Chromosome imbalances are the leading cause of pregnancy loss in humans and play major roles in male and female infertility. Within the past two decades, the development and application of preimplantation genetic diagnosis (PGD) has played an important role in infertility practices worldwide. The purpose of this review is to discuss, how PGD may be applied in combating numerical chromosomal abnormalities and in Robertsonian and reciprocal chromosome translocations. We shall consider prevalence and risk of each aberration, interchromosomal effects and rationale behind use of PGD in each case. Numerical chromosome abnormalities (aneuploidy and polyploidy) in particular affect a very high proportion of preimplantation embryos (~ 50%). Given that a majority of preimplantation embryos are aneuploid, PGD can be used to screen embryos and transfer euploid embryos to improve pregnancy rates and reduce spontaneous abortions. The rationale of utilize PGD to transfer only euploid embryos would seem sound, but controversies exist surrounding application of PGD for aneuploidy detection. To this end, we will discuss the dichotomy between favorable descriptive reports and less favorable randomized clinical trial data. This review will discuss the trend towards differing sources of embryonic DNA (e.g. polar body vs blastomere vs blastocyst) as well as development of novel technologies for 24 chromosomes analysis.

Testis and ovary serve an important role of producing male and female gametes. Their normal functioning is very important for the proper formation of sperm and ovum and thus has a critical role in the successful fertility outcome. Synchronized activity of various cells in the gonads is needed to provide favorable niche for the growth and development of the germ cells. Among various ways of cellular communication, intercellular communication is mediated by gap junctions, which provides open but selective exchange of ion and molecules of restricted size between two adjoining cells. The basic unit of gap junction is connexins. Their important role has been speculated in the maintenance of homeostasis, morphogenesis, cell differentiation, and growth control in higher organisms. The expression of gap junction proteins in reproductive tissues has drawn the attention and interest of researcher to investigate their role in the reproductive outcome. The reports about the correlation of gap junction protein expression pattern in infertility patients and in animal models have suggested their implication in fertility. Some of these gap junction proteins seem to have redundant functions, whereas some could be very critical in the normal fertility and could not be dispensable for the successful outcome of the reproduction.

The assessment of the endometrial receptivity at the time of human chorionic gonadotrophin (hCG) is one of the key factors for success of all ART procedures.

To assess, if 3D and 3D power Doppler assessment of endometrial receptivity before giving hCG, helps improving pregnancy rates in superovulation with IUI cycles.

A prospective randomized study of 2500 cycles of IUI was done over a period of twelve months for pre-hCG endometrial assessment.

Endometrial assessment was done on Voluson 730 Expert, (Wipro GE) using transvaginal multifrequency volume probe 5 to 9 MHz. When follicles and endometrium were considered mature by 2D US and color Doppler, 3D and 3D power Doppler assessment of the endometrium was done before giving hCG. These values were evaluated for conception and nonconception groups.

Conception rates were higher, when endometrial volume was between 3 and 7 cc. In our study, we have found endometrial FI > 20 and endometrial VFI > 40 as most optimum.

3D ultrasound is accurate for volume assessment of endometrium. 3D and 3D PD, when used with 2D US and color Doppler for pre-hCG endometrial assessment, it would definitely improve implantation rates in IUI cycles.

General practitioners as well as obstetricians are coming across a large number of pregnant women whose conceptions are following a period of infertility or treatment for the same. There is a controversy in the literature regarding the occurrence of adverse outcomes of pregnancy in such women.

To assess the maternal and perinatal outcome in pregnancies that occurred after a period of infertility and to compare the outcome in spontaneous conceptions with the conceptions following treatment for infertility

Retrospective analysis of hospital records of 200 pregnancies following infertility during the year 2009 in a tertiary care center in South India.

All the women were divided into two groups, viz: Group 1—those who had history of infertility but conceived spontaneously and Group 2—those with history of infertility and conceived only after treatment for infertility. The main outcome measures were antenatal complications and adverse neonatal complications.

