Diagnostic laparoscopy, infertility, and endometriosis—5 years experience

Abstract - 

The objectives of this study were to determine the importance of diagnostic laparoscopy for the accurate diagnosis of endometriosis and to correlate the findings with infertility. Participants in this study included 336 women who were 18–45 years old, had no past medical history of abdominal operations, and complained of chronic symptoms of pelvic pain. In all these cases there were no pathological pelvic ultrasound findings. Also, nongynaecological diseases where excluded. Diagnostic laparoscopy was performed in all patients. In 191 women (56.8%) no pathology was found during the diagnostic laparoscopy, and 89 women (26.4%) actually reported improvement or even complete cure from their symptoms after the operation. In the majority of pathological cases the laparoscopy revealed various stages of endometriosis (n = 101; 30%). Other gynecological causes which were diagnosed during the laparoscopy where pelvic adhesions due to inflammatory disease (n = 37; 11%), ovarian cysts (n = 5; 1.5%), and uterine fibroids (n = 2; 0.5%). Diagnostic laparoscopy is the most accurate method for excluding the pathology related with chronic pelvic pain. Endometriosis seems to be responsible for the majority of pathological cases. Almost 60% of women have no pathology when examined with laparoscopy. A high percentage of symptoms can be phycogenic.

Introduction - 

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. While a number of theories have been proposed for the pathogenesis of endometriosis, that of retrograde menstruation is the most popular and plausible. Retrograde menstruation is common and is seen in 75–90% of women who have had laparoscopies at the time of menstruation [1]. Menstrual blood does not always contain endometrial cells and the factors that influence implantation of ectopic endometrium are uncertain, for the prevalence of endometriosis has been estimated as 1–20%. Women with endometriosis appear to have altered immune function, which may permit implantation of regurgitated endometrium. Most endometriotic lesions have the classic blue/black pigmented appearance. Atypical lesions could be similar to blisters, white plaques, nodules, and peritoneal defects [2, 3]. It has been suggested that nonpigmented lesions are more common in younger women and that darker lesions represent older disease [4].

The associated symptoms can impact on general physical, mental, and social well being. However, women may not have any symptoms at all. Laparoscopy is the mainstay of diagnosis and classification of endometriosis. All classification systems for endometriosis are subjective and correlate poorly with pain symptoms but may be of value in infertility prognosis and management.

Materials and methods -

This retrospective study included 336 women who were 18–45 years old. The women in our study group had no past medical history of abdominal operations and all of them complained of symptoms of chronic pelvic pain. The duration of symptoms was at least 6 months in order to be characterized as chronic. Of these women, 106 were also referred for primary or secondary infertility. In all these cases, gynaecological examination and transvaginal pelvic ultrasound were performed. There were no pathological pelvic ultrasound findings. Also, nongynaecological diseases were excluded. Diagnostic laparoscopy was performed in all these women by four different consultant obstetricians gynaecologists.

Results -

In 191 women (56.8%) no pathology was found during the diagnostic laparoscopy, and 89 women (26.4%) actually reported improvement or even complete cure from their symptoms after the operation. In the majority of pathological cases the laparoscopy revealed various stages of endometriosis (n = 101; 30%) that was diagnosed during the procedure on observation of the lesions and, in cases of endometriomas, also by histopathology report. For the women with endometriosis, almost 85% (n = 84) complained of primary or secondary infertility. Other gynecological causes which were identified with laparoscopy were pelvic adhesions due to inflammatory disease (n = 37; 11%), ovarian cysts (n = 5; 1.5%), and uterine fibroids (n = 2; 0.5%). No pathology was found in 16 (15%) women with primary or secondary infertility. The cause for infertility in 6 (5.5%) women was pelvic adhesions due to inflammatory disease. Endometriosis accounted for 80% (n = 84) of infertility cases (Figs.1).

