Cochrane Review

Question: Should we advise oral Inositol supplement in subfertile women with PCOS prior to infertility treatment?

Focus: 

OrAL Inositol supplementATION versus no supplementATION or  folic ACID supplementATION prior to trEATMENT for infertility.1

Population of interest:
Subfertile women with PCOS undergoing oVULATION induction or IVF. The MAJORITY of the TRIALS included women PLANNED for IVF, while few included women PLANNED for oVULATION induction.

Intervention under investigation: 
OrAL Inositol supplementATION  prior to infertility trEATMENT. Most of the studies included pretrEATMENT for up to 8-12 weeks prior to IVF.

What was the comparison?
No supplementATION or stANDARd supplementATION (periconcEPTIONAL Folic ACID).

What were the main outcomes?
Live birth, clinicAL prEGNANCy AND miscARRIAGE rATe.

Results in short:

• Eleven  trials included 1472 subfertile women with PCOS. Out of eleven TRIALS, nine involved PCOS women undergoing IVF.

• Live birth rate: No difference in live birth rate with supplementation of oral Inositol vs. no supplementATION  in women undergoing IVF (OR 2.42,95% CI 0.75 to 7.83; P = 0.14; 2 RCTs; 84 women; very loW-QUALITY evidence).
• Clinical pregnancy rate: No difference  in clinical pregnancy rates with  supplementation  of  oral  Inositol  vs. supplementATION   in women undergoing IVF (OR 1.27, 95%CI 0.87 to 1.85; P = 0.22; 4RCTs; 535 women; very loW-QUALITY evidence).
• Miscarriage  rate:  Significantly  higher  miscarriage  rate  with supplementation  of  oral  inositol  vs.  no  supplementATION  in women undergoing IVF (OR 0.40, 95% CI 0.19 to 0.86; P = 0.02;4 RCTs; 535 women; I²= 66%; very loW-QUALITY evidence).

Limitation:

• No pooled evidence wAS AVAILABLE for women with PCOS undergoing oVULATION  induction, AS  only single TRIALS,  performed cOMPARING  of Inositol versus Clomiphene citrATe or orAL insulin sensitising AGENTS, were included.

• There wAS clinicAL heterogeneity in pooled ANALYSIS due to vARIATION in the dose AND durATION of supplementATION of Inositol for IVF pretrEATMENT  . Most of TRIALS  used Myoinositol AND  doses vARIED from 550-4000 mgs AND durATION of supplementATION  vARIED from “first DAY of cycle to embryo trANSFer”  or upto six months prior to IVF.

• The  controlled  ovARIAN  hyperSTIMULATION  protocols  (ANTAGONIST vs. AGONIST) used in the TRIALS were not reported.

• None  of  the  TRIALS  in  the  IVF  pre-trEATMENT  group,  nor   in  the oVULATION  induction  group  reported  on  side  effects  rELATed  to myo-inositol.

Evidence based practice points:

• Currently, there is uncertainty regarding role of routine Inositol supplementation in PCOS women undergoing IVF  with no difference being found in live birth or clinical pregnancy rates following Inositol supplementation versus no supplementation.

• Further, due to changing clinical practice towards more liberal use of “ freeze all” policy in PCOS women at high risk of OHSS, there may increased uncertainty about role of Inositol supplementation before IVF.
• There is also insufficient evidence for Inositol supplemention in PCOS women undergoing ovulation induction due to paucity of trials.

• Further clarity on the role of Inositol would be possible only after high quality randomized trials evaluating its role  in  PCOS women for ovulation induction and IVF are available.

Reference:

1. Showell  MG,  MACKenzie-Proctor  R,  JorDAN  V,  Hodgson  R,  FARQUHAR  C. Inositol for subfertile women with polycystic ovARY syndrome. CochrANE DATABASE Syst Rev. 2018, Issue 12: CD012378.

Source: https://www.indianfertilitysociety.org/ifs-catalyst-cochrane-vol-5/

Mohak laparoscopy and infertility center is the Best IVF Center in Indore; we offer IVF Treatment at affordable cost with high success rates. We provides a comprehensive and supportive fertility treatments such as ivf, iui & icsi treatment. Book an appointment today https://www.mohakivf.com

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To More Post: FET may be more vulnerable to a suboptimal environment

FET may be more vulnerable to a suboptimal environment

“Can outdoor air pollution affect the FET and fresh ET outcome in IVF cycles?”