The statistical package SSPS version 15.0. Chi-square and student ‘t’ test was used for nonparametric and parametric variables.

The incidence of hypertension was 60% and that of gestational diabetes was 7%. Obstetric complications included increased incidence of preterm labor (23.5%) and premature rupture of membranes (38%). There was no statistically significant difference in both groups though the medical complications especially hypertension was high in the pregnancies following spontaneous conceptions, i.e. untreated group. There was a greater demand for the NICU care mainly because of prematurity. The PNMR was (40/1000) less than the institutional rate of 72/1000 births.

There is increased incidence of hypertension premature rupture of membranes and preterm delivery in pregnancies following infertility. There is no significant statistical difference in the adverse pregnancy outcomes between spontaneous conception and those treated for infertility.

Pregnancies following infertility are at increased risk of developing hypertension and preterm labor and hence these women should be screened for the same and preventive measures to be undertaken to achieve good maternal and perinatal outcome.

Multiple pregnancy and preterm delivery are well-known complications of IVF/ICSI treatment. Fetal reduction is also performed in the cases of high order multiple pregnancy. There is increased impetus on transferring fewer embryos, preferably only one in younger women.

186 women, who conceived following IVF/ICSI treatment participated in a questionnaire study regarding their knowledge and attitudes towards multiple embryo transfer, fetal reduction and multiple pregnancy

A majority of women said that they were aware of the complications of multiple pregnancy (90%) and preterm delivery (85%). Nevertheless, none of them opted for a single embryo transfer. A positive pregnancy test was more important to most women than the outcome of that pregnancy (74%). Fetal reduction did not pose any moral concerns to most women (67%). Anxiety about the safety of the remaining twins persisted throughout pregnancy (73%). Having twin babies did not affect the quality of life of most women (74%).

Indian women were similar with their western counterparts in desiring multiple embryo transfer in order to maximize their chance of getting a positive pregnancy result. The negative impact of twin or higher order pregnancy appears to be disregarded by the women prior to getting pregnant. The confidence of the treating physician to offer single embryo transfer also appears to affect the patients’ choices.

The current study aimed to determine the prevalence of obesity and gestational diabetes (GDM) and the association of obesity and gestational diabetes with adverse pregnancy outcomes in a population of pregnant women. Routine antenatal care included the estimation of body mass indices, assessment of blood glucose levels, including glucose challenge tests and oral glucose tolerance test, fetal growth monitoring and nutritional counseling. The prevalence of GDM and obesity in this population was 8.43% (95% CI: 7.47-9.40) and 19.49% (95% CI: 18.12-20.87) respectively. The prevalence of obesity increased to 54.63% (95% CI: 52.91-56.36), if we used the ICMR guidelines for BMI in this population. Cesarean sections (adjusted OR: 2.04, 95% CI: 1.43-2.89), large for gestational age (LGA) babies (adjusted OR: 3.82, 95% CI: 2.11-6.92) and macrosomia (adjusted OR: 20.90, 95% CI: 3.29-132.77) was associated with obesity in GDM (based on the ICMR guidelines for BMI). Results from this study indicate that gestational diabetes and obesity are increasingly important priorities for perinatal care in India.

Heterotopic pregnancy is rare in natural conception and most often presents as life threatening emergency like acute abdomen and hemorrhagic shock. In early unruptured stages, it presents nonspecifically, mimicking normal or abnormal pregnancy manifestations. A high index of suspicion and a definitive search for it even after confirming normal intrauterine gestation is needed. This little effort ensures a timely diagnosis and management thus preventing catastrophe. We hereby report a primigravida with unruptured heterotopic pregnancy following a natural conception, who presented as nonspecific abdominal pain. Transvaginal ultrasound was inconclusive. Emergency laparoscopy clinched the diagnosis and allowed conservative salpingostomy and continuation of intrauterine pregnancy.