In vitro maturation (IVM) of the human oocytes has recently found an important niche among assisted reproductive techniques (ART). Even though the ovarian stimulation protocols continue to evolve and last for few days, they are still not patient-friendly. The development of several follicles is associated with a high risk of ovarian hyperstimulation syndrome (OHSS), leading to hospitalization that can be fatal. Natural IVF cycles, mild stimulation with low dose gonadotrophins and IVM of human oocytes ready for fertilisation now offer an alternative to the traditional IVF treatment. Infertile women with polycystic ovaries or polycystic ovarian syndrome (PCOS) form the main category of patients who would benefit from IVM. However, concern exists that IVM may interfere at the epigenetic level and in particular with genomic imprinting. For normal embryonic development, timely acquisition of correct imprinting patterns in oocytes and maintenance of genomic imprinting after fertilisation is required. It is therefore necessary that patients undergoing IVM be offered preimplantation genetics screening (PGS) prior to embryo transfers. This review considers our current understanding of in-vitro maturation of human oocytes and its importance in clinical applications.

Fertility preservation has been paid much attention recently, as the survival rate of cancer patients after therapy has increased significantly. Cryopreservation of gametes or embryos has been practiced prior to cancer therapy, to preserve fertility, as various modes of cancer therapy are gonadotoxic, reducing reproductive potential of cancer survivors. Although cryopreserving semen or testicular tissue has been the prominent means of fertility preservation for men, it has been still experimental for pre-pubertal boys. Treating by Assisted reproduction Techniques with cryopreservation of oocytes or embryos is the promising way of fertility preservation in women prior to cancer therapy. Livebirths have been reported after auto transplantation of cryopreserved ovarian cortex. Such an approach may not be practical in women with ovarian or endometrial or Estrogen sensitive breast cancer as transplantation of ovarian cortex may reintroduce the disease. Oophorectomy in such patients is not uncommon leading to total infertility of patients. Alternative approaches are available to preserve fertility of such women. Harvesting oocytes for cryopreservation in women without male partners or embryos after in vitro maturation and ICSI of harvested oocytes in women with male partners have been reported as modern means of fertility preservation in ovarian cancer patients. Efficacy of such approaches is reviewed in this article.

Endometriosis is a multifactorial disease characterized by inflammatory changes in the pelvic cavity and symptoms of pain, infertility, and menstrual irregularities. Several theories have been proposed since Samson's theory of retrograde menstrual flow. Iron has been found to be one of the major factors involved in the above-mentioned theory. Abundant retrograde flow of blood into the pelvic peritoneum, followed by the destruction and consumption of the free red cells by the macrophages results in an iron overload both intra-and extracellular. Being a strong catalyst to the formation of free radicals, iron contributes significantly to the rise in the levels of reactive oxygen species, which cause the oxidative stress (OS). Besides stimulating the formation of free radicals and contributing to OS, increased iron in the macrophages also activates a sustained and overstimulated inflammatory response that is responsible for much of the symptoms seen in endometriosis; in particular infertility, due to extensive intraperitoneal adhesions. While genetic factors play a role in determining a woman's response to OS, lifestyle also plays an important part. Dietary deficiency of vitamin C, vitamin E, and micronutrients such as selenium and manganese results in an acquired deficiency of antioxidants and an exaggerated response to the OS. Consumption of fresh fruits, green vegetables, etc. that are rich in antioxidants has been shown to be beneficial in alleviating the symptoms of endometriosis as well as in improving pregnancy rates. Theoretical advantages seem to be present in localized iron chelation as a method of medical management of endometriosis; however, further studies need to be conducted to confirm that the benefits outweigh the risks.