Introduction: Ambient air pollution has been associated with human infertility and IVF outcomes. Choe et al1 study indicated  lower pregnancy rates in IVF cycles may be linked to ambient air pollution during controlled ovarian stimulation and the  post-transfer period. Does outdoor air pollution differentially affect the outcomes of frozen–thawed embryo transfer (FET) and  fresh transfer?

Summary: Wang et al2 studied the affect of air pollution on IVF treatment cycles in 11148 patients contributing to 16290 transfer  cycles between January 2013 and December 2016. The average age of the cohort was 31.5 years. Inverse distance weighting  interpolation was used to estimate the daily ambient exposures to six pollutants (PM2.5, PM10, SO2, NO2, CO, O3) at an IVF clinical  site, according to the data from fixed air quality monitoring stations in the city. The exposures of each cycle were presented as  average daily concentrations of pollutants from oocyte retrieval to embryo transfer/cryopreservation. Exposures were analyzed in  quartiles. A generalized estimating equation was used to evaluate the association between pollutants and IVF outcomes. The clinical  pregnancy rate and live birth rate of the cycles was 55.1% and 47.1% respectively. Among the included cycles, 4013 patients received  5299 FET cycles, resulting in 42.7% live birth per ET, whereas 9553 patients received 10991 fresh transfer cycles, resulting in 49.2%  live birth per ET. Increased SO2 and O3 levels were significantly associated with lower live birth rates in FET cycles, whereas none  of the pollutants were significantly associated with lowering of IVF outcomes in fresh transfer cycles. The FET cycles in the highest  quartile of SO2 and O3 exposure had significantly lower live birth rates (adjusted OR) in comparison with those in the lowest  quartile. Models involving all transfer cycles and interaction terms (FET exposures) suggested that FET significantly enhanced the  effects of SO2 and O3 exposure on IVF outcomes (P < 0.001). Accounting for all six pollutants, women in the highest quartile of SO2  still had the lowest live birth rates (OR 0.61, 95%CI 0.47–0.80).

Conclusion: This study implied that embryos undergoing FET may be more vulnerable to a suboptimal environment than those  undergoing fresh transfer. Increased SO2 and O3 levels at the site of IVF unit were significantly associated with lower live birth rates  following FET but did not affect the contemporary fresh transfer outcomes. In heavily polluted sites or seasons, fluctuation in FET  outcomes may be partially explained by the dynamic changes of ambient gaseous air pollutant.

Source: https://www.indianfertilitysociety.org/fertility-news-volume-8-march-2019/

Mohak IVF centre led by Dr. Shilpa Bhandari is a leading IVF centre in Indore, MP. At Mohak, we provide you affordable IVF costs in Indore with world class services. We also specialize in various other Infertility Treatments such as- IUI, ICSI etc. Mohak IVF centre is inarguably among the Best Infertility hospital in Indore and houses one of the finest IVF specialists in Indore. With a high success rate in IVF procedures Mohak is now becoming Best IVF centre in MP as well.

Visit us or book an appointment to experience the best test tube baby centre in Indore and infertility treatment in indore. https://www.mohakivf.com

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To More Post: Diabetes and lower fertility rates are associated

Who should be treated by IVF in unexplained subfertility?

“Should we be trying expectant management or IVF treatment?”

INTRODUCTION: The clinical indications for IVF, initially started from bilateral tubal blockage and now has  extended to unexplained subfertility in which there is no identifiable cause or barrier to conception. There is little  evidence from randomized controlled trials that IVF is effective in these couples.Which couples with unexplained  subfertility can expect increased chances of ongoing pregnancy with IVF compared to expectant management ?

SUMMARY: Eekelen et al1 recently compared outcomes in couples with unexplained subfertility undergoing IVF  (n = 40921) from registry data to couples with the same type of subfertility on expectant management. Those  couples on expectant management (only intercourse) comprised a prospective nation wide Dutch cohort (n =  4875) and a retrospective regional cohort from Aberdeen, Scotland (n =975). They excluded couples who had tried  for less than 1 year to conceive, cases of anovulation, tubal occlusion, mild or severe endometriosis or male  subfertility. Matching of couples who received IVF and couples on expectant management based on their  characteristics to control for confounding were done. They fitted a Cox proportional hazards model including  patient characteristics, IVF treatment and their interactions to estimate the individualized chance of conception  over 1 year, either following IVF or expectant management for all combinations of patient characteristics. The  endpoint was conception leading to ongoing pregnancy, defined as a foetus reaching a gestational age of at least 12  weeks. The adjusted 1year chance of conception was 47.9% (95% CI: 45.0–50.9) after IVF and 26.1% (95% CI:  24.2–28.0) after expectant management. The absolute difference in the average adjusted 1 year chances of  conception was 21.8% (95%CI: 18.3–25.3) in favour of IVF. The effectiveness of IVF was influenced by female age,  duration of subfertility and previous pregnancy. IVF was effective in women under 40 years, but the 1 year chance  of an IVF conception declined sharply in women over 34 years. In contrast, in woman over 40 years of age, IVF was  less effective, with an absolute difference in chance compared to expectant management of 10% or lower.  Regardless of female age, IVF was also less effective in couples with a short period of secondary subfertility (1 year)  who had chances of natural conception of 30% or above.