Discussion - 

It is well known that the degree of endometriosis does not correlate with symptomatology: pelvic pain, dyspareunia, and dysmenorrhea. Moreover, it is not possible to predict which patients will develop progressive disease with resultant pelvic adhesions and ovarian cysts. Finding endometriosis may be coincidental in some women [5]. Careful laparoscopic assessment of the pelvis reveals signs of endometriosis in up to 18% of women with proven fertility [6]. For a definitive diagnosis of endometriosis, visual inspection of the pelvis at laparoscopy is the gold standard investigation unless disease is visible in the posterior vaginal fornix or elsewhere [5]. A meta-analysis against a histological diagnosis showed that a positive laparoscopic examination increases the likelihood of detecting the disease to 32% (95% CI; range, 21–46%) and a negative laparoscopy decreases the likelihood to 0.7% (95% CI; range, 0.1–5%) [7]. There is insufficient evidence to justify scheduling the laparoscopy for a specific time in the menstrual cycle, but it should not be performed during or within 3 months of hormonal treatment to avoid underdiagnosis [8, 9]. At laparoscopy, deeply infiltrating endometriosis may have the appearance of minimal disease, resulting in an underestimation of disease severity [10]. Positive histology confirms the diagnosis of endometriosis; negative histology does not exclude it. Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal. In cases of ovarian endometrioma and in deeply infiltrating disease, histology should be obtained to identify endometriosis and to exclude rare instances of malignancy.

Laparoscopy is the gold standard diagnostic test in clinical practice for the accurate diagnosis of endometriosis [5]. Compared with laparoscopy, transvaginal ultrasound (TVS) has limited value in diagnosing peritoneal endometriosis, but it is a useful tool to make or exclude the diagnosis of an ovarian endometrioma [11]. At present, there is insufficient evidence to indicate that magnetic resonance imaging (MRI) is a useful test to diagnose or exclude endometriosis compared to laparoscopy [5]. A number of markers for endometriosis have been proposed, and probably the most commonly used is the glycoprotein CA-125, an oncofetal celomic epithelium differentiation antigen. It has been suggested that 35 U/ml could be used as a cut-off serum concentration for CA-125, below which endometriosis is unlikely to be present. Unfortunately CA-125 measurements do not correlate well with either the progression of the disease or the response of endometriosis to treatment. Compared with laparoscopy, measuring serum levels of CA-125 has no value as a diagnostic tool. The test’s performance in diagnosing all disease stages is limited, since it has about 28% sensitivity [12]. The test’s performance for moderate to severe endometriosis is a bit better with a sensitivity reaching 47% [12].

There is still debate about the extent to which endometriosis affects fertility in the absence of pelvic deformity. It has been suggested that the peritoneal environment is altered with interference to the sperm motility, to the oocyte pick-up by the fallopian tube, and to fertilization. Fertility can also be impaired due to dyspareunia caused by endometriosis. It is easy to assume that severe endometriosis can affect fertility by distorting pelvic anatomy with adhesions [13, 14]. The effect of endometriosis on assisted conception therapy results is unclear. According to HFEA (Human Fertilization and Embryology Authority), there is no difference in pregnancy rates in patients with endometriosis, without taking into account the stage of endometriosis [15]. Other authors insist that the fertilization rate, pregnancy rate (PR) per transfer, and birth rate were significantly lower in patients with severe endometriosis (stages III and IV) in comparison with patients with tubal infertility [16].

In almost 50–60% of cases with chronic pelvic pain symptoms, no organic cause is found during laparoscopy [17, 18]. In fact, it may be even more difficult to differentiate the organic from psychogenic pain in patients with symptoms lasting more than 6 months. Whatever the original cause of the chronic pelvic pain, it is quite likely that other facts, mainly psychological, could maintain or exacerbate the symptoms. Patients with chronic pelvic pain are more often found to suffer from depression and somatization disorders. These facts could explain that in a significant percentage of patients, although no organic pathology is found, there is improvement or even cure from the symptoms after a diagnostic laparoscopy [17, 19].

According to our study 85% of women with endometriosis also had infertility problems, and endometriosis accounted for almost 80% of all infertility cases. Of all patients, 30% reported chronic pelvic pain due to endometriosis, and in only 16 of 101 (16%) women with endometriosis no fertility problems were found.

Conclusions - 

Diagnostic laparoscopy is the most accurate method for excluding the pathology related to chronic pelvic pain. Endometriosis seems to be responsible for most pathological cases of chronic pelvic pain and also for the highest percentage of cases who are referred with primary and secondary infertility. Almost 60% of women with symptoms of chronic pelvic pain have no pathology when examined with laparoscopy.

Source - https://gynecolsurg.springeropen.com/articles/10.1007/s10397-007-0357-7

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To More Post: Failed IVF: Not an end to life

Can open tubal microsurgery still be helpful in tubal infertility treatment?