Background: Female genital tuberculosis (FGTB) primarily an asymptomatic disease is one of the most important causes of female infertility in developing countries. Damage to the pelvic organs after genital tuberculosis (GTB) is a well recognized entity .It is thus prudent to diagnose and treat GTB as early as possible to prevent or at least to minimize the damage to the genital organs. Although diagnosis of GTB has been a challenge, its detection and treatment cannot be based on single test and multiple markers must be utilised with the clinical background and early treatment instituted. Objective: The present study was aimed to diagnose or predict GTB based primarily on imaging modalities in the form of hysterosalpingography, pelvic ultrasound and supported by the basic laboratory investigations like Mantoux test, Erythrocyte Sedimentation rate (ESR) . Once the diagnosis or prediction of GTB was made, an early institution of anti tubercular therapy was done and patients were followed up to observe the spontaneous pregnancy rate. Material And Methods: This was a prospective study wherein the patients underwent complete evaluation for infertility including a hysterosalpingograhy and pelvic ultrasonography. The patients were considered to be positive for genital tuberculosis if three or more of the following were found on evaluation: raised ESR ( ≥ 20mm/first hour), Mantoux test positive ( induration ≥ 10 mm), HSG picture or Ultrasonological picture suggestive of GTB. Observation: It was seen that out of the 400 women who were included; 265 women (Group A) were adjudged to have genital tuberculosis as per our study protocol and thus were started on ATT whereas 135 (group B) were not put on antitubercular therapy. Within this duration (during or after completion of ATT), 157(59.2%) conceived spontaneously in group A, on the other hand only 27(20%) women conceived spontaneously in group B. This difference was found to be statistically significant (P Value<0.0001). Conclusion: Although Genital tuberculosis poses a great diagnostic challenge because of its varied presentations, diverse imaging pictures, and myriads of tests with its own limitations, it is advisable not to resort to all of them. Tests which are simple, feasible, specific and sensitive, and facilitates early diagnosis should be carried out. Institution of anti-tubercular treatment should be done in early disease, thus enhancing the chance of pregnancy and preventing irreversible damage to the genital organs.

Objectives: The aim was to compare the metabolic derangements in normoandrogenic and hyperandrogenic women with polycystic ovarian syndrome. Materials and Methods: This cross-sectional comparative study was designed to compare the metabolic derangements in normoandrogenic and hyperandrogenic women with polycystic ovary syndrome (PCOS). Hyperandrogenic women were defined on the basis of either biochemical or clinical evidence. Metabolic derangements were compared among the two groups based on various parameters including serum triglyceride level (≥150 mg/dl), high-density lipoprotein (≤50 mg/dl), fasting blood sugar (FBS) (≥100 mg%), impaired glucose tolerance (2 h postprandial BS ≥140 mg%) and fasting glucose/fasting insulin (FI) ratio (≤4.5). Results: Among 200 PCOS women included in this study, 120 (60%) women were hyperandrogenic whereas the rest 80 (40%) women were normal. Among the two groups, there was no significant difference between the anthropometric parameters including the body mass index, waist circumference and waist-hip ratio. Level of glucose intolerance was measured using FBS, oral glucose tolerance test and FI levels, but there was no significant difference found between the two groups (P > 0.05). Furthermore, androgen excess was not found to be associated with derangement in lipid profile. Conclusion: PCOS is definitely a risk factor for metabolic derangement but it is irrespective of androgen excess, as observed in the above study. Normoandrogenic PCOS women are equally at risk of metabolic derangements; therefore, they should also be screened for metabolic abnormalities at first detection.

This case presentation illustrates correct diagnosis of scar ectopic pregnancy by ultrasonography in correlation with the compliant of intermenstrual bleeding and pain in lower abdomen. The transvaginal ultrasonography finding suggested missed abortion in scar pregnancy. Prompt decision of laparoscopic management was taken depending upon the status of the patient and desire to preserve the fertility. Patient recovered uneventfully and conceived naturally after 10 months. She had uneventful antenatal period, underwent elective lower segment cesarean section (LSCS) at 36 weeks and delivered full-term baby. Early and accurate diagnosis, prompt management of scar ectopic pregnancy can preserve fertility.

Dysmenorrhoea membranacea is a rare condition in which there is spontaneous expulsion of the fragments of endometrium in a cylindrical piece retaining the shape of the uterus. Here we present a case of dysmenorrhoea membranacea in 53 year old female patient who was on hormonal therapy for her irregular menstrual history, presented with the history of menorrhagia and passage of clots since one month.. Patient was subjected to D&C , during PV examination there was an expulsion of this endometrial cast. On histopathology it was diagnosed as dysmenorrhoea membranacea. It is an uncommon diagnosis, predominantly occurring in second and third decade of life. We also reviewed the literature associated with this lesion.