Deepika Krishna - Academia.edu (original) (raw)

Papers by Deepika Krishna

Fertility and Sterility, 2014

This three volume set is a comprehensive guide to assisted reproductive technology (ART) for clin... more This three volume set is a comprehensive guide to assisted reproductive technology (ART) for clinicians. The editors have assembled a medical textbook which is comprehensive, well-illustrated, and insightful with regard to the modern principles and practice of ART. The editors assembled a truly international team of contributors that expands all continents, giving the reader an opportunity to be familiar with ART practice around the world, without losing sight of universal scientific principles that are applicable to individual medical practice; and this is perhaps its most notable contribution. These books allow the reader, regardless of the country of practice, to gain solid principles of ART that are applicable both in developed and underdeveloped countries. This practical manual is an invaluable reference for clinicians specializing in infertility management and includes nearly 1,000 full-color photographs, each with a brief description to enhance understanding.

Background: The purpose of present study was to evaluate the role of pre-ovulatory GnRH agonist t... more Background: The purpose of present study was to evaluate the role of pre-ovulatory GnRH agonist therapy on IVF outcomes in GnRH antagonist cycles. Methods: In this prospective study we recruited 100 infertile women undergoing IVF cycles with GnRH antagonists. The patients were assigned to two groups: Group A (the study group, n=42) were assigned for receiving hCG+triptorelin for the final oocyte maturation and group B (the control group, n=58) were assigned for only hCG. The t-test, chi-square (χ2), and Fisher's exact test were used for data analysis. A p<0.05 was taken as statistically significant. The results are presented by mean± SD, and in percents (%). Results: LH levels significantly (p<0.001) increased in the study group on the day of oocyte retrieval. All embryological parameters including the number of mature oo-cytes, fertilization and cleavage rates, number of high quality embryos and number of cases whose embryos were frozen were non-significantly higher in t...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Nov 26, 2019

HCG binds to LH receptor causing follicular maturation, luteinization and ovulation. It has 6-7 t... more HCG binds to LH receptor causing follicular maturation, luteinization and ovulation. It has 6-7 times increased biological activity with half life persisting upto 5-6 days. 3

Principles and Practice of Assisted Reproductive Technology, 2019

International Journal of Infertility & Fetal Medicine

Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. It... more Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. It is difficult to decipher OHSS pathophysiology. 1 The occurrence is directly proportional to estradiol in blood, follicle number, and human chorionic gonadotropin (hCG) with more chances of happening in polycystic ovarian disease. Complete prevention of OHSS is never possible, but endocrine profile and ultrasonographic follicular monitoring are the mainstay of its prediction. Complications such as hemoconcentration, hypovolemia, and thromboembolism can occur. Withholding hCG, continuation of gonadotropin-releasing hormone analogs, coasting, agonist trigger, intravenous albumin, dopamine agonists, and cryopreservation of embryos are cornerstones of OHSS prevention. 2 Mild OHSS usually requires no active therapy. Moderate and severe cases have to be treated. Surgery may be needed in ruptured ovarian cysts, torsion, or concomitant ectopic pregnancy. Transvaginal paracentesis is recommended in cases of severe ascites. Inpatient management is typically based on preventing complications such as derangement of kidney and liver functions, thrombosis, and severe respiratory depression. Recent ART treatment protocols behold more patient-friendly mild ovarian stimulation regimes that are individualized depending on patient's ovarian reserve. 3

Journal of Human Reproductive Sciences, 2012

treatment modalities or who have coexisting infertility factors. [3] Many controlled ovarian stim... more treatment modalities or who have coexisting infertility factors. [3] Many controlled ovarian stimulation (COS) strategies have been offered for the treatment of patients with PCOS undergoing IVF. However, there is no compelling evidence for the advantage of one stimulation protocol over the other. [3] The ESHRE/ASRM consensus document has recently stressed the need to perform further randomized controlled trials (RCTs) comparing FSH stimulation protocols with the use of GnRH agonist versus GnRH antagonists. [3] PCOS patients undergoing COS have a high risk of developing ovarian hyperstimulation syndrome (OHSS), a serious iatrogenic complication of ovarian stimulation. [4] Gonadotropin releasing hormone antagonists have been shown to offer an advantage over standard long agonist protocol in terms of decreasing incidence of OHSS, short duration of treatment, lower cost, lesser dose of gonadotropins required and being more patient friendly. Although there are some RCTs comparing GnRH agonists versus antagonists in the PCOS population, there is still a lack of consensus as to which protocol is better. [5-7]

