Geeta Nargund

• St George's, University of London

Background The live birth rates (LBRs) do not rise after a certain number of oocytes are collected in fresh IVF cycles. Although the detrimental effect of high ovarian response on the endometrium has been recognised, the effect of high oocyte yield on oocyte competency remains disputed. The purpose of this study was to examine whether high oocyte y...

Nearly 200 million people worldwide suffer from infertility. Disparities exist between developed and developing countries due to differences in the availability of infertility care, different reimbursement policies and socio-cultural differences surrounding procreation. In low- and middle-income countries (LMICs), specialised infertility centres ar...

Background: Assisted reproductive techniques services are often not accessible to the majority of infertile couples in Low and Middle Income Countries (LMIC) due to high costs. Lowering IVF laboratory costs is a crucial step to make IVF affordable for a larger part of the world population. We developed a simplified culture system (SCS) which has p...

The practice of ovarian stimulation for IVF is undergoing a fundamental re-evaluation as recent data begin to successfully challenge the traditional paradigm that ovarian stimulation should be aimed at the retrieval of as many oocytes as possible, in the belief that this will increase pregnancy rates. An opposing view is that live birth rate should...

Research question Can a novel closed simplified IVF culture system be used to achieve outcomes comparable to those obtained with intracytoplasmic sperm injection (ICSI) followed by conventional culturing? Design This analysis is part of a non-inferiority prospective study comparing ICSI and a simplified culture system (SCS) for gamete fertilizatio...

Research question: Is there a difference in perinatal outcome in the same patient cohort for babies conceived following randomization of sibling oocytes allocated to a simplified IVF culture system (SCS) or intracytoplasmic sperm injection (ICSI) followed by conventional culturing? Design: The study compared the perinatal outcomes of 367 babies...

What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. Accurate diagnosis of congenital anomalies still remai...

Professor Dr Geeta Nargund is a pioneer in the field of Natural and Mild IVF and Advanced Ultrasound Technology in Reproductive Medicine, and founder and Medical Director of CREATE Fertility Natural and Mild IVF clinics. She is also an accredited trainer for special skills modules of the Royal College of Obstetricians & Gynaecologists London and th...

Mild approaches in assisted reproduction are aimed at achieving quality and not quantity of gametes, embryos, and endometrium with a view to protecting the long-term health and welfare of women and children at an affordable cost. The true success of IVF is in creating children who are full term and normal for gestational age without compromising th...

Background: Infertility care is one of the most neglected health care issues in developing countries (DC), affecting more than 50 million couples. The social stigma of childlessness still leads to isolation and abandonment. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of in...

A case is reported of a patient with critically low anti-mullerian hormone (AMH) having successful 'rescue' oocyte retrieval in natural in vitro fertilization (IVF) cycle 24 hours after the initial procedure had resulted in no oocyte being collected. Following administration of 10,000 units human chorionic hormone (hCG) a second retrieval was perfo...

This study reports the outcome results froma pilot clinical trial using a simplified laboratorymethod for human IVF. This system reproducibly generates de novo the atmospheric and culture conditions that support normal fertilization and preimplantationembryogenesis to the hatched blastocyst stage without the need for specializedmedical-grade gases...

A case is reported of a patient with critically low anti-mullerian hormone (AMH) having successful ‘rescue’ oocyte retrieval in natural in vitro fertilization (IVF) cycle 24 hours after the initial procedure had resulted in no oocyte being collected. Following administration of 10,000 units human chorionic hormone (hCG) a second retrieval was perfo...

Cryopreservation of embryos, oocytes, or ovarian tissues is the main option for female fertility preservation. Oocyte cryopreservation has emerged as especially important: the dramatic increase in the number of infants born from vitrified oocytes indicates that it is becoming one of the most important intervention options. However, oocyte cryoprese...

Mild approaches in assisted reproduction are at the forefront of new developments in IVF practice. Further prospective randomised studies are required. The obligation to make ART safer, affordable and patient-friendly is upon us and ISMAAR is committed to making this happen. The papers published in this special issue would represent a significant s...

The definition presented here represents the first realistic attempt by the scientific community to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. POR to ovarian stimulation usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. It has been recognized...

