Contents Page no.
Title Page i
Dedication ii
Approval of the viva-voce board iii
Certificate by the Supervisor iv
Acknowledgements v
Declaration vii
List of Symbols and Abbreviations viii
Abstract xi
List of tables xii
List of figures xiii
Contents xv
Chapter 1
Introduction 1
1.1. Introduction to infertility 2
1.1.1. Female infertility 3
1.2. Causes of female infertility 4
1.3. Evaluation of female partner 9
1.4. Treatment of infertile women 11 1.4.1. Ovulation induction/ovarian stimulation
protocols
12 1.4.1.1. Clomiphene citrate (CC) 13 1.4.2.2. Gonadotropins 14 1.4.2.3. Letrozole 15
1.5. Assisted Reproductive Techniques (ART) 16
1.5.1. IVF/ICSI 16
1.5.2. IUI 17
Chapter 2
Literature Review 18
2.1. Letrozole as an ovulation inducing agent 19
2.1.1. Comparison with CC and FSH 20
2.1.2. Pregnancy outcome in IVF 21
2.1.3. Congenital anomalies 22
2.2. Ovarian stimulation and oocyte/embryo quality 22 2.1.1. Meiotic spindle imaging and oocyte quality 23 2.1.2. Meiotic spindle and polarization microscopy 24
2.3. Implantation of the embryo 26
2.3.1. Uterine receptivity markers 26
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2.3.1.1. Integrins 27
2.3.1.2. LIF 28
2.3.1.3. Pinopodes 28
2.4. Scope of the work 31
2.5. Objectives of the study 32
Chapter 3
Letrozole in infertile PCOS women 34
3.1. Introduction 35
3.2. Materials and Methods 36
3.2.1. Subject selection 36
3.2.2. Ovulation induction protocols 37
3.2.3. Immunoassay of hormones 38
3.2.4. Statistics 38
3.3. Results 40
3.4. Discussion 41
Chapter 4
Letrozole in ovulatory women 47
4.1. Introduction 48
4.2. Materials and Methods 49
4.2.1. Subject selection 49
4.2.2. Ovulation induction protocols 49
4.2.3. Immunoassay of hormones 50
4.2.4. Statistics 50
4.3. Results 50
4.4. Discussion 52
Chapter 5
Letrozole effect on mice oocyte and embryo quality 55
5.1. Introduction 56
5.2. Materials and Methods 58
5.2.1. Ovarian stimulation 58
5.2.2. Spindle imaging by polarization microscopy 58 5.2.3. In vitro fertilization and embryo culture 59
5.2. 4. Statistics 59
5.3. Results 60
5.4. Discussion 65
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Chapter 6
Letrozole effect on endometrial receptivity 69
6.1. Introduction 70
6.2. Material and Methods 72
6.2.1. Patient selection and ovarian stimulation 72 6.2.2. Endometrial tissue collection and sample
preparation
73 6.2.3. Isolation and staining of endometrial cells
for flowcytometry
73
6.2.4. Scanning Electron Microscopy 74
6.2.5. Cell cycle analysis 74
6.2.6. Statistical analysis 75
6.3. Results 75
6.3.1. Unexplained infertility 75
6.3.2. Male factor infertility 79
6.4. Discussion 82
Chapter 7
Summary and future scope 87
7.1. Summary 88
7.2. Future scope 88
Chapter 8
References 90
Curriculum vitae 112
Published Papers 114
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