Journal of the Turkish German Gynecological Association, 2015

To investigate the efficacy of low-dose gonadotropin-releasing hormone (GnRH) agonist for final o... more To investigate the efficacy of low-dose gonadotropin-releasing hormone (GnRH) agonist for final oocyte maturation in females undergoing assisted reproductive treatment (ART) cycles. Nine females undergoing ovarian stimulation in a GnRH antagonist protocol who received triptorelin 0.1 mg to trigger final oocyte maturation were included. Treatment outcomes of these patients were compared with those of controls, matched for age and oocyte number (n=14), who received 0.2 mg triptorelin at the same time. The luteal phase was supported with vaginal micronized progesterone and oral estradiol hemihydrate 2 mg twice daily. The mean (±) numbers of retrieved, metaphase II, and fertilized oocytes were 15.66±7.82, 14±7.28, and 10.11±5.86, respectively. The implantation and clinical pregnancy rates were 46.1% and 71.4%, respectively. Of the pregnancies, 2 were live births, 1 was a preterm birth (twins), 2 are on-going, and 2 ended as miscarriages. No case of OHSS was encountered. On comparison of...

International Journal of Infertility & Fetal Medicine, 2015

Ovarian torsion is an uncommon gynecological emergency that requires prompt recognition and treat... more Ovarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. Timely investigation and management can make the difference between ovarian loss and salvage, an outcome of great importance in the population of reproductive age females. Our case series is about clinical presentation and management approach of adnexal torsion in a tertiary care fertility center. Adnexal torsion was found mainly in the reproductive age during poststimulation postovulatory period in all cases. Ultrasound was the most commonly used imaging modality. Ovarian stimulation was the risk factor seen in all the patients. Diagnosis of adnexal torsion was mostly clinical. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was possible in all cases except one.

Journal of Human Reproductive Sciences, 2008

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common (15-20%) endocrine disorde... more BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common (15-20%) endocrine disorders in women of childbearing age. Although it is a major cause of infertility, its etiology remains unknown and its treatment difficult. AIM: To evaluate the incidence, treatment and outcome of patients with PCOS. DESIGN: Retrospective analysis. MATERIALS AND METHODS: PCOS patients (914 of the 1057) attending the outpatient department (OPD) from June 2003 to February 2008 were evaluated for this study. Of the 914 patients investigated, 814 came for treatment and these patients were studied for hormonal disturbances and their response to various modalities of treatment. RESULTS: Of the 2270 infertility patients, 46.50% (1057) had PCOS, out of these, 86.47% (914) were investigated and 77% (814) came for treatment. Our overall pregnancy rate was 48.40% (394/814). The pregnancy rate per cycle with timed intercourse (TI) was 44.77% (47/105), 17.09% (286/1673) with intrauterine insemination (IUI), 29.82% (51/171) with in vitro fertilization (IVF) and 22.22% (10/45) with frozen embryo transfer (FET). The maximum number of pregnancies (85.29%, 284/333) were achieved in the first three treatment cycles. The abortion rate was 19.01% (73/384) and the incidence of ectopic pregnancy was 5.47% (21/384). Complications seen were in the form of ovarian hyperstimulation (OHSS), retention cyst on day two and multiple pregnancies in 11.71% (228/1946) of the total treatment cycles. CONCLUSION: Most PCOS symptoms could be adequately controlled or eliminated with proper diagnosis and treatment. Thus, ovulation induction (OI) protocols and treatment modalities must be balanced for optimal results.

Journal of reproduction & infertility, 2012

The purpose of present study was to evaluate the role of pre-ovulatory GnRH agonist therapy on IV... more The purpose of present study was to evaluate the role of pre-ovulatory GnRH agonist therapy on IVF outcomes in GnRH antagonist cycles. In this prospective study we recruited 100 infertile women undergoing IVF cycles with GnRH antagonists. The patients were assigned to two groups: Group A (the study group, n = 42) were assigned for receiving hCG + triptorelin for the final oocyte maturation and group B (the control group, n = 58) were assigned for only hCG. The t-test, chi-square (χ(2)), and Fisher's exact test were used for data analysis. A p < 0.05 was taken as statistically significant. The results are presented by mean± SD, and in percents (%). LH levels significantly (p < 0.001) increased in the study…

Journal of Human …, 2008

Empty follicle syndrome (EFS), although rare with an incidence of 0.2-7%, is a frustrating condit... more Empty follicle syndrome (EFS), although rare with an incidence of 0.2-7%, is a frustrating condition where no oocytes are retrieved in in vitro fertilization (IVF), even though ultrasound and estradiol measurements show the presence of many potential follicles. It is ...