Title : Human Chorionic Gonadotrophin (HCG) trigger-mediated ovulation induction in tobacco-mediated infertility management in North Indian women undergoing IVF/ICSI regimens: A pilot reproductive medicine study with public health impact
Abstract:
Introduction: Infertility is a global public health problem; cost-effective patient-friendly treatment modalities along with psychosexual intervention strategies are essential for tobacco-mediated infertility control/prevention/management among ethnically disparate populations.
Objectives: My pilot study aimed to assess hCG-trigger mediated ovulation-induction and differential in vitro fertilization (IVF) success trends among infertile women of North Indian ethnicity.
Material and Methods: Prospective study designed in a hospital-based setting with enrollment of infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) at IndiraIVF Center, Lucknow, Uttar Pradesh, India (N=910 women; April-September 2020); inclusion criteria: age>35 years, North Indian ethnicity, married>1 year, absence of full-term clinical pregnancy, endometrial thickness <6 mm/thin endometrium; exclusion criteria: prior ≥2 IVF failures, fibroids/adenomyosis/cervical cancer/endometriosis. IVF success was determined by evaluating total frozen embryos transferred/month, average oocyte yield/donor, oocyte quality, M-II oocytes, biochemical/clinical pregnancy (beta-human chorionic gonadotropin positivity/fetal cardiac activity). Mycobacterium tuberculosis positivity was assessed by GeneXpert polymerase chain reaction based technology, and psychosexual intervention-incorporated marital relationship counseling sessions/therapy, referrals for psychiatric assessments (cognitive impairment/schizophrenia/depression). Tobacco-usage was ascertained using bilingual Questionnaire (English/Hindi dialects) with supporting registered nurses; written informed consent of participants was taken and study was approved by Institutional Review Board.
Results: Mean age and endometrial thickness of study participants were 34.1 years (SD ±0.8) and 9.1 mm (SD ±0.2), respectively; average Body-Mass-Index (BMI) and anti-müllerian hormone (AMH) levels were 25.0 kg/m2 and 2.2 ng/mL. Embryos transferred/month:123-April/165-May/183-June/159-July/139-August/141September, and pregnancies/β-hCG positivity:96/134/145/120/106/113 for months of April, May, June, July, August, September 2020. Subgroup-stratification demonstrated M-II vs total oocytes retrieved were 70%,68%, 71%,72%,77%,67%. Overall IVF success rates were 78%-April/81%-May/80%-June/75%-July/76%-August/82%-September; frozen embryo-transfer success was 72%-April/78%-May/70%-June/69%-July/63%-August/77%-September. M.tb. (55.6%)/HPV-positivity (12.0%) and self-reported tobacco-usage (100% response-rate) were significantly associated with aberrant fetal cardiac activity, higher trends of intrauterine-growth-restriction and still-births (P<0.05). English/Hindi-speaking infertile women self-reported treatment-related satisfaction rates of 80%-100%.
Conclusions: M-II oocytes’-yield, sociodemographics of infertile women, and increasing age/aberrant AMH/BMI profiles/endometrial receptivity/diminished ovarian reserve are promising predictors of IVF/ICSI success in genetically distinct patient population-subset(s). Future multicentric gene-epidemiology/association public health studies with nursing interventions are warranted for development of predictive biomarkers in infertility management post-Covid-19/Omicron pandemic vaccination-era, and identifying aberrant microbiome at maternal-fetal interface tilting “embryonic/fetal-fate” towards still-birth/death.
Audience Take Away:
- My promising reproductive medicine study emphasizes that M-II oocytes’-yield, sociodemographics of infertile women, and increasing age/aberrant AMH/BMI profiles/endometrial receptivity/diminished ovarian reserve are promising predictors of IVF/ICSI success in genetically distinct patient population-subset(s).
- Future multicentric gene-epidemiology/association public health studies with nursing interventions are warranted for development of predictive biomarkers in infertility management post-Covid-19/Omicron pandemic vaccination-era, and identifying aberrant microbiome at maternal-fetal interface tilting “embryonic/fetal-fate” towards still-birth/death.
