Bloom Fertility Centre

Intrauterine human chorionic gonadotropin (hCG) administration prior to embryo transfer has been explored as a method to improve embryo–endometrial synchrony, but clinical evidence remains inconsistent due to variations in dosage, timing, embryo stage, and cycle type. This study evaluated the clinical impact of a pre-transfer intrauterine hCG flush performed 48–72 h before frozen embryo transfer (FET) in hormonally prepared cycles. This prospective non-randomized cohort study included 200 women with primary infertility undergoing FET with at least one good-quality blastocyst. Participants were assigned either to the hCG flush group (n = 100) or a control group (n = 100). In the control group, 20 participants discontinued before FET for non-medical reasons, and one was lost to follow-up, leaving 79 for analysis. Outcomes included implantation rate, clinical pregnancy rate, live birth rate, miscarriage rate, multiple pregnancy rate, and procedure-related adverse events. Logistic regression generated odds ratios (ORs) with 95% confidence intervals (CIs). A p-value < 0.05 was considered significant. Baseline demographics and cycle parameters were comparable between groups (hCG flush vs. control group, respectively). Implantation rate did not differ significantly between the hCG flush and control groups (58.2% vs. 54.6%, respectively; p = 0.39). Clinical pregnancy rates were similarly comparable between the groups (73.0% vs. 79.7%, respectively; p = 0.88). The live birth rate was higher in the hCG group (70.0%) than the control group (62.0%), although not statistically significant (OR 1.51; 95% CI 0.76–2.99; p = 0.21). Multiple pregnancy rates were also comparable between hCG group and control group (15.0% and 24.0%, respectively, p = 0.18). However, a reduction in miscarriage rate was observed in the hCG group (3.0%) on comparing with the control group (16.4%) (p < 0.001). Pre-transfer intrauterine hCG administration 48–72 h before blastocyst-stage FET did not significantly influence implantation, clinical pregnancy, or live birth rates but was associated with miscarriage rate. These findings from this preliminary study suggest a potential biological effect of localized hCG exposure on early gestational maintenance and warrant confirmation through larger, multicentre randomized controlled studies.

Access to comprehensive sexual health education (SHE) is limited in India's urban slum communities, where socio-structural barriers restrict awareness of reproductive health. Existing interventions have emphasised menstruation and contraception, with less emphasis on other domains of SHE such as consent, abortion, infertility and gender norms. This study investigated the extent of sexual health knowledge among women in Dharavi, Mumbai, exploring how sociodemographic factors influence understanding across key domains. A cross-sectional survey was administered in Dharavi, Mumbai in 2024 across 4 weeks. A 30-item, multilingual questionnaire, adapted from the Demographic Health Survey Woman's Questionnaire, was fully completed by 430 participants aged 10 and above. Descriptive statistics were used to assess awareness levels. Chi-square tests and logistic regression models evaluated associations between knowledge, age, education and information sources. Most participants reported access to sexual health information (74.7%) and decision-making confidence (65.3%), yet 77.7% still expressed a need for further education. Knowledge and awareness were highest for menstrual health (83.7%) and hygiene (91.4%), but lower for consent (67.0%), contraception (58.6%), abortion (55.3%) and infertility (52.3%). Older participants and those with higher education demonstrated greater knowledge, but key gaps within domains persisted across all groups. Health clinics were the most common information source (36.7%), but participants who accessed media, despite low usage (4.9%), demonstrated the highest levels of knowledge overall. Significant disparities remain in SHE knowledge among marginalised urban populations, particularly in domains beyond menstruation and hygiene. These findings underscore the importance of embedding inclusive, evidence-based sexuality education within healthcare services, school curricula and digital platforms. Addressing topic-specific gaps and diversifying trusted information sources are critical to improving reproductive health literacy and autonomy in low-resource urban settings.

BackgroundAdenomyosis and endometriosis are hormone-dependent benign gynecological disorders with overlapping features suggesting that they may share a common origin despite being considered distinct entities. This study compares the expression of candidate genes in the eutopic endometrium of diffuse adenomyosis, ovarian endometriosis, co-existent adenomyosis–endometriosis, and controls.MethodsPublicly available transcriptomic datasets comprising endometrial tissue of women with adenomyosis, endometriosis, and women with healthy endometrium were analyzed, and overlapping differentially expressed genes (DEGs) were determined. Gene ontology and pathway enrichment analyses were performed to determine shared biological processes. A protein–protein interaction (PPI) network was constructed using the overlapping DEGs and the key genes identified. These genes and corresponding proteins were further validated in the patient population (25 women in each group of diffuse adenomyosis, ovarian endometrioma, co-existent adenomyosis–endometriosis). Thirty women with healthy endometrium having infertile male partners were recruited as controls for comparison purposes. Receiver operating characteristic (ROC) curves were generated for the key genes to evaluate their discriminatory accuracy in classifying isolated adenomyosis. Finally, the gene expressions were correlated with patient clinical characteristics.Results23 significant DEGs (log2 fold-change > 1, p < 0.05) were found to be common between adenomyosis and endometriosis datasets, with serine-type endopeptidase activity emerging as the most enriched molecular function. PPI network analysis identified MMP7, MMP11, IGFBP5, SERPINA1, THBS1 as the hub genes. In addition, MMP9 and TIMP1 exhibited a strong association with the hub gene network. Experimental validation showed altered expression in adenomyosis as compared to controls and other disease groups. MMP9 and MMP7 showed strong discrimination for adenomyosis vs. endometriosis [area under the curve (AUC) = 0.93] and co-existent cases (AUC = 0.97), respectively. The expression of most of the genes in the co-existent group did not align with adenomyosis or endometriosis. MMP7 expression positively correlated with uterine volume in adenomyosis; MMP11 could be negatively associated with myometrial wall thickness ratio.ConclusionsDistinct expression profiles were observed in diffuse adenomyosis versus ovarian endometriosis and co-existent phenotype. Expression of key genes indicated enhanced ECM remodeling in adenomyosis, with MMP7, MMP9, and MMP11 emerging as potential discriminatory markers. The divergent expressions in the co-existent phenotype suggest distinct molecular mechanisms that merit further study.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03412-7.

