778 cycles, of women, who were undertaken in this retrospective analysis of in vitro fertilization cycles who underwent fresh and FET. These women were randomly divided into two groups, fresh embryo transfers (n = 410) and FETs (n = 368). Both groups were compared with their respective outcome measures such as the clinical pregnancy rates (CPRs), miscarriage rates, multiple pregnancy rates as well as live births and birth weights. Results: The mean age of the participants in fresh and FET groups was 31.13 ± 4.39 and 31.45 ± 4.25, respectively. There were statistically significant differences with respect to clinical pregnancy (P = 0.002) between the groups. Fetal miscarriage rates (30.14% vs. 23.53%) as well as birth weights were not statistically significant (P = 0.164) between fresh versus FET. The results clinically signified that the FET gives a lower miscarriage rate and higher CPRs while not affecting the average fetal birth weight. Conclusion: Adjusting the baseline characteristics and exclusion criteria of participants, women undergoing FET were associated with better clinical outcomes than women undergoing fresh ET cycles Contrary to existing literature, our incidence of neonatal morbidities, or large birth weights were not increased and fetal macrosomia did not occur. Gaining debates on the advantage of frozen over fresh transfers and its effects on obstetric and neonatal outcomes may require a large multicenter pooling of data and analyses.
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Comparative analysis of outcome of morula versus blastocyst transfer p. 26
Himanshu Bavishi, Sonali Tawde, Falguni Bavishi, Parth Bavishi
DOI:10.4103/tofj.tofj_18_19  
Introduction: The human embryonic genome is not activated before 4–8 cell stage, so morphological grading on D2/3 does not predict the pregnancy potential of embryo. Sequential media and better culture conditions have made D4/5 embryo transfers (ETs) feasible. Embryos enter the uterus as morulae, which is the rationale behind D4 ET. Aims and Objectives: The aims and objectives of this study were to compare the in vitro fertilization (IVF) outcomes of morula versus blastocyst transfers in fresh IVF intracytoplasmic sperm injection (ICSI) cycles in terms of implantation rates, clinical pregnancy rates (CPRs), and live birth rates (LBRs). Materials and Methods: This is a retrospective study conducted in Bavishi Fertility Institute, Mumbai and Ahmedabad, from January 2017 to September 2018; a total of 349 in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) cycles in females <37 years old, were analyzed, among which 53 were in morula group and 296 in blastocyst group. Cases with severe endometriosis, huge fibroids, severe male factor infertility, and TESA/PESA ICSI were excluded. Outcomes were analyzed statistically in terms of implantation rate, clinical pregnancy rate, and live birth rates. Statistics: Chi-square test (with Yates correction, if required) and unpaired t-test were used for statistical analysis. Results: The implantation rate, CPR, and LBR in morula versus blastocyst group were 34.54% versus 37.79%, 45.28% versus 51.35% and 37.73% versus 45.6%, respectively. Conclusion: The outcome in terms of implantation rate, CPR, and LBR of blastocyst transfer was marginally better than that of morula transfer, but statistically did not reach any significance. Morula transfers done in selective situations offer effective alternative to blastocyst ET without compromising results.
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CASE REPORTS Top

Rare occurrence of spontaneous ovarian hyperstimulation syndrome in frozen-thawed embryo transfer cycle resulting in healthy twin birth p. 32
Kamala Selvaraj, Priya Selvaraj, K Suganthi, Vijaya Annigeri
DOI:10.4103/tofj.tofj_5_20  
This article is about an incidence of spontaneous ovarian hyperstimulation syndrome (OHSS) following a frozen embryo transfer (FET) with hormone replacement therapy. OHSS, a potentially life-threatening condition, is an iatrogenic complication of controlled ovarian stimulation; therefore, it is very important to prevent and treat OHSS with calculated doses of ovulation-inducing agents. The OHSS is triggered by vasoactive mediators, which are released from hyperstimulated ovaries. The syndrome can also occur in stimulation with clomiphene and gonadotropins. The occurrence of OHSS is more common in young women (<35 years) with low body mass index (BMI) (BMI<21 kg/m2), patients with polycystic ovarian syndrome, 10 and above antral follicle count, high serum estrogen concentration, and multiple ovarian follicles at the time of surrogate luteinizing hormone surge of human chorionic gonadotropin administration and multiple pregnancies. It is mandatory to freeze all the embryos and canceling that particular cycle to avoid OHSS. However, to our surprise we found OHSS occurring in frozen-thawed hormone replacement cycle. Although spontaneous OHSS (sOHSS) remains a rare event, females with a history of OHSS may have an elevated risk for sOHSS. Usual monitoring of pregnancy following FET helps in early diagnosis of this very rare condition which can be managed conservatively.
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Fertility preservation in breast cancer p. 37
Sadhana Patwardhan, Mangala Ketkar, Rita Bang, Nitya Agrawal
DOI:10.4103/tofj.tofj_16_19  
Fertility preservation is a discipline that has emerged within the past 20 years and aims to enhance the quality of life of survivors by preserving their reproductive endocrine capacity. The need for fertility preservation has to be weighed against morbidity and mortality associated with cancer. There is thus a need for a multidisciplinary collaboration between oncologists and reproductive specialists to improve the awareness and availability. Increasing the lifespan of cancer survivors due to early diagnosis and management and current trend of delaying childbearing has led to many cancer survivors who intend to have a child after cancer treatment, hence comes the role of oncofertility. Herein, we report a case of cancer breast who underwent in vitro fertilization at our center for fertility preservation.
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Live birth following the transfer of a euploid blastocyst derived from monopronuclear zygote p. 42
Surleen Kaur, Kirtirupa Nandi, Shipra Gupta, Nidhi Sehrawat
DOI:10.4103/tofj.tofj_1_20  
The objective of the present study is to report a case of a live birth following the transfer of a blastocyst derived from monopronuclear zygote that was found to be an euploid by preimplantation genetic testing for aneuploidy (PGT-A). The study was conducted at a tertiary care-assisted reproductive technology center. A 35-year-old female with a secondary infertility, polycystic ovaries, and with the history of recurrent implantation failure underwent an in vitro fertilization cycle followed by a frozen embryo transfer cycle. The main outcome measure was clinical pregnancy and live birth. The patient was considered pregnant after obtaining a βhCG level of 1334 mIU/mL after 14 days following embryo transfer and delivered a healthy baby girl at 30 weeks by cesarean section. In this study, transfer of frozen-thawed monopronuclear-derived blastocyst that was detected euploid with PGT-A, resulted in a healthy live birth. Therefore, we suggest that embryos from monopronuclear zygotes should not be discarded but instead be screened by PGT-A to ascertain the euploid status, especially in the absence of bipronuclear-derived embryos.
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