At present, India Meteorological Department (IMD) issues various monthly and seasonal operational forecasts for the south-west monsoon season using models based on latest statistical techniques with useful skill. Operational models are reviewed regularly and improved through in house research activities. For the forecasting of the south-west monsoo...

The definition presented here represents the first realistic attempt by the scientific community to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. POR to ovarian stimulation usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. It has been recognized...

Investigation of the probable cause of infertility is complex and in many instances a complicated process. Another adverse factor is stress and there is nothing more stressful than uncertainty and delay especially in couples struggling with involuntary childlessness. Unfortunately infertility investigations are frequently strung out over many month...

The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) was founded to promote a more physiological, less drug-oriented, lower risk, less expensive and more patient friendly approach to assisted reproduction embracing not only natural cycle treatment but also mild stimulation protocols and in-vitro maturation of oocytes. Rec...

Ovarian stimulation to achieve multiple follicle development has been an integral part of IVF treatment. In the context of improved laboratory performance, the need for a large number of oocytes as an integral part of a successful IVF programme may be questioned. The aim of the current debate is to summarize the studies performed during the last de...

We will assess to what extent in vitro fertilization (IVF) is effective in increasing the number of births overall and whether earlier application of IVF will increase this number. We simulate 100 000 women trying for their first and second child. Natural and IVF pregnancy rates and infertility rates are age-dependent and based on published data. T...

Mild ovarian stimulation for in vitro fertilization (IVF) aims to achieve cost-effective, patient-friendly regimens which optimize the balance between outcomes and risks of treatment. Pubmed and Medline were searched up to end of January 2008 for papers on ovarian stimulation protocols for IVF. Additionally, references to related studies were selec...

IVF is performed with oocytes collected in natural and stimulated cycles. Different approaches to ovarian stimulation have been employed worldwide. Following the introduction of GnRH antagonists and strategies to reduce multiple births such as single embryo transfer, there is a genuine scientific interest in the revival of natural cycle and mild ap...

Severe ovarian hyperstimulation syndrome (OHSS) is a rare but potentially fatal condition associated with conventional IVF treatment. It is found predominantly in women with polycystic ovaries who have an exaggerated response to exogenous FSH, leading to a large number of follicles and an overproduction of vascular endothelial growth factor with re...

The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) is founded to promote a more physiological, less drug-oriented, lower risk, less expensive and more patient friendly approach to Assisted Reproduction embracing not only natural cycle treatment but also gentle stimulation protocols and in-vitro maturation of oocytes. Re...

The study was designed to compare the follicular phase of women with recurrent pregnancy loss and a healthy control group. It is possible that a defective or aberrant follicular phase may be associated with poor oocyte quality leading to a production of an embryo with compromised quality and hence early pregnancy loss. Prospective case-control stud...

To compare sonographic endometrial characteristics in in-vitro fertilization (IVF) cycles between women who conceive and those who do not. Thirty-five women undergoing IVF treatment participated in the study. Using three-dimensional (3D) power Doppler ultrasound, we assessed endometrial patterns, volume and vascularization, after follicle stimulati...

The growth of the follicles induced by gonadotropins during IVF treatment is accompanied by physiologic angiogenesis, which is essential for the maturation of the oocytes. We describe the IVF-induced changes in the vascularization and compare normal with polycystic ovaries (PCOs). Prospective study. Assisted reproductive unit at a university hospit...

Incubation of gradient purified human spermatozoa, which are routinely maintained in media prior to IVF and intracytoplasmic sperm injection (ICSI), induced DNA strand breaks (up to 89 nicks x 10(-3) bp) and chromatin release. Unlike highly dispersed Alu repeat sequences, the centromeric heterochromatin was much less susceptible to endonuclease att...

To evaluate whether power Doppler predicts ovarian response to gonadotrophin stimulation during in vitro fertilization (IVF). Forty-five women were divided into low-reserve (n = 12) and normal-reserve (n = 33) ovarian groups, according to antral follicle count. Transvaginal three-dimensional power Doppler ultrasonographic examinations were performe...

