Dr. K. Jayaprakasan - Academia.edu (original) (raw)

Papers by Dr. K. Jayaprakasan

A Practical Guide to Setting Up an IVF Lab, Embryo Culture Systems and Running the Unit, 2013

Thank you very much for reading a practical guide to setting up an ivf lab embryo culture systems... more Thank you very much for reading a practical guide to setting up an ivf lab embryo culture systems and running the unit. Maybe you have knowledge that, people have look numerous times for their favorite readings like this a practical guide to setting up an ivf lab embryo culture systems and running the unit, but end up in malicious downloads. Rather than reading a good book with a cup of coffee in the afternoon, instead they cope with some harmful virus inside their computer.

The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systema... more The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review

Assisted Reproduction Techniques, 2021

Ultrasound in Obstetrics & Gynecology, 2011

Oral poster abstracts pregnancy of uncertain viability (IPUVI) after a single visit at the primar... more Oral poster abstracts pregnancy of uncertain viability (IPUVI) after a single visit at the primary transvaginal scan (TVS). Methods: Prospective observational study. Between Nov 2006 and Jan 2010, all pregnant women presenting to the EPU underwent a TVS. Data was collected from women with an IPUVI at primary TVS. These women were followed up until the outcome (viable or non-viable pregnancy at the end of the first trimester) was established. More than 40 historical, clinical and ultrasonographic (US) end points were recorded for analysis, at which US data included the crown-rump length (CRL) as well as gestational sac (GS) and yolk sac (YS) measurements in 3 planes. Variables for preliminary model development were determined by stepwise logistic regression. Results: 2048 pregnant women underwent TVS, out of which 268 (13.1%) were classified with an IPUVI. 237 women with an IPUVI on primary TVS (84%) returned for follow up until the outcome was established (52.3% viable, 47.7% non-viable). 185 of these data sets have been used for model building. The variables used in the model were maternal age, gestational age in days by LMP, CRL in mm, mean GS size in mm, and previous normal vaginal delivery. The predictive ability of our model was measured with an AUC of 0.91 and its sensitivity and specificity for viable was shown to be 81.1% and 85.3% respectively. Conclusions: We have developed a valid model to predict the likelihood of a viable pregnancy at the end of the first trimester in women, who present with an IPUVI on primary ultrasound. This may help to counsel women with this common condition. We aim to test this model prospectively to evaluate its performance.

Challenges and Management Options, 2012

The Cochrane database of systematic reviews, Jan 30, 2014

Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfer... more Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced. To determine the effectiveness and safety of removal of endometrial polyps in subfertile women. Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Speci...

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2009

To assess the reliability of automated measurements of the total antral follicle count (AFC) made... more To assess the reliability of automated measurements of the total antral follicle count (AFC) made using Sono-Automatic Volume Count (SonoAVC), and to compare these to two-dimensional (2D) and manual three-dimensional (3D) techniques. Fifty-five subjects aged under 40 years who had 3D transvaginal ultrasound examination in the early follicular phase of their menstrual cycle were prospectively recruited. 3D datasets were acquired and subsequently analyzed. The total AFC (2-10 mm antral follicles) was calculated by two observers using three independent methods: 2D real-time equivalent (2D-RTE), 3D manual multiplanar view (3D-MPV), and SonoAVC. For measurements made using SonoAVC, the initial automated count (sAVC-AA) was recorded and postprocessing (sAVC-PP) then applied to identify follicles that had been missed or incorrectly included. Intraclass correlation and limits of agreement were used to evaluate the methods. The intra- and interobserver reliability of measurements of total AF...

Ultrasound in Obstetrics and Gynecology, 2008

Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes ... more Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes in the absence of OHSS. Ovarian vascularity (vascularisation index, VI; flow index, FI; and vascularisation flow index, VFI), total antral follicle count (AFC), and mean ovarian volume (OV) were measured. ANOVA and Kruskal Wallis test were used to compare the groups dependent on the distribution of the data. Multiple logistic regression analysis was used to compare the predictive value of these variables against age and basal FSH for the development of poor response and OHSS. Results: The ovarian VI, FI, and VFI were similar in all three groups (Table 1). Compared to controls, AFC and OV were significantly lower (P < 0.001) in poor responders and significantly higher (P < 0.001) in subjects who developed OHSS. Multiple regression analysis showed the AFC was the only significant (P < 0.001) ultrasound predictor of poor or exaggerated ovarian response and that the 3D ovarian vascular indices offered no additional information. Parameters Control group (n = 100) OHSS group (n = 50)

