Correlation and discordance of anti-mullerian hormone with follicle stimulating hormone in infertile women with premature ovarian insufficiency and diminished ovarian reserve

Background: The objective of the study was to explore the correlation and discordance of anti-mullerian hormone (AMH) and follicle stimulating hormone (FSH) in the selected population of premature ovarian insuffiency and diminished ovarian reserve.Methods: This was a retrospective analysis of the data obtained from the women who presented to the Gynae Endocrine Clinic of the Infertility unit of the Department of Obstetrics & Gynaecology from 2015 to 2017. Discordance was defined as abnormal basal FSH (>10 IU/l) with assuring AMH (>1 ng/ml). Statistical analysis was done with SPSS version 23.Results: There were 36 women with premature ovarian insufficiency and 35 women with diminished ovarian reserve. The correlations between basal FSH and AMH are not significant. AMH values are relatively higher in younger age groups. There are extreme high outliers in both POI and DOR groups, more in younger age group. The discordance between AMH and basal FSH was more in women categorized to have diminished ovarian reserve, compared to women with premature ovarian insufficiency.Conclusions: Those women who are younger than 35 years and have high FSH combined with reassuring AMH should be counseled with care regarding the prognosis of their treatment

Laparoscopic findings of infertile women at Bangabandhu Sheikh Mujib Medical University

Background: Laparoscopy is an important component of infertility work up. It is the gold standard for evaluation of pelvic pathology and assessment of tubal patency. Objective: The objective of the study was to analyze the laparoscopic findings of infertile women presenting at Infertlity unit of Bangabandhu Sheikh Mujib Medical University. Method: We had a retrospective cross-sectional study on Japaroscopic findings of 110 women. Results: Out of all patients 22.7% women had endometriosis. Various degrees of adhesion of pouch of Douglus was present in 16.4 %. Regarding tubal pate:1cy , 26.4% had unilateral block and 28.2% had bilateral block. Conclusion: A significant number of infertile women at the Infertility unit of BSMMU has tuboperitoneal disease and bilateral tubal block and ultimately need in vitro fertilization

Laparoscopic findings of infertile women at Bangabandhu Sheikh Mujib Medical University

Background: Laparoscopy is an important component of infertility work up. It is the gold standard for evaluation of pelvic pathology and assessment of tubal patency. Objective: The objective of the study was to analyze the laparoscopic findings of infertile women presenting at Infertlity unit of Bangabandhu Sheikh Mujib Medical University. Method: We had a retrospective cross-sectional study on Japaroscopic findings of 110 women. Results: Out of all patients 22.7% women had endometriosis. Various degrees of adhesion of pouch of Douglus was present in 16.4 %. Regarding tubal pate:1cy , 26.4% had unilateral block and 28.2% had bilateral block. Conclusion: A significant number of infertile women at the Infertility unit of BSMMU has tuboperitoneal disease and bilateral tubal block and ultimately need in vitro fertilization

Use of ebastine a mast cell blocker for treatment of oligozoospermia

Background: Global infertility prevalence rates are difficult to determine, due to the presence of both male and female factors which complicate any estimate which may only address the woman and an outcome of a pregnancy diagnosis or live birth. Although overall male fertility does not appear to have declined, there is evidence for decline in sperm quality. Sperm count below 15×106 sperm/ml is called oligozoospermia. The aim of this study was to evaluate the efficacy of ebastine on sperm count of oligospermic infertile men.Methods: This was a longitudinal clinical trial study and was conducted in the infertility unit outdoor, Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Bangladesh during the period from January 2015 to December 2015. This study was conducted among the male patients and followed purposive sampling technique. Finally, 334 cases were enrolled in this study.Results: From the total 334 patients in group I, mean sperm count was 10.32±2.71 million/ml in pretreatment and 18.87±9.56 million/ml in post treatment. The difference was statistically significant (p0.05). 63.9% oligospermic male showed improvement in sperm count in ebastin group and 18.1% in placebo group.Conclusions: Sperm count had significantly improved after three months’ treatment period with ebastin than placebo. Therefore, this study suggested that mast cell blocker ebastine can be helpful than placebo to improve the patients’ sperm count with oligospermia