CONCLUSION: For couples in which the woman is under 40 years of age, IVF is associated with higher chances  of conception than expectant management in unexplained subfertile couples. IVF should be used selectively based  on judgements on gain compared to continuing expectant management for a given couple.

SOURCE

https://www.indianfertilitysociety.org/fertility-news-volume-10-july-2019/

Mohak laparoscopy and infertility center is one of the Best infertility hospital in indore, That provides the best IVF and test tube baby treatment in Indore. All treatments in our hospital are done at affordable price and cost by IVF experts only. One of the leading test tube baby center in Indore. visit our website and book an appointment https://www.mohakivf.com  and call us this number  78980-47572 / 80852-77666

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To More Post: 10 Super-Foods that improves the sperm count and enhances fertility in males

In the case of unexplained subfertility, who should be treated with IVF cycles?

“What should we to trying among expectant management and IVF treatment?”

INTRODUCTION:

The bilateral tubal blockage led to the starting of the clinical indications for IVF, which has now reached to unexplained subfertility, which does not have an identifiable cause (barrier) to conception. Not much evidence as results of from randomized controlled trials could say that these couples got any positive effect from IVF. What type of couples should look for more possibilities of ongoing pregnancy with the help of IVF in comparison to expectant management?

SUMMARY:

In a recent comparison, Eekelen et al1 compared results in couples having unexplained subfertility and undergoing IVF (n = 40921) from registry data to those couples who have a similar type of subfertility on expectant management. The couples on expectant management (just intercourse) consisted of a prospective nationwide Dutch cohort (n = 4875) as well as a retrospective regional cohort from Aberdeen, Scotland (n = 975). Couples who attempted for less than a year to conceive, tubal occlusion, cases of anovulation, severe or mild endometriosis or male subfertility were not included. Couples on expectant management and those who received IVF, their matching on the basis of their characteristics to control for confounding were done. A model called Cox proportional hazards was fitted by them which included patient characteristics, the process of IVF treatment as well as their interactions to calculate the possibility of conception of each individual in a year, either by expectant management or by following IVF for all sets of patient characteristics. Conception leading to ongoing pregnancy was the endpoint, which is defined as a foetus entering gestational age near 12 weeks. When the adjusted 1year possibility was calculated, it was found to be 47.9% (95% CI: 45.0–50.9) post IVF whereas after expectant management it was found to be 26.1% (95% CI: 24.2–28.0). Calculating the absolute difference resulted in being 21.8% (95%CI: 18.3–25.3) favouring IVF in terms of average adjusted 1-year chances of conception. Factors like duration of subfertility, female’s age and previous pregnancy record influenced the effectiveness of IVF. Although IVF was found to be useful for women under 40 years of age, in case of women over 34 years, the one-year possibility of an IVF conception fell gradually. In contrast, IVF was less effective in women aged 40 or more, and the absolute difference chance is 10% or less in comparison to expectant management. However, IVF was found to be less effective in partners having a short period of secondary subfertility (< 1 year) who were having 30% or more chances of neutral conception.

CONCLUSION:

In the case of unexplained subfertile couples, when the woman is under 40, the chances of conception are higher with IVF than expectant management. On the basis of judgements on the gain in comparison to that of expectant management for a couple, IVF should be used selectively.

REFERENCES:

1. R van Eekelen, N van Geloven, M van Wely, S Bhattacharya, F van der Veen, M J Eijkemans, D J McLernon. IVF for unexplained subfertility; whom should we treat?, Human Reproduction, dez072, https://doi.org/10.1093/humrep/dez072

SOURCE: 

https://www.indianfertilitysociety.org/fertility-news-volume-10-july-2019/

Mohak laparoscopy and infertility center, part of a multi specialty,advanced care facility, is the Best infertility hospital in indore. Mohak IVF is the best fertility center in Indore, India with advanced technology, interactive & caring hospitality and great success rate. The affordable ivf cost in indore makes it preferential for the couples in need of infertility treatment, Test-tube Baby treatment and IVF treatment. The IVF specialist, doctors and the professional staff of center offers IVF, andrology, embryology, assisted reproductive technology, ICSI treatment and also offers IVF financing at our fertility center.To book an appointment with the Doctors/ best IVF specialist at the best IVF center in MP, Indore, Visit: https://www.mohakivf.com/ivf-center-in-indore.htm or Call- 78980-47572 / 80852-77666.