Ultrasound in Obstetrics and Gynecology, 2008

Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes ... more Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes in the absence of OHSS. Ovarian vascularity (vascularisation index, VI; flow index, FI; and vascularisation flow index, VFI), total antral follicle count (AFC), and mean ovarian volume (OV) were measured. ANOVA and Kruskal Wallis test were used to compare the groups dependent on the distribution of the data. Multiple logistic regression analysis was used to compare the predictive value of these variables against age and basal FSH for the development of poor response and OHSS. Results: The ovarian VI, FI, and VFI were similar in all three groups (Table 1). Compared to controls, AFC and OV were significantly lower (P < 0.001) in poor responders and significantly higher (P < 0.001) in subjects who developed OHSS. Multiple regression analysis showed the AFC was the only significant (P < 0.001) ultrasound predictor of poor or exaggerated ovarian response and that the 3D ovarian vascular indices offered no additional information. Parameters Control group (n = 100) OHSS group (n = 50)

Ultrasound in Obstetrics and Gynecology, 2009

Objective: To determine whether cervical length measured by transvaginal ultrasound at 18–22 week... more Objective: To determine whether cervical length measured by transvaginal ultrasound at 18–22 weeks could be used to predict the probability of Cesarean delivery in primiparous women at term. Methods: A total of 568 primiparous healthy patients with a singleton pregnancy had their cervical length measured using transvaginal ultrasound at the time of fetal anomaly survey at 18–22 weeks gestation. Patients with a cervical length shorter than 15 mm, those who delivered before term as well as patients with pre-existing medical diseases were excluded from the study group. The patients were followed prospectively and their term delivery data was collected including the gestational age at delivery, mode of delivery, reason for Cesarean section and neonatal outcome. Results: A total of 482 patients delivered at term and their delivery data were analysed. Patient data was categorized according to quartile of cervical length measured at 18–22 weeks. There was no difference in the baseline characteristics between the patients in the 4 quartiles (age, BMI, gestational age at delivery, neonatal weight). The Cesarean section rate was lowest in patients in the first quartile of cervical length (13.3%), and was significantly higher (p<0.001) in patient with a cervical length at the fourth quartile (40–50 mm). Failure of progress in labour as a cause for Cesarean section was significantly (p<0.001) more common in patients in the fourth quartile (40%). Conclusion: Cervical length measurement by transvaginal ultrasound at mid gestation can be used to predict the likelihood of Cesarean section at term in primiparous patients.

Ultrasound in Obstetrics and Gynecology, 2008

Oral communication abstracts program considering as region of interest the 2 mm uterine tissue su... more Oral communication abstracts program considering as region of interest the 2 mm uterine tissue surrounding endometrium. Endometrial pattern (EP) and thickness (EP), endometrial volume (EV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated until the day of HCG administration. Results: The all PDA indexes (VI, FI and VFI) were statistically significantly higher in the pregnant group whereas triple-line endometrial pattern and EV did not. Neither the transfer day nor the number of transferred embryos (mean 2.1 + 0.9) showed a statistically significant difference between the two groups. In our hand the number of grade I transferred embryos did not show any statistically significant difference in both groups. Conclusions: During COH endometrial and subendometrial vascularization indexes show a statistically significant increase in the pregnant women. 3D US PDA is a fast useful tool to evaluate endometrial receptivity in IVF cycles.

