Yogesh Kumar

Ovarian interleukin profile and pregnancy outcome in women undergoing assisted reproduction: A prospective study

Context: Ovarian interleukins (ILs) mediate folliculogenesis, gametogenesis, fertilization, embryo development and implantation. Aims: Evaluation of the role of the quantitative levels of follicular fluid (FF) IL-1Beta (1β), IL-10 and IL-12B (p-40 subunit) in women underwent assisted reproduction. Setting and Design: Prospective observational study conducted between July 2013 and August 2015 at University Hospital’s in vitro fertilization (IVF) set up in North India. Materials and Methods: Women (n = 168) were worked up for IVF/intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. FF samples were pooled and collected from ovarian follicles of size ≥16 mm for each woman on the day of oocyte retrieval. Quantitative levels of IL-1β, IL-10 and IL-12B were estimated by enzyme-linked immunosorbent assay technique. Quantitative levels along with demography, cycle characteristics, endometrial thickness, number of retrieved oocytes, fertilization rate and embryos quality were compared between pregnant and nonpregnant groups of women. Student T-test, Mann–Whitney U-test, chi-squares test and logistic regression were applied as appropriate. Statistical significance level was calculated at P < 0.05. Results: Women (n = 168) were divided into pregnant (Group A; n = 75) and nonpregnant (Group B; n = 93) groups. The median levels of IL-1β, IL-10 and IL-12B levels were found significantly lower in women in Group A as compared to Group B [41.2 pg/mL (1.7–370) vs. 78.5 (5.6–313.58); P < 0.001FNx08, 53.2 pg/mL (1.8–183.7) vs. 135.2 pg/mL (1.3–385.4); P < 0.001FNx08 and 115.3 pg/mL (3.8–822.9) vs. 178.3 pg/mL (36.1–1938.3); P < 0.009FNx01, respectively]. Conclusion: Lower concentrations of IL-1β, IL-10 and IL-12B in FF were found in a protagonist with positive pregnancy outcome and can be served as a reliable predictive marker of successful IVF/ICSI-ET outcome in women underwent assisted reproduction.

A prospective study to assess the mental health and quality of life in women undergoing assisted reproduction

Context: Infertile women may experience high levels of psychological distress. The assessment of stress levels specifically related to infertility and the quality of life during infertility management needs to be evaluated. Aims: To study the psychological health of women undergoing assisted reproduction. Settings and Design: A cross-sectional study conducted between March 2014 and April 2015 at a tertiary care in-vitro fertilization setup in India. Subjects and Methods: Clinical interview and self-report measures were applied for an assessment of the psychological state of infertile women (N = 186). Anxiety was evaluated by Hamilton’s Rating Scale and Sinha’s Comprehensive Anxiety Test. Depression was assessed using Hamilton’s Rating Scale, Amritsar Depressive Inventory. Fertility and Quality of Life Questionnaire (FertiQoL) was applied to measure infertility specific stress. Overall life stress, covering all areas of life, was assessed using Presumptive Stressful Life Events Scale. Cornell Medical Index was applied to evaluate overall physical and mental health. Statistical Analysis: Student’s t-test and chi-square test were applied, and statistical significant levels were calculated at P < 0.05. Results: Clinically, significant depression was identified in 60.11–64.86% of the women. However, relatively lesser frequency of anxiety (27–37%) was observed. FertiQoL scores suggest that infertility treatment in itself is stressful, and nearly 80% of women reported increased levels of general life stresses. Conclusion: Being infertile has profound detrimental psychological impact on the life of women. Women undergoing treatment had significant high levels of psychological stress, depression and anxiety along with a lowered quality of life.

Blind signal modulation recognition through clustering analysis of constellation signature

Modulation classification using OPTICS clustering algorithm has been proposed.Algorithm is reliably classifying 4ASK, 8ASK, BPSK, QPSK and 8QAM above 9dB SNR.Classification is unsupervised and generalized for any orders ASK, PSK and QAM.Algorithm is implemented and tested on real time RF signal using labVIEW. Automatic recognition of digital modulation schemes is becoming an active research area in many covert operations. It has many military applications where surveillance and electronic warfare requires a type of modulation in intercepted signal to prepare jamming signals. Most of the approaches are based on modulated signals component, but the modulation type can be best identified with the use of constellation diagram. The proposed technique is able to recognize M-QAM, M-ASK, and M-PSK modulation scheme in Additive White Gaussian Noise (AWGN) environment. As the constellation points form clusters in the I-Q plane, the order of the modulation can be obtained by estimating the correct number of clusters, which is calculated by OPTICS algorithm. The least square error has been calculated using linear regression from the obtained constellation points, to identify either ASK or PSK and QAM. The error is least for ASK which differentiates ASK from PSK and QAM. To identify between the PSK and QAM, k-means clustering is employed to find the number of centroids equal to order of modulation estimated by OPTICS. With the difference in maximum and minimum absolute value of the centroids, PSK or QAM is recognized. The proposed method shows an improvement in the classification accuracy which reaches 100% using 1024 symbols at 20dB compared to 98.89%, 98.05%, and 98% when using more complex classifiers like Support Vector Machine, Naive Bayes Classifier, KNN respectively. The method used is unsupervised whereas most of the methods in the literature require training phase to set the thresholds or weights for final model to detect modulation type. This algorithm is also implemented in LabVIEW, and tested on real-time signals. An intelligent system is made which does not require any knowledge of symbol rate, carrier frequency, and any training phase to set thresholds, and detects the type of modulation blindly in real time. Modulated RF signals are generated by NI PXIe-5673 (RF transmitter). NI PXI 5600 is used to downconvert RF signal and NI PXI-5142 (100 MS/s OSP digitizer) is used to sample the downverted signal.

Preovulatory normal saline pertubation prior to intrauterine insemination increases conception rate in unexplained infertility

Context: Intrauterine insemination (IUI) is widely used for fertility management for unexplained infertility (UI). Washed sperm are placed into uterine cavity to achieve pregnancy. The success rate of IUI with combined ovulation induction is always debated. Aims: The aim of the study is to analyze the effect of preovulatory pertubation with lignocaine, normal saline versus no-pertubation on conception rate during IUI cycle in women with UI. Settings and Design: A prospective, randomized controlled trial was conducted at University hospital tertiary referral center. Subjects and Methods: Of 464 women with UI, 320 women who fulfilled inclusion criteria were enrolled in the study. Ovulation induction was started with appropriate protocol. Women underwent transvaginal sonography till they achieved 2–3 dominant follicles of size ≥17–18 mm and endometrial thickness of ≥7 mm. Randomization was done by chit-pull system into three groups. Pertubation was carried out with low dose lignocaine or normal saline after 12–14 h of human chorionic gonadotropin administration. Pertubation groups were compared with no-pertubation IUI group. Statistical Analysis: Data were compared with unpaired Student’s t-test and Chi-square test appropriately. Results: Conception rate was 7.4% in lignocaine group, 20.7% in normal saline group, and 10.3% in control group. Conclusions: Pertubation with normal saline was associated with significant increase in IUI conceptions and live births as compared to no-pertubation group. Lignocaine pertubation was associated with the lowest conception rates but outcomes were not significantly different from the control. Hence, preovulatory saline pertubation prior to IUI is recommended to improve pregnancy rates in UI.