A 32-year-old married for three years, who had taken treatment for primary infertility, approached for assisted reproductive techniques (ART) after the failure of 10 cycles of ovulation induction with clomiphene citrate (CC) and laparoscopic ovarian drilling (LOD) two years ago. She was evaluated and found to have anti-Mullerian hormone (AMH) of 0.63 ng/ml and antral follicle count (AFC) of four and was treated with dehydroepiandrosterone sulphate (DHEA-S) for three months. Her AMH increased to 1.2 ng/ml and AFC to seven and she underwent three cycles of ovulation induction and intrauterine insemination (IUI) which was unsuccessful. She conceived naturally after the fourth cycle of ovulation induction with gonadotropins without cycle monitoring. Her Pregnancy was supported with progesterone until 36 weeks, and she underwent elective lower segment Caesarean section (LSCS) for mid-pelvic contraction at 38 weeks of pregnancy. The Caesarean section inspection of the ovaries showed bilateral charring and a few tubo-tubal adhesions. Her postoperative period was normal and mother and baby were discharged on the fifth postnatal day.

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Background: Clinical trials to assess the benefits of acupuncture on in vitro fertilisation (IVF) treatment have differed in study design, protocol, outcome measures and commercial bias. This heterogeneity has precluded any firm conclusion regarding the efficacy, or otherwise, of acupuncture in this field. To address this, 15 international acupuncturists with experience in treating women during IVF participated in Delphi questionnaires and reached a consensus protocol to be used in future research. We were among the first to adopt this newly agreed standard protocol. The aim of this study was to address whether the agreed acupuncture consensus protocol is beneficial for IVF outcomes and may be offered to women undergoing IVF. Methods: An randomised controlled trial, in which 157 women were randomised to receive either acupuncture treatment three times in the treatment cycle in addition to our standard IVF protocol (n = 79) or no acupuncture treatment (n = 78) in their first or second IVF cycle. They were between 23 and 43 years with body mass index below 30. The study group (n = 79) received acupuncture based on the Delphi consensus protocol, between days 6 and 8 of ovarian stimulation, and twice on the day of embryo transfer, before and after transfer. The IVF practitioner was blinded to the randomisation. The primary end point was live birth. Results: Fifteen out of 79 women in the intervention group withdrew from the study compared to 9/78 women from the control group (P < 0.001). A per-protocol analysis revealed that the rate of live births (27/64, 42% vs. 11/69, 15.94%, P = 0.001) and positive pregnancy tests (34/64, 53% vs. 19/69, 27.53%, P = 0.013) were significantly higher in the acupuncture group compared with the control group. Conclusion: The results of this study imply that acupuncture may be offered as a possible method of improving IVF outcome. This study followed a widely approved consensus protocol hoping to settle disagreement in the literature and resolve previous disparity. Trial Registration: ClinicalTrials NCT02683967.

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Twin tubal ectopic pregnancies are rare forms of ectopic pregnancies, with an incidence of one in 200 ectopic pregnancies. We present a rare case of ruptured ectopic pregnancy which occurred due to twin tubal pregnancy. This was a spontaneous pregnancy with no risk factor for ectopic pregnancy.

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Background: Male infertility encompasses up to 50% of all infertility cases and can be due to a variety of causes. Besides cytogenetic abnormalities, hormonal and environmental factors such as trauma, heat, toxins, radiation and nutritional deficiency have been shown to affect spermatogenesis. This study aims to look for the possible risk factors that impair the normal sperm production, which is reflected in semen analysis. Materials and Methods: A total of 601 men underwent semen analysis at Infertility Centre in this prospective case–control study. After undergoing semen analysis, those with azoospermia (AZ), oligozoospermia (OL) and asthenozoospermia (AS) were selected as cases of the study, whereas those with normal semen analysis results were selected as controls. All participants were interviewed with a standardised questionnaire to assess for the known & possible risk factors of infertility & data was analysed. Results: Mean & standard deviation (SD) age of the participants was 33.38 ± 5.63 years. History of varicocele was found to be significantly associated with AZ/OL [adjusted odds ratio (OR_adj) 5.4] and AS (OR_adj 6.9). Similarly, men with a history of mumps orchitis had a significant association with both AS (OR_adj 2.13) and OL/AZ (OR_adj 2.62). Men who chewed tobacco had about twice more chances of having OL/AZ. Activities related to scrotal heat exposure except hot water bath were not associated with sperm quality [AS (OR_adj 0.68) and OL/AZ (OR_adj 0.59)]. Motorcycle riders were found to have decreased association with low semen quality AS (OR_adj 0.53) and OL/AZ (OR_adj 0.50). Conclusion: Varicocele, mumps orchitis and tobacco chewing are significant risk factors that have shown to decrease semen quality and can contribute to male infertility.

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Chronic endometritis is an asymptomatic condition. It results from persistent inflammation of the endometrial lining caused by the presence of microorganisms in the uterine cavity. It is often associated with infertility and poor reproductive outcome. The pathogenesis of chronic endometritis and its association with infertility has been reviewed. Diagnostic modalities and treatment for chronic endometritis are also discussed.

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Endometriosis is a disease known to be detrimental to fertility. Women with endometriosis, and the presence of endometrioma, may require assisted reproductive technologies to achieve a pregnancy. Aim: Our aim was to evaluate the effect of endometriosis and the presence of an endometrioma on outcomes of conventional in vitro fertilization/intra-cytoplasmic sperm injection (ICSI). Materials and Methods: The study group consisted of 45 infertile women with either unilateral or bilateral ovarian endometrial cysts of less than 3 cm. The control group consisting of 50 patients with mild male factor infertility was candidate for ICSI treatment during the same time period as the study groups. Both groups were compared for number of oocytes retrieved, grades of oocytes, as well as embryo quantity and quality. Results: Our findings showed similar follicle numbers, good embryo grades (I or II) and pregnancy rates in the compared groups. However, patients with endometriosis had higher gonadotropin consumption than the control group. The mean number of retrieved oocytes in patients with endometriosis was significantly lower than control group (P < 0.0001). The numbers of metaphase II (MII) oocytes were significantly lower in patients with endometriosis as compared to the control group 6.11 ± 2.92 vs. 9.32 ± 4.71, respectively (P = 0.0002). In patients with unilateral endometriosis, there were significant differences in terms of fertilization rate, retrieved oocyte and MII oocyte between the normal and involved ovaries; P < 0.5. Conclusion: The endometriomas group had a significantly poorer ovarian response and required significantly more ampoules of follicle-stimulating hormone per cycle. They showed poor ovarian response with lower total numbers of retrieved oocytes and lower MII oocytes during the stimulation phase; however, it does not affect the quality of embryos and pregnancy rate per patient.

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