Maternally imprinted PEG10 and SGCE, separated by approximately 2.15 Mb from Syncytin (HERV-W) gene at 7q21.3, are implicated in choriocarcinoma and Silver-Russell syndrome. Here we have analyzed the temporal regulation of mRNA expression of these genes in placenta and demonstrate that Syncytin gene activation is highest in term placenta, PEG10, do...

To evaluate the changes taking place in the ovaries during pituitary down-regulation. Prospective observational study of women undergoing IVF treatment. A tertiary referral center for assisted reproduction. Forty women who received the long buserelin acetate treatment protocol. Transvaginal three-dimensional power Doppler ultrasound examinations be...

To assess intraobserver and interobserver variability in ovarian volume and gray-scale and color flow index measurements using transvaginal, three-dimensional, power Doppler ultrasonography. Eleven women (22 ovaries) were examined on day 8 of controlled ovarian hyperstimulation therapy, which was part of their in vitro fertilization treatment proto...

This article has reviewed some of the clinical uses of Doppler ultrasound to illustrate important physiological and patho-physiological processes in reproductive medicine. Some of the findings are now indisputable. High uterine artery resistance is associated with poor implantation and hyperandrogenic polycystic ovary syndrome. High uterine artery...

Effect of the side of ovulation on uterine, ovarian, and follicular blood flow parameters and various hormone levels. Prospective, observational study. Fertility Clinic, St. George's Hospital. Nineteen women with regular menstrual cycles. Pulsed Doppler measurements and serum hormonal concentrations during midfollicular, periovulatory, and midlutea...

To evaluate the characteristics of polycystic compared to normal ovaries using three-dimensional (3-D) power Doppler ultrasonography. We recruited 42 volunteers, all of whom were commencing IVF treatment. Each patient was examined in the cycle preceeding the start of drug therapy during the late follicular phase. If eight or more subcapsular follic...

To determine ovarian blood flow characteristics using three-dimensional power Doppler ultrasound. We examined 30 patients (30 cycles) prior to the start of their in vitro fertilization treatment in the late follicular phase using three-dimensional power Doppler ultrasound. The volume, vascularization index, flow index, vascularization flow index, m...

To assess intraindividual variation of follicle stimulating hormone, luteinising hormone, estradiol, progesterone, inhibin A, and inhibin B in three successive ovulatory cycles correlated with transvaginal ultrasound monitored morphological changes in the ovary. Serial transvaginal color and pulsed Doppler ultrasound and serum hormone analysis were...

If you have strong views on any matter related to ultrasound, it is highly likely you will receive a summons to write an editorial on the subject for the White Journal. This editorial is my attempt to justify my frequently expressed opinion that ultrasound is not used effectively in most departments of reproductive medicine and proper use of modern...

Insufficient perfusion of placenta in pre-eclampsia is commonly associated with oxidative stress leading to increased superoxide formation and reduced invasion of uterine spiral arteries by differentiated migratory cytotrophoblasts. The superoxide dismutase (SOD) level, responsible for eliminating toxic superoxides, drops significantly in pre-eclam...

Background Multiple studies have confirmed a lower implantation and pregnancy rates in women who exhibit a homogenous pattern of the endometrium compared to a triple-line pattern on the day of hCG administration. However, there are no studies comparing the pattern of endometrium and its vascularization on the days of oocyte retrieval and embryo tra...

Background The study was conducted to determine the pattern of the vascular changes during the normal menstrual cycle in the ovaries using the 3D Power Doppler imaging technique.Methods Observations were made during 19 normal menstrual cycles. Women were scanned transvaginally using VOLUSON 530D ultrasound machine during midfollicular, perifollicul...

The appropriateness of many investigations for subfertility will continue to be of debate for some time yet. Of most benefit to the concerned couple would be a process that is diagnostically accurate, expeditious and reliable. It should be performed with a minimum of invasion and provide both patient and clinician with useful prognostic information...

The imprinting control region (ICR) located far upstream of the H19 gene, in conjunction with enhancers, modulates the transcription of Igf2 and H19 genes in an allele-specific manner. On paternal inheritance, the methylated ICR silences the H19 gene and indirectly facilitates transcription from the distant Igf2 promoter, whereas on the maternal ch...