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To More Post: 10Super-Foods that improves the sperm count and enhances fertility in males.

10 Super-Foods that improves the sperm count and enhances fertility in males

In life, at certain moment everyone desires of having babies. But when that desire does not get fulfilled, then you must try to know the reason behind it. If you are planning to have a baby and want to increase your chances, you should introduce these super-foods in your daily diet. Presenting list of such 10 super-foods that if you include in your diet will help you to improve your sperm count, sperm quality and your sexual life

1. Dark Chocolate- Considered as the best food to increase sperm count. It is made of cacao beans that are full of antioxidants. It also contains an enzyme called L-Arginine that increases the volume of your sperm.

2. Eggs- Eggs are rich in Vitamin E and protein that helps in the motility of the sperm. Eggs in general are known as the basic super food, also help in increasing sperm count. Consuming eggs also protects sperm from free radical, hence increases chances of fertilisation.

3. Spinach- We never take it seriously when we gets the suggestion to eat leafy vegetables but these are very good for our body as they help to regulate vital activities, additionally it contributes to sperm production, being rich in folic acid, helps in development of sperm.

4. Bananas- It is rich in magnesium, vitamin B1 and C, also contains a rare enzyme known as Bromelain. These all helps in increasing sperm production and boosting sperm motility. Banana is considered as super food because it also regulates the sex hormone and helps in cheering mood.

5. Walnut- Already known as brain food, being rich in omega-3 fatty acids, walnuts improve the vitality of sperm, also help in increasing the sperm count.

6. Red meat- It is great source of zinc, also a rich in folic acid and selenium helps to improve sperm health and assist in sperm production and mobility.

7. Pomegranates- These are well known to increase sex drive. Rich in antioxidants, they help to increase quality of sperm production.

8. Olive oil- It helps in keeping the bad cholesterol level low and enhances the oxygen flow to testicles helping in development of healthy sperm and improves the sperm count.

9. Berries- Goji berries, raspberries, strawberries, cranberries, etc., contains antioxidant, and anti-inflammatory nutrients that helps to improve the production and quality of sperm.

10. Carrots- It helps in increasing the motility and mobility of sperm, having beta-carotene. It can be consumed as salads raw, or cooked with vegetables.

Mohak laparoscopy and infertility center, part of a multi specialty advanced care facility, is the Best infertility hospital in Indore. Mohak IVF is the Best ivf center in Indore, India with advanced technology, interactive & caring hospitality and great success rate. The affordable IVF treatment cost makes it preferential for the couples in need of infertility treatment in indore , Test-tube Baby treatment, and IVF treatment. The IVF specialist in indore, doctors and the professional staff of center offers IVF, andrology, embryology, assisted reproductive technology, ICSI treatment and also offers IVF financing at our fertility center.

To book an appointment with the Doctors/ best IVF specialist at the best IVF center in MP, Indore

Visit: https://www.mohakivf.com or Call - 78980-47572 / 80852-77666

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To Read More : :   Different types of blocked fallopian tubes

Mohak IVF- Best Test Tube Baby Center In Indore

IVF or In Vitro Fertilization, also known as Test Tube Baby is the most preferred assisted reproductive technology which is most effective in helping women pregnant.

In this, an egg is fertilized outside the body and thereafter implanting inside the uterus.

Data says that more than 8 million babies have been born using IVF (In-Vitro Fertilization) until now (2019).

IVF Facts you should know:

● When no other treatments worked after hitting, IVF (In-Vitro Fertilization) can still help

in conceiving.

● This is done by fertilizing the egg in a laboratory dish outside the body and then

implanting it in order to carry the pregnancy.

● By 2022, the Indian market for IVF services is projected to touch $775.9 million at a CAGR of 16.6 % from the year 2016 to 2022.

Normal pregnancy involves the penetration of sperm inside a women’s egg and fertilization after ovulation inside the body, once the production of the matured egg from the ovaries.

The fertilized egg starts developing by attaching itself to the womb or uterus wall. This process is known as natural conception.

However, in case a woman fails to achieve pregnancy naturally or without assistance, she can opt for fertility treatment.