Ultrasound in Obstetrics and Gynecology, 2010

Oral communication abstracts Methods: 1120 consecutive subjects who were about to undergo IVF cyc... more Oral communication abstracts Methods: 1120 consecutive subjects who were about to undergo IVF cycle were prospectively recruited. 3D transvaginal ultrasound and venepuncture were performed in the early follicular phase of the menstrual cycle. Subjects were excluded if they had ovarian cysts or if their treatment was cancelled due to failed downregulation. Age, AFC, ovarian volume and FSH were the independent variables. The main outcome measures were non-pregnancy, poor ovarian response and ovarian hyperstimulation syndrome (OHSS). Normality of the data was checked. Logistic regression and ROC curve analyses were performed to evaluate the predictive ability of the variables. Sensitivity, specificity, positive likelihood ratio and post-test probability for each outcome measure were calculated at different AFC cutoffs. Results: 1012 subjects were included for final analysis. The mean (SD) age was 34.3 (4.4) years. AFC was the best predictor of poor response (AUC: 0.837) and OHSS (AUC: 0.742). Age and AFC were equally predictive of non-pregnancy. The probability of nonpregnancy, poor ovarian response and OHSS at different cutoff levels of AFC is defined. Conclusions: AFC, being the best predictor, provides prognostic information on IVF treatment outcome. The pregnancy rate decreases as the AFC decreases with a 48% and 5% chance of ongoing pregnancy with AFC of ≥ 24 and ≤ 4 respectively.

Human Reproduction, 2012

HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Fertility and Sterility, 2013

Introduction Methods Data acquisition Definitions Statistical analysis Results Data acquisition P... more Introduction Methods Data acquisition Definitions Statistical analysis Results Data acquisition Prediction of an excessive response using ORTs and patient characteristics Effect of FSH dosage and study protocol on excessive response prediction Influence of age, BMI and duration of subfertility on the accuracy of ORTs in excessive response prediction

Journal of Clinical Medicine, 2022

As most congenital uterine abnormalities are asymptomatic, the majority of them are detected inci... more As most congenital uterine abnormalities are asymptomatic, the majority of them are detected incidentally. While most women with uterine anomalies have a normal reproductive outcome, some may experience adverse reproductive outcomes. Accurate diagnosis and correct classification help in the appropriate counselling of women about their potential reproductive prognosis and risks and for planning any intervention. Evaluation of the internal and external contours of the uterus is the key in making a diagnosis and correctly classifying a uterine anomaly. Considering this, the gold standard test has been the combined laparoscopy and hysteroscopy historically, albeit invasive. However, 3D ultrasound has now become the diagnostic modality of choice for uterine anomalies due to its high degree of diagnostic accuracy, less invasive nature and it being comparatively less expensive. While 2D ultrasound and HSG are adequate for screening for uterine anomalies, MRI and combined laparoscopy and hy...

A Practical Guide to Setting Up an IVF Lab, Embryo Culture Systems and Running the Unit, 2013

Thank you very much for reading a practical guide to setting up an ivf lab embryo culture systems... more Thank you very much for reading a practical guide to setting up an ivf lab embryo culture systems and running the unit. Maybe you have knowledge that, people have look numerous times for their favorite readings like this a practical guide to setting up an ivf lab embryo culture systems and running the unit, but end up in malicious downloads. Rather than reading a good book with a cup of coffee in the afternoon, instead they cope with some harmful virus inside their computer.

The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systema... more The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review

Assisted Reproduction Techniques, 2021

Ultrasound in Obstetrics & Gynecology, 2011

Oral poster abstracts pregnancy of uncertain viability (IPUVI) after a single visit at the primar... more Oral poster abstracts pregnancy of uncertain viability (IPUVI) after a single visit at the primary transvaginal scan (TVS). Methods: Prospective observational study. Between Nov 2006 and Jan 2010, all pregnant women presenting to the EPU underwent a TVS. Data was collected from women with an IPUVI at primary TVS. These women were followed up until the outcome (viable or non-viable pregnancy at the end of the first trimester) was established. More than 40 historical, clinical and ultrasonographic (US) end points were recorded for analysis, at which US data included the crown-rump length (CRL) as well as gestational sac (GS) and yolk sac (YS) measurements in 3 planes. Variables for preliminary model development were determined by stepwise logistic regression. Results: 2048 pregnant women underwent TVS, out of which 268 (13.1%) were classified with an IPUVI. 237 women with an IPUVI on primary TVS (84%) returned for follow up until the outcome was established (52.3% viable, 47.7% non-viable). 185 of these data sets have been used for model building. The variables used in the model were maternal age, gestational age in days by LMP, CRL in mm, mean GS size in mm, and previous normal vaginal delivery. The predictive ability of our model was measured with an AUC of 0.91 and its sensitivity and specificity for viable was shown to be 81.1% and 85.3% respectively. Conclusions: We have developed a valid model to predict the likelihood of a viable pregnancy at the end of the first trimester in women, who present with an IPUVI on primary ultrasound. This may help to counsel women with this common condition. We aim to test this model prospectively to evaluate its performance.

