Ghorbian S. Applications of Cell-Free Fetal DNA in Maternal Serum. Int J Infertility Fetal Med 2012;3(2):33-39.

The effect of endometrial thickness on pregnancy rates in assisted reproductive technology (ART) patients has been evaluated by many authors, with controversial results. Endometrial thickness has been utilized as an indirect indicator for endometrial receptivity.

To evaluate relationship between endometrial thickness on day of embryo transfer and pregnancy outcome in in vitro fertilization and embryo transfer (IVF-ET) cycles. Should we cancel cycles based on endometrial thickness only?

A prospective analysis was conducted at Dr Kamini Rao Hospital, Bangaluru, of 239 patients. Various parameters were compared between pregnant and nonpregnant patients to see whether there is any cut-off for endometrial thickness on day of embryo transfer by which we can predict good prognosis in form of pregnancy and what effect other variables on endometrial thickness and pregnancy respectively and should we cancel embryo transfer, if endometrial thickness is not within certain range?

In the study population, 174 (73%) had primary and 65 (27%) had secondary infertility, Ovarian stimulation was performed with long protocol in 37% cases, antagonist protocol in 47% and other protocols like microflare, short, ultralong, ultrashort in 15%. Mean age of patients was 31.04 ± 3.79 years. Among causes of infertility male factor was present in 39%, tubal factor was seen in 18%, unexplained were 13%, polycystic ovarian syndrome in 11%, poor ovarian reserve in 4.1% and mixed causes in 13%. Majority of our patients were in normal and overweight as per body mass index (BMI). ET were easy in 90% of cases and 14 (5.8%) ETs were cancelled. The reason for cancellation was ovarian hyperstimulation syndrome (OHSS) in 9 cases, fluid in cavity in 2 cases, one patient had hyperpyrexia on day of ET and 2 cases of failed fertilization. Endometrial thickness was >10 mm in 35% cases. Overall clinical pregnancy rate was 39% with implantation rate of 21%, fertilization rate of 92% and cleavage rate of 95% and live birth rate of 26%. There were more follicles, oocytes and embryos, the endometrium was >10 mm and embryo quality was higher among women who became pregnant when compared with nonpregnant women after assisted reproduction though not statistically significant (p > 0.05). The pregnancy rate improved as endometrial thickness increased showing a linear association.

Increased endometrial thickness is associated with higher pregnancy rates, but as such a cut off cannot be decided. In our study we have seen pregnancies at both thin and thick endometrium so we should not cancel ET merely on the basis of endometrial thickness as pregnancy is affected by multiple variables and not by endometrial thickness alone.

Sharma R, Rao K, Srinivas MS, Jones T. Is Endometrial Thickness on the Day of ET Really Predictive of IVF Outcome? Int J Infertility Fetal Med 2012;3(2): 40-47.

The aim of this study was to find out if endometrial vascularity can be used as a predictive factor for implantation

This is a retrospective study of 500 ovum donation—embryo transfer cycles, with basal S FSH > 25. Those with endometrial thickness of >8 mm with intact junctional zone and uterine artery PI < 3.2 were taken for embryo-transfer. Vaginal micronized progesterone was started from the day of ovum pick up of the ovum donor. Two fresh grade 1, 4-6 cell embryos, were transferred on day 3. Progesterone support was continued till the day of β-hCG. β-hCG was checked in all patients followed by USG 2 weeks later. Results were observed for four groups, depending on vascularity zones 1, 2, 3, 4.² Follow-up with ultrasound was done till 8 weeks for ongoing pregnancy.

The biochemical pregnancy rates and ultrasound evidenced pregnancy rates were very high when vascularity was seen in zone 3 and 4 of endometrium with low abortion rates.

We believe that endometrial vascularity is an important parameter to assess the implantation potential of the endometrium.

Nagori C, Panchal S. Endometrial Vascularity: Its Relation to Implantation Rates. Int J Infertility Fetal Med 2012;3(2):48-50.

The aim of this case-control study was to compare the efficacy of highly purified human menopausal gonadotropin (HPhMG) vs recombinant follicle stimulating hormone (r-FSH) treatments following GnRH agonist suppression in patients undergoing intracytoplasmic sperm injection (ICSI) with moderate male factor infertility in terms of oocyte and embryo quality and clinical pregnancy outcomes.

A total of 240 infertile women were treated with HP-hMG group (n: 120 patients) or (r-FSH group, n: 120 patients) following GnRH agonist suppression (long regimen). Inclusion criteria for the study groups were infertility due to moderate oligoastheno-teratospermia with no associated female infertility factor, previous ART cycles <2, female patients aged 19 to 35 years with normal basal FSH, regular ovulatory cycles and BMI <30 kg/m².

Treatment durations and gonadotropin doses were similar in both groups. Cycle cancellation rates, clinical pregnancy and miscarriage rates, total and metaphase II oocytes retrieved, fertilization rate, number of embryos transferred were all similar in both groups. The clinical pregnancy rates were 45.9% (n: 50/109) in the r-FSH group and 40.4% (n: 44/109) in the HP-hMG group.

HP-hMG is effective as r-FSH in terms of oocyte and embryo quality and clinical pregnancy outcomes in patients undergoing ICSI with moderate male factor infertility.

Dalal RJ, Pai H, Palshetkar N. Effectiveness of HP-hMG vs r-FSH in Patients undergoing IVF/ICSI Cycles with Moderate Male Factor Infertility. Int J Infertility Fetal Med 2012;3(2):51-56.

To evaluate the prognostic value of first postembryo transfer beta human chorionic gonadotropin (hCG) levels in pregnancy outcome in an assisted reproductive technology (ART) program.

Seventy-one women with an initial beta-hCG value of greater than 5 mIU/ml postembryo transfer in the ART program were taken in to the study. The beta-hCG test was done 14 days after embryo transfer. The period of study was from January 2008 to August 2010.

A significant correlation was found in beta-hCG values between viable and nonviable pregnancies. In women who had a day 2 embryo transfer the mean beta-hCG value was 608 ± 580 mIU/ml, in comparison to women who had a day 5 transfer 1,527 ± 2,024 mIU/ml, and this was statistically significant.

Women who had a single embryo transfer had a mean betahCG level of 168 mIU/ml, two embryos 464 mIU/ml and three embryos 612 mIU /ml.

Mean beta-hCG value was highest in women who developed gestational diabetes [2,074 mIU/ml] women with pregnancyinduced hypertension (PIH) had a mean beta-hCG value of 674 mIU/ml, and with antepartum hemorrhage the value was lower 220 mIU/ml.

To summarize, beta-hCG level is an useful marker for prognosticating early pregnancy well being, for predicting multiple pregnancies. When interpreting the first beta-hCG level uniformly after 2 weeks of embryo transfer, day of transfer of embryos should be taken into account. The number of embryos transferred does not alter the beta-hCG level significantly. BetahCG level implications in pregnancy complications, like gestational diabetes (GDM), PIH, APH, require further research and would be a useful tool for early screening and surveillance of pregnancy.

Jayachandran KD, Natarajan P, Pandiyan R. First Postembryo Transfer Beta-hCG Level and Pregnancy Outcome in an Assisted Reproductive Technology Program. Int J Infertility Fetal Med 2012;3(2): 57-62.

Marakani LR, Gundabattula SR. Recurrent Molar Pregnancy: An Obstetric Dilemma? Int J Infertility Fetal Med 2012;3(2):63-64.

Dalal RJ, Pai H, Pandya S. Difficult Airway with HELLP Syndrome. Int J Infertility Fetal Med 2012; 3(2):65-67.