Primary subfertility with partial septate uterus and longitudinal vaginal septum

A 22 year old married woman presented with the complaints of severe dyspareunia, difficulty in conceiving for 18 months, menorrhagia and dysmenorrhoea since menarche. Clinical examination revealed longitudinal vaginal septum. Ultrasound scan revealed two endometrial cavities with a single cervix. Hysterosalpingogram revealed septum which had separated the endometrial cavity with no free spillage of contrast media on both fallopian tubes. Ultrasound KUB and intravenous urethrography did not reveal any abnormality in the urinary system. Resection of vaginal septum, hysteroscopic septoplasty and diagnostic laparoscopy were performed. Three months after the surgery, she was relieved from the symptoms. However, no comments on fertility issue can be made at the moment as the couple is practicing contraceptive methods

Ovarian function following intra-ovarian injection of platelet rich plasma in premature ovarian aging

Background: Premature ovarian aging as evidenced by AMH levels less than 0.5 ng/ml is predictive of reduced success in management of infertility. The most effective treatment is in vitro fertilization which is not affordable or acceptable to most of our patients with low socioeconomic background. Intra-ovarian injection of autologous platelet rich plasma (PRP) improves the ovarian reserve markers but it remains to be seen whether it improves the pregnancy rate.Methods: This was a prospective study of 29 patients with poor ovarian reserve (age between 30-40 years, AMH<0.5 ng/ml), AFC<4 in both ovaries) who received intra ovarian injection of platelet rich plasma. The patients were followed up for one year and data was collected about clinically relevant outcomes like pregnancy.Results: Four women (13.8%) had pregnancy, of which 3 were spontaneous and one was following ovarian stimulation and intrauterine insemination. All had diagnosed clinical pregnancy, of which two women had live birth.Conclusions: Given the 13.8% rate of pregnancy within one year we can speculate that PRP injection may be a reasonable alternative to in vitro fertilization in women with diminished ovarian reserve.

Effect of omega 3 fatty acid in infertile males with oligozoospermia

Background: Oligozoospermia is the cause of male infertility in 33.3% of cases. Omega-3 fatty acid has been utilized in infertility because of its widespread availability, low cost, and high safety profile. We intended to conduct a study to evaluate the efficacy of omega-3 fatty acid in oligozoospermia. Methods: A prospective comparative study was conducted in the outdoor of the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2022 to August 2023. A total of 70 Infertile males with oligozoospermia, were enrolled in the study. The participants were assigned to the omega-3 fatty acid group who was treated with omega-3 fatty acid 1 gm orally twice daily for 12 weeks. The other group was treated with placebo orally twice daily for 12 weeks. Sixty patients completed the 12 weeks of treatment. The changes in sperm count were determined. Results: The mean age of the participants was 35.6±4.59 years. Following treatment with omega-3 fatty acid significant improvement was observed in sperm count from 11.10±2.81 million/ml to 34.2±31.36 million/ml. Significant improvement in total motile sperm count was also observed. At the end of 12 weeks of treatment 76.7% of participants in the omega 3 fatty acid group and 10.0% in the placebo group had normozoospermia. Conclusions: Supplementation with omega-3 fatty acid results in improvement of sperm concentration and total motile sperm count in infertile men with oligozoospermia

Primary subfertility with partial septate uterus and longitudinal vaginal septum

A 22 year old married woman presented with the complaints of severe dyspareunia, difficulty in conceiving for 18 months, menorrhagia and dysmenorrhoea since menarche. Clinical examination revealed longitudinal vaginal septum. Ultrasound scan revealed two endometrial cavities with a single cervix. Hysterosalpingogram revealed septum which had separated the endometrial cavity with no free spillage of contrast media on both fallopian tubes. Ultrasound KUB and intravenous urethrography did not reveal any abnormality in the urinary system. Resection of vaginal septum, hysteroscopic septoplasty and diagnostic laparoscopy were performed. Three months after the surgery, she was relieved from the symptoms. However, no comments on fertility issue can be made at the moment as the couple is practicing contraceptive methods

Surgical versus non-surgical intervention in endometriosis with infertility: a patient preference trial

Background: Hormonal suppression decrease pain and reduce endometrioma size in women with endometriosis. There are medications like cabergoline which reduce inflammation associated with endometriosis but do not prevent ovulation. Hormonal suppression followed by cabergoline may allow pregnancy in women with endometriosis. The objective of the study was to assess and compare the efficacy of medical versus surgical management in infertile women with endometriosis. Methods: A patient preference clinical trial was carried out on 20 women who wish pregnancy and has sonographic evidence of endometrioma and pain. They were counseled adequately about the advantages and disadvantages of surgical and medical management of endometriosis with infertility and were asked to make a choice. The interventions were applied according to patient preference. The interventions were i) dienogest for 3 months when cyst size ≤5 cm and letrozole plus norethisterone for 