Challenges and Management Options, 2012

The Cochrane database of systematic reviews, Jan 30, 2014

Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfer... more Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced. To determine the effectiveness and safety of removal of endometrial polyps in subfertile women. Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Speci...

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2009

To assess the reliability of automated measurements of the total antral follicle count (AFC) made... more To assess the reliability of automated measurements of the total antral follicle count (AFC) made using Sono-Automatic Volume Count (SonoAVC), and to compare these to two-dimensional (2D) and manual three-dimensional (3D) techniques. Fifty-five subjects aged under 40 years who had 3D transvaginal ultrasound examination in the early follicular phase of their menstrual cycle were prospectively recruited. 3D datasets were acquired and subsequently analyzed. The total AFC (2-10 mm antral follicles) was calculated by two observers using three independent methods: 2D real-time equivalent (2D-RTE), 3D manual multiplanar view (3D-MPV), and SonoAVC. For measurements made using SonoAVC, the initial automated count (sAVC-AA) was recorded and postprocessing (sAVC-PP) then applied to identify follicles that had been missed or incorrectly included. Intraclass correlation and limits of agreement were used to evaluate the methods. The intra- and interobserver reliability of measurements of total AF...

Ultrasound in Obstetrics and Gynecology, 2008

Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes ... more Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes in the absence of OHSS. Ovarian vascularity (vascularisation index, VI; flow index, FI; and vascularisation flow index, VFI), total antral follicle count (AFC), and mean ovarian volume (OV) were measured. ANOVA and Kruskal Wallis test were used to compare the groups dependent on the distribution of the data. Multiple logistic regression analysis was used to compare the predictive value of these variables against age and basal FSH for the development of poor response and OHSS. Results: The ovarian VI, FI, and VFI were similar in all three groups (Table 1). Compared to controls, AFC and OV were significantly lower (P < 0.001) in poor responders and significantly higher (P < 0.001) in subjects who developed OHSS. Multiple regression analysis showed the AFC was the only significant (P < 0.001) ultrasound predictor of poor or exaggerated ovarian response and that the 3D ovarian vascular indices offered no additional information. Parameters Control group (n = 100) OHSS group (n = 50)

Ultrasound in Obstetrics and Gynecology, 2008

Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes ... more Oral communication abstracts subjects had normal ovarian response with retrieval of 4-15 oocytes in the absence of OHSS. Ovarian vascularity (vascularisation index, VI; flow index, FI; and vascularisation flow index, VFI), total antral follicle count (AFC), and mean ovarian volume (OV) were measured. ANOVA and Kruskal Wallis test were used to compare the groups dependent on the distribution of the data. Multiple logistic regression analysis was used to compare the predictive value of these variables against age and basal FSH for the development of poor response and OHSS. Results: The ovarian VI, FI, and VFI were similar in all three groups (Table 1). Compared to controls, AFC and OV were significantly lower (P < 0.001) in poor responders and significantly higher (P < 0.001) in subjects who developed OHSS. Multiple regression analysis showed the AFC was the only significant (P < 0.001) ultrasound predictor of poor or exaggerated ovarian response and that the 3D ovarian vascular indices offered no additional information. Parameters Control group (n = 100) OHSS group (n = 50)

Ultrasound in Obstetrics and Gynecology, 2009

Objective: To determine whether cervical length measured by transvaginal ultrasound at 18–22 week... more Objective: To determine whether cervical length measured by transvaginal ultrasound at 18–22 weeks could be used to predict the probability of Cesarean delivery in primiparous women at term. Methods: A total of 568 primiparous healthy patients with a singleton pregnancy had their cervical length measured using transvaginal ultrasound at the time of fetal anomaly survey at 18–22 weeks gestation. Patients with a cervical length shorter than 15 mm, those who delivered before term as well as patients with pre-existing medical diseases were excluded from the study group. The patients were followed prospectively and their term delivery data was collected including the gestational age at delivery, mode of delivery, reason for Cesarean section and neonatal outcome. Results: A total of 482 patients delivered at term and their delivery data were analysed. Patient data was categorized according to quartile of cervical length measured at 18–22 weeks. There was no difference in the baseline characteristics between the patients in the 4 quartiles (age, BMI, gestational age at delivery, neonatal weight). The Cesarean section rate was lowest in patients in the first quartile of cervical length (13.3%), and was significantly higher (p<0.001) in patient with a cervical length at the fourth quartile (40–50 mm). Failure of progress in labour as a cause for Cesarean section was significantly (p<0.001) more common in patients in the fourth quartile (40%). Conclusion: Cervical length measurement by transvaginal ultrasound at mid gestation can be used to predict the likelihood of Cesarean section at term in primiparous patients.