Abstract -  In 30 years, 1,669 patients underwent open microsurgery for tubal diseases. Several techniques like adhesiolysis, reanastomosis, fimbrioplasty, salpingoneostomy, proximal reconstruction, isthmo-ostial anastomosis and reimplantation are described. Results were excellent for patients with a favourable prognosis (1,517 patients) and with very high pregnancy rate: 80% pregnancies with delivery for tubal reversal, 68% for proximal diseases, 75.1% for fimbrioplasty and 55% for salpingoneostomy. Risks of ectopic pregnancy were very low: 1.5% for tubal reversal (because the tubes were healthy), 4% for proximal diseases, 4% for fimbrioplasty and 6.7% for salpingoneostomy. Results were very low for patients with a poor prognosis (152 patients): 10% pregnancies with delivery for distal diseases, less than 20% for proximal diseases and 22% ectopic pregnancies. Open microsurgery can still be helpful in treating tubal infertility: results are better than those obtained with laparoscopic reconstructive surgery and better than those obtained with in vitro fertilization for patients with a favourable prognosis. Patients are only operated one time and can have several pregnancies. Open tubal microsurgery is a minimal invasive surgery and saves costs (it requires a small number of instruments and minimises sutures; patients can return home 4 days after surgery, at the latest). Results on fertility are very favourable.

Between 1977 and 2007, 1,669 patients underwent a minilaparotomy for tubal diseases. Minilaparotomy means a laparotomy with minimal tissue injury, applying microsurgical principles and procedures.

One of the first principles we followed was the temporary but absolute contraindication for surgery in case of active infection and active inflammation (for example endometriotic red lesions).

We also applied the following principles:

• gentle handling of tissues
• atraumatic manipulation of the tubal serosa and mucosae, of the ovary and of the peritoneum
• selective bipolar coagulation: only the vessels (and not the surrounding area) must be dessicated by fine bipolar microelectrodes
• continuous irrigation to keep the surgical area clear at all times and to avoid the tissue from drying out (and especially the tubal serosa and the ovary)
• perfect protection of the abdominopelvic cavity against infection risk using the sterile “wound drape”
• complete resection of pathologic tissues
• complete restoration of the serosa: closure of all peritoneal defects to avoid formation of de novo adhesion and recurrence of previous adhesion (peritoneal defects in case of adnexal disease due to previous infection or inflammation do not scar easily and quickly because the subserosal tissue is not a normal tissue; it is usually rich in inflammatory cells). A peritoneal closure with fine material and inverted stitches scars better and faster than a large defect without peritoneal closure
• use of very fine resorbable sutures 7/0 and 8/0
• last, use of a well mastered surgical technique: the surgery must be successful the first time. Repeat surgery never gives favourable results

Most of these principles were described by Gomel [1] in 1977. Open microsurgery is a method that proves to be cost efficient: the same microscope has been used for 17 years. Sets of instruments were only changed every 4 to 5 years. We only need one suture of 7/0 and one of 8/0 for two tubes. The maximum length of hospital stay is 4 days (only 3 days for 40% of the patients).

Materials and methods

Patient characteristics

• bifocal tubal lesions (distal and proximal occlusion in the same tube)

• distal tubal lesions with poor prognosis: extended dense adhesion, sclerohypertrophic tube, intra-ampullary adhesions, lack of mucosal folds [2]

• significant and extended proximal lesions including the isthm, the intramural segment and the ostium uterinum

After 1987, when in vitro fertilization (IVF) results became acceptable, we abandoned reconstructive surgery for these lesions and decided to perform salpingectomy in order to increase IVF results. We only operated tubal lesions with a favourable prognosis.

As a consequence, 1,517 patients with a favourable prognosis underwent reconstructive microsurgery between 1977 and 2007:

485 tubal reversals

527 distal tubal lesions

505 proximal tubal lesions

Materials

From 1977 to 1994, we used a Zeiss OPMI 6 microscope. A Leica-Wild M-690 was introduced after 1994. Five instruments of 15 and 18 cm long were needed:

• two Moria forceps with very fine extremity (0.5 and 0.2 mm)

• one Martin–Landanger microscissor

• one Jacobson–Aesculap needle holder

• one Codman forceps for bipolar coagulation

• For two tubes, one 7/0 and one 8/0 polydioxanone sutures are usually sufficient.

Methods

Preoperative investigations

All patients had complete investigations: hormonal analysis, male analysis, hysterosalpingography, hysteroscopy and sometimes recanalisation, diagnostic laparoscopy with blue dye test. Results were written down before surgery and then compared with operative images (all surgery were taped first with 8-, then 16-mm film camera Beaulieu, and then with 3-CCD Sony DXC 930 P video camera) and with postoperative histological examination of all resected lesions. The analysis is therefore not entirely retrospective.

