Objectives: To assess the ovulatory, pregnancy rates and side effects of tamoxifen (TMX) in women who are infertile with polycystic ovarian syndrome (PCOS) and who did not conceive with three cycles of clomiphene citrate (CC). Study Design: A prospective interventional study. Population: Seventy-four women who were infertile with PCOS and who did not achieve pregnancy after a minimum of three cycles of CC were included in the study. Materials and Methods: TMX was given orally from Day 2 to Day 6 of the menstrual cycle, with a dose of 40 mg in the 1^st cycle and 80 mg in the subsequent two cycles. Transvaginal ultrasound was used for follicular monitoring from Day 10 and on every alternate day till the day of ovulation or till the 20^th day of the cycle. Statistical Analysis: Ovulation rates with different doses were compared using McNemar test. Kruskal–Wallis test was used to find out differences in maximum follicular diameter and endometrial thickness (ET) between 3 cycles. Results: The mean maximum follicular diameter was 16 ± 5.2 mm, and the mean ET was 8.9 ± 1.7 mm with an ovulatory rate of 41.90% with 40 mg of TMX. Mean increase in the maximum follicular diameters with 80 mg of TMX was higher when compared with 40 mg (P value − 0.000) of TMX. Increasing the dose of TMX in cycles 2 and 3 resulted in a statistically significant increase in the ovulatory rates; however, it was not so with ET. There were no clinical pregnancies, and minor side effects occurred in 14.1% of the participants. Conclusion: TMX induced ovulation only in 56% of the participants, and optimum ET was achieved in 92.7% of the participants; in addition, there were no pregnancies. Hence, TMX is not a useful ovulation inducing agent for CC failure/CC-resistant PCOS.

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Single fetal demise in twin pregnancy in late second or third trimester is a complex clinical situation and the management may face a dilemma. This is a rare case report of continuing pregnancy for 9 weeks in an intrauterine insemination (IUI) conceived dichorionic diamniotic twin pregnancy with intrauterine fetal demise of one twin at 25 weeks of gestation. A gravida 2 abortion 1 presented to Jaipur fertility centre (Department of Reproductive Medicine & Medical Genetics, MGUMST) with unexplained infertility of 3 years. She conceived with IUI at first attempt. The routine antenatal care scan at 25 weeks revealed 25 weeks 3 days single live fetus and second fetus 21 weeks with absent fetal heart pulsation and features of hydrops. The patient was hospitalized for conservative management. Regular follow-up was performed with daily fetal movement count, weekly coagulation profile, and ultrasound for fetal well-being. Inj. betamethasone was given for lung maturation at 32 weeks of gestation. She underwent caesarean section at 34 completed weeks for the preterm premature rupture of the membrane, the outcome being first fetus 2.2 kg female with Apgar score 7/10 and second macerated female fetus of 840 g. Postoperative period was uneventful for both mother and newborn. The baby was on regular check-up under a neonatologist. Her growth and neurological development was optimum according to her age group as seen on the long-term follow-up for 1 year.

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Male factor infertility is the sole cause of infertility in approximately 20% of the infertile couples with sperm playing a crucial role in the whole process of fertilization. Many technologies such as swim-up and density gradient techniques have been developed for the counting and sorting of sperms over the past few decades. Microfluidic technology was introduced into this field at the beginning of the 21^st century. Studies have reported that conventional semen processing techniques have adverse effects on sperm deoxyribo nucleic acid (DNA) integrity leading to decreased pregnancy rates and are also associated with potential promutagenic alterations to sperm DNA. A gravity-driven microfluidic device, on the other hand, isolates motile sperms with good DNA integrity from seminal plasma, dead sperm, and debris, using microscale laminar flow without centrifugation. The objective of this review study is to evaluate whether microfluidic sperm sorters allow the effective recovery of sorted motile sperm without DNA damage compared with the centrifugation and swim-up procedure.

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Introduction: Infertility is a major public health problem worldwide, including India. Tobacco consumption (smoking/chewing) is a significant predictor of metabolic perturbations in reproductive physiology, including infertility. The early identification of risk factors associated with infertility susceptibility in ethnically disparate population subsets is an attractive cost-effective strategy in infertility control, prevention, and management. Materials and Methods: A comprehensive literature search using PubMed and Medline scientific database(s) (last accessed November 4, 2017) was performed by the authors for the inclusion of most relevant articles in this review. Public health research studies for developing cost-effective infertility risk-assessment protocols in low-resource settings targeting couples who are infertile in India are ongoing for reducing the increasing burden of reproductive disorders and addressing the psychological/financial distress associated with the exorbitant cost of infertility treatment procedures, namely in-vitro fertilization. Results: With our clinical research experience in reproductive medicine/infertility, we strongly advocate the implementation of cost-effective community-based tobacco-cessation infertility management guidelines with robust public health research models in the specific population subsets of varying genetic landscapes and socioeconomic strata. Anti-tobacco public awareness campaigns should be organized for efficiently addressing health risks associated with tobacco consumption/cigarette smoking. Conclusion: The authors speculate that oxidative stress caused by tobacco in the physiological milieu may be diminished by therapeutically targeting specific metabolic/biochemical signaling pathways associated with cellular stress/death, immunomodulation, and inflammation. Biomarker development/validation for the stringent management of tobacco-mediated infertility will certainly provide spectacular gains in our current understanding of the pathophysiological basis of tobacco-related reproductive aberrations/disorders, primarily infertility, in the 21^st century.

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