Ultrasound in Obstetrics and Gynecology, 2008

Oral communication abstracts program considering as region of interest the 2 mm uterine tissue su... more Oral communication abstracts program considering as region of interest the 2 mm uterine tissue surrounding endometrium. Endometrial pattern (EP) and thickness (EP), endometrial volume (EV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated until the day of HCG administration. Results: The all PDA indexes (VI, FI and VFI) were statistically significantly higher in the pregnant group whereas triple-line endometrial pattern and EV did not. Neither the transfer day nor the number of transferred embryos (mean 2.1 + 0.9) showed a statistically significant difference between the two groups. In our hand the number of grade I transferred embryos did not show any statistically significant difference in both groups. Conclusions: During COH endometrial and subendometrial vascularization indexes show a statistically significant increase in the pregnant women. 3D US PDA is a fast useful tool to evaluate endometrial receptivity in IVF cycles.

Ultrasound in Obstetrics and Gynecology, 2010

Oral communication abstracts Methods: 1120 consecutive subjects who were about to undergo IVF cyc... more Oral communication abstracts Methods: 1120 consecutive subjects who were about to undergo IVF cycle were prospectively recruited. 3D transvaginal ultrasound and venepuncture were performed in the early follicular phase of the menstrual cycle. Subjects were excluded if they had ovarian cysts or if their treatment was cancelled due to failed downregulation. Age, AFC, ovarian volume and FSH were the independent variables. The main outcome measures were non-pregnancy, poor ovarian response and ovarian hyperstimulation syndrome (OHSS). Normality of the data was checked. Logistic regression and ROC curve analyses were performed to evaluate the predictive ability of the variables. Sensitivity, specificity, positive likelihood ratio and post-test probability for each outcome measure were calculated at different AFC cutoffs. Results: 1012 subjects were included for final analysis. The mean (SD) age was 34.3 (4.4) years. AFC was the best predictor of poor response (AUC: 0.837) and OHSS (AUC: 0.742). Age and AFC were equally predictive of non-pregnancy. The probability of nonpregnancy, poor ovarian response and OHSS at different cutoff levels of AFC is defined. Conclusions: AFC, being the best predictor, provides prognostic information on IVF treatment outcome. The pregnancy rate decreases as the AFC decreases with a 48% and 5% chance of ongoing pregnancy with AFC of ≥ 24 and ≤ 4 respectively.

Human Reproduction, 2012

HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Fertility and Sterility, 2013

Introduction Methods Data acquisition Definitions Statistical analysis Results Data acquisition P... more Introduction Methods Data acquisition Definitions Statistical analysis Results Data acquisition Prediction of an excessive response using ORTs and patient characteristics Effect of FSH dosage and study protocol on excessive response prediction Influence of age, BMI and duration of subfertility on the accuracy of ORTs in excessive response prediction

Journal of Clinical Medicine, 2022

As most congenital uterine abnormalities are asymptomatic, the majority of them are detected inci... more As most congenital uterine abnormalities are asymptomatic, the majority of them are detected incidentally. While most women with uterine anomalies have a normal reproductive outcome, some may experience adverse reproductive outcomes. Accurate diagnosis and correct classification help in the appropriate counselling of women about their potential reproductive prognosis and risks and for planning any intervention. Evaluation of the internal and external contours of the uterus is the key in making a diagnosis and correctly classifying a uterine anomaly. Considering this, the gold standard test has been the combined laparoscopy and hysteroscopy historically, albeit invasive. However, 3D ultrasound has now become the diagnostic modality of choice for uterine anomalies due to its high degree of diagnostic accuracy, less invasive nature and it being comparatively less expensive. While 2D ultrasound and HSG are adequate for screening for uterine anomalies, MRI and combined laparoscopy and hy...