The aim of this study was to investigate whether the hCG-oocyte collection interval has any influence on the oocyte recovery rate, fertilization rate, and outcome of IVF-ET cycles. Five hundred thirty-three consecutive patients undergoing their first IVF-ET treatment cycle at King's Assisted Conception Unit between 1993 and 1995 were included in th...

IVF treatment, which involves ovarian stimulation, poses significant health problems such as ovarian hyperstimulation and is associated with a high incidence of multiple pregnancy and premature birth. In this paper, we demonstrate how natural cycle IVF is an effective and potentially cost-effective alternative treatment option for certain groups of...

Purpose: During assisted conception treatment the male partner is under stress and consequently can fail to produce semen sample prior to egg collection. Failure to produce spermatozoa at a given time could lead to cancellation of the procedure. Methods: We report the use of emergency percutaneous epididymal sperm aspiration (PESA) for temporary er...

The aim of the study was to evaluate the feasibility of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes during hysterosalpingo-contrast sonography (HyCoSy). Women attending the fertility clinic were offered a Fallopian tubal patency test as part of the initial investigation. Hysterosalpingo-c...

Following intracytoplasmic sperm injection (ICSI), ~60–70% of oocytes are fertilized and of these embryos, ~45% withstand in-vitro culture conditions to produce healthy blastocysts. The efficiency of implantation of 2–4-cell embryos selected at the pronuclear stage and that of blastocysts are comparable. However, prolonged selection of embryos in v...

This report describes the use of an Argyle trocar catheter for the drainage of pelvic abscesses following transvaginal ultrasound-directed follicle aspiration (UDFA) for oocyte collection. Three patients treated with this technique recovered uneventfully. We conclude that the use of an Argyle trocar catheter for colpotomy in the management of pelvi...

Following intracytoplasmic sperm injection (ICSI), ∼60–70% of oocytes are fertilized and of these embryos, ∼45% withstand in-vitro culture conditions to produce healthy blastocysts. The efficiency of implantation of 2–4-cell embryos selected at the pronuclear stage and that of blastocysts are comparable. However, prolonged selection of embryos in v...

The principal aim of the study was to relate ultrasound-derived indices of blood flow in individual follicles on the day of, but before, the administration of human chorionic gonadotrophin (HCG) to the subsequent recovery of oocytes and the production of preimplantation embryos. Data were obtained from 21 women (aged 29-43 years) with bilateral tub...

A mock embryo transfer under ultrasound guidance helped to plan an embryo transfer in a woman with previous vaginoplasty.

To determine whether the use of smaller diameter needles at oocyte collection reduces pain without jeopardizing the treatment outcome. Prospective randomized study. The Assisted Conception Unit, Kings College Hospital, United Kingdom. One hundred twelve patients undergoing an IVF-ET treatment cycle. Study patients were aged < or = 38 years and had...

This study was carried out to investigate whether ovarian cystectomy interferes with follicular recruitment and the number of oocytes retrieved in an in-vitro fertilization (IVF) cycle. Patients who had previously undergone unilateral ovarian cystectomy (n = 90) and control patients (n = 90) with no history of ovarian surgery were included in our s...

The aim of this study was to elucidate possible relationships between ultrasound indices of follicular blood flow, oocyte recovery and the subsequent production and morphological quality of preimplantation embryos. A total of 27 women with bilateral tubal occlusion, undergoing treatment for infertility by in-vitro fertilization and embryo transfer,...

The study determines mortality and morbidity levels during pregnancy and the perinatal period in those conceiving through IVF in the Republic of Ireland in comparison with other parts of the world and a peer infertile group conceiving spontaneously whilst on the IVF clinic books. Six hundred and sixty couples had 187 IVF pregnancies from whom 220 b...

The first year's activity of a fully out-patient based, self financing, in vitro fertilisation service is reported. 98 couples had superovulation regimes tailored to need. 138 cycles were started. 109 retrievals were attempted using the vaginal ultrasound probe under Fentanyl and Midazolam sedation. In 106, oocytes were successfully retrieved (aver...