Pituitary microadenomas are benign adenohypophyseal tumors most commonly related to hormonal dysregulation, possibly affecting fertility and reproductive function. This case report presents a 24-year-old female with a pre-existing preclinical diagnosis of pituitary microadenoma presenting to assisted reproductive treatment for subfertility. In spite of regular menstrual cycles and lack of any of the features of hyperprolactinemia at treatment, her clinical history warranted meticulous hormonal assessment and customized stimulation protocol. After controlled ovarian stimulation, ICSI, and frozen embryo transfer of two blastocysts, she got pregnant. To her astonishment, she was diagnosed with a heterotopic pregnancy, as evidenced by the presence of intrauterine and tubal gestation. This case points towards the intricate interplay between pituitary pathology and ART outcome. It emphasizes the need for individualized fertility management in patients with pituitary disease, who could have atypical or unpredictable responses to stimulation and implantation. The successful diagnosis and management of this uncommon dual-gestation event emphasize the caution required in the evaluation and multidisciplinary management in ART cycles with underlying endocrine pathology.

Abstract Study question Are sperms that instinctively migrate from low viscosity zone to higher viscosity zone better for performing ICSI? How can viscosity-gradient micropatterning technique improve outcomes? Summary answer Sperms capable of cutting through higher viscosity have better motility patterns and morphology. This technique improves IVF outcomes and reduces sperm selection time by 80–85%. What is known already Conventional ICSI procedure is performed by selecting sperm from a PVP streak to inject into an M2 oocyte. This selection process can take time based on the quality of sperm. Exposure of sperms and oocytes in an ICSI dish for a longer time during the procedure can be harmful to gametes and can also cause epigenetic modifications. There are multiple modifications and techniques that aim at improving outcomes.Ex. Physiological Intracytoplasmic Sperm Injection (PICSI) uses chemotaxis to isolate sperms that can give better results. Magnetic Assisted cell sorting (MACS) uses a magnetic field to separate sperms with better DNA content. Study design, size, duration This is a sibling oocyte study conducted over six months. Samples of 108 routine patients were taken for study. Every case was divided into two where one half of the M2 oocytes were injected using conventional selection of sperms and the other half of the M2 oocytes were injected using selection after viscosity-gradient micropatterning technique. Embryos were allowed to grow separately and results were tabulated. Participants/materials, setting, methods Compositions of ratios of PVP and Flushing media at 1:0, 3:1, 1:1, 1:3 and 0:1 were prepared respectively. Concentric circles of reducing PVP gradients were drawn around a 100% PVP streak. Bridges were drawn connecting all the layers using a stripper tip and oil was overlaid. Sperms were loaded in the outermost layer and incubated. Sperms were checked for in the middle PVP streak after every 5 minutes and chosen for ICSI. Main results and the role of chance The technique demonstrated significant improvements in ART outcomes. Fertilization rates increased from 90.3% to 93.9%, Day 3 high-quality embryo rates rose from 81.8% to 89.1%, and Day 5 blastocyst formation rates improved from 44% to 51.5%. The process reduced sperm selection time by 80–85%, optimizing embryologist workflow. These results were observed across 108 patients and were statistically significant (p &amp;lt; 0.05). The results were as follows: Total M2 oocytes injected by conventional ICSI= 342 Total number of oocytes fertilized = 309 (90.3%) Day 3 (grade A+ grade B) = 253 (81.8%) Day 5 blast (AA, AB , BB grades ) = 136 (44%) Total M2 oocytes injected by viscosity-gradient micropatterning technique = 345 Total number of oocytes fertilized= 324 (93.9%) Day 3 (grade A+ grade B) = 289 (89.1%) Day 5 blast (AA,AB,BB grades) = 167 (51.5%) The pattern and distribution of sperms at the isolation zone were random. It was observed that most sperms that made it to the central PVP streak had the corkscrew motion. This nature of the isolated sperms could be because of the fact that only sperms with a special motility pattern can cut through higher viscosity zones. Limitations, reasons for caution The miscible nature of the gradients compel the user to perform the selection procedure within a time frame. Contraindications are not determined. Results are based on in vitro data; further clinical validation is required to confirm scalability and reproducibility across diverse patient samples. Wider implications of the findings This technique offers a cost-effective, real-time, and easily integrable solution for ICSI. It requires no extra consumable or equipment from those used for conventional ICSI. Its ability to improve embryo quality and ART success rates could have a significant global impact on fertility treatments. Trial registration number No