Since the late 1970s, IVF has been in practice. 25th July 1978 is considered to be a Golden Day in the Medical Science when Louise Brown, the first “Test Tube Baby” was born. The procedure was completed with the collaboration of Robert Edwards and Patrick Step toe who are now considered to be the pioneers of IVF.

“Follicular Aspiration” is a minor surgical procedure by which the egg is collected. The collected egg is then kept together with the sperm and then stored in an environmentally regulated chamber. The sperm is expected to enter the egg after a few hours.

ICSI (Intracytoplasmic Sperm Injection) is the procedure in which the sperm is directly injected into the egg.

The fertilized egg transforms in an embryo after division. Among the best embryos, one or the two of them are selected for transfer.

To help the womb reach the lining of the embryo, the going to be a mother is given HCG (Human Chorionic Gonadotrophin) or progesterone.

In-vitro fertilization (IVF) is considered ideal for those (women) who could not conceive after

having regular unprotected intercourse or even after artificial insemination for 12 cycles. IVF

can be the ultimate option when the fallopian tubes of the woman are blocked.

Mohak IVF- Best infertility hospital in indore, part of a multi-specialty advanced care facility, is the best test tube baby center in indore. Mohak IVF is the best fertility center in Indore, India with advanced technology, interactive & caring hospitality and great success rate. The affordable IVF treatment cost makes it preferential for the couples in need of infertility treatment, Test-tube Baby treatment, and IVF treatment. The IVF specialist, doctors and the professional staff of center offers IVF, andrology, embryology, assisted reproductive technology, ICSI treatment and also offers IVF financing at our fertility center. To book an appointment with the Doctors/ best IVF specialist at the best IVF center in MP, Indore, Visit: https://www.mohakivf.com or Call- 78980–47572 / 80852–77666

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Read More : Different types of blocked fallopian tubes

Different types of blocked fallopian tubes

Female reproductive system has muscular tubes with the lining of delicate hair-like structures called the fallopian tubes. Working in both directions, this hair help an egg to gain motility and travel from the ovaries to the womb (uterus), as well as help sperm, come up from womb.

Fimbriae are the finger-like structures where each fallopian tube ends. The fimbriae’s role is to catch and guide an egg after the ovary releases it.

The fallopian tube being located near most of the fertilized eggs plays an important role in conception. In case of damage of any part of the fallopian tube, let's say by an infection or surgery, the scar tissue blocks them and it may lead to infertility.

The type of fallopian tube blockage depends on the root cause of the blockage and location of occurrence. It can be found out with the help of certain medical screenings.

Its types are:-

1.  Distal Tubal occlusion-This type of blockage occurs when the fallopian tube is obstructed at the end, which is closest to the ovary. Usually, it happens as an after effect of a sexually transmitted disease ‘Chlamydia Trachomatis.’ This medical condition is even termed as hydrosalpinx.

2.  Mid-segment blockage- This type of blockage occurs in the midsection of the fallopian tube. It might happen due to any operation or infection, as this area is more susceptible to tubal ligation damage.

3.  Proximal Tubal Occlusion - This blockage occurs due to an infection, inflammation or complexity from a past abortion, miscarriage or even a pelvic inflammatory disease(PID).In such blockages, the ending of the tube, which is close to the uterus is obstructed.

4. Chronic Salpingitis- It is a consequence of any inflammation or a microbial infection in the fallopian tube. If the infection isn’t treated properly, it develops acute salpingitis, in which the inner walls of the fallopian tube get stuck and turn red and inflated, ultimately causing irreversible damage to the tubes.

5.  Hematosalpinx - It a medical condition in which the fallopian tube starts bleeding, causing the build-up of blood clots inside the tube eventually leading to blockage.

6.  Pyosalpinx- In such type of blockage, the fallopian tube is entirely filled and usually swollen with pus.

7.  Hydrosalpinx- It is a condition in which some serious or clear fluid is filled inside the fallopian tubes. The obstruction may become inflated, giving it a shape like that of a sausage. Such condition eventually leads to the blockage of the tubes at the ends.

Blocked fallopian tubes can possibly be opened with the help of surgery. Although, it totally depends on the position of blockage and the extent of scarring.

Mohak IVF Centre, 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 / Test tube Baby Treatment cost along with the satisfaction of being consulted by the most renowned IVF specialists/ Doctors in Indore ,M.P. Come join us in our voyage towards better healthcare facilities for infertile couples and experience the Best Infertility Treatment in Indore.

More Post: WHAT ISPCOS/PCOD?