Preoperation and per operation procedures

Prior to the laparotomy, a Pezzer catheter is introduced into the uterine cavity. This catheter is brought into sterile fields and allows the preoperative injection of sterile dilute methylene blue solution for verification of the tubal patency. After a short Pfannenstiel incision (6/7 cm), we protect the pelvis with a “wound-drape”. The uterus and adnexa are elevated by packing the Douglas cul-de-sac with moistened compresses. Continuous irrigation of the surgical area using a physiological salt solution mixed with noxytioline and corticoid (permanently evacuated by a Redon drain positioned in the Douglas pouch) keeps the operating area always clear. It keeps the tissues always moistened to prevent tissue drying, avoids formation of adhesion and allows for bipolar coagulation. Extreme gentleness is exercised. Tissue traumatism is prevented by the gentle handling the tubes and the ovary with fingers rather than sharp instruments. At the end of the operating time, a meticulous cleaning of the pelvic cavity is useful.

For 30 years, several peritoneal instillates were used: Ringer's lactate which is not compatible with noxytioline, 30% dextran 70, Intergel, icodextrin 4% solution, etc., but we think it is not necessary to use instillates if the microsurgical technique is perfect: minimal tissue traumatism, perfect haemostasis, no tissue necrosis, no infection risk. We do not use these instillates in case of tubal reversal because the tubes are healthy; there is no peritoneal defect and no risk of adhesion.

Postoperation procedure

All patients (except tubal reversal) were treated with antibiotics and dexamethasone during the postoperative inflammatory time (18 to 25 days).

Patients could return home 4 days after surgery (40% of them left hospital after 3 days). Ovarian induction was prescribed after the second postoperative menstruation. Hysterosalpingography was prescribed 6 months and laparoscopy 1 year after surgery if the patient failed to conceive.

Follow-up procedure

Ninety-one percent of patients were followed up for at least 2 years. Loss of follow-up patients was classified as surgical failure because infertile women always inform their surgeon when they are pregnant or when they have an ectopic pregnancy.

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To More Post: Endometrial scratch for infertile polycystic ovary syndrome (PCOS) women undergoing laparoscopic ovarian drilling: a randomized controlled trial

Endometrial scratch for infertile polycystic ovary syndrome (PCOS) women undergoing laparoscopic ovarian drilling: a randomized controlled trial

Abstract

Background - 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

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To More Post: Fallopian Tube And Its Function

Fallopian Tube And Its Function

A slender tube via which eggs finds its way from an ovary to the uterus is known as a Fallopian tube. In the female reproductive tract, there is one ovary and one fallopian tube on each side of the uterus.

Cilia are the small hair-like projections found on the cells of the lining of the Fallopian tube. For the movement of the egg through the channel (tube) into the uterus, these tubal cilia are important. In case, because of some infection, the tubal cilia are damaged, the egg might stay in the tube instead of getting ‘pushed along’ normally.

Infection can also lead to partial or complete blockage of the tube with scab tissue, actually stopping the egg from getting inside the uterus.

The chance of an ectopic pregnancy where the pregnancy develops inside the Fallopian tube or somewhere else in the abnormal location outside the uterus increases with any growth (like an infection, tumours, endometriosis, or scar tissue in the pelvic adhesions (pelvis) that lead to chinking or twisting of the tube) which rupture the Fallopian tube or shrink its diameter.

The Fallopian tube, also known as the uterine tube is meant to carry an egg to uterus from the ovary. Normally a woman has two uterine tubes in her body, unless a surgery, biological abnormality or ectopic pregnancy lead to the loss of one tube.

The ampulla is a part of Fallopian tube usually where an egg gets fertilized by male sperm. Then the derived fertilized egg develops into blastocyst and gets into the uterus where it remains developing until birth.

It is seen in some women who suffer from an ectopic or tubal pregnancy that keeps their Fallopian tube and their lives as well in trouble. When a fertilized egg stays in the tube instead of moving to the uterus, it results in Ectopic pregnancy. A surgery that terminates the pregnancy is performed in order to treat it.

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To More Post: Sperm tail-tracking technique could improve male fertility testing

Sperm tail-tracking technique could improve male fertility testing

"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/

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To More Post: IVF and chances of Twins

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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How BABY grow in the womb, journey from birth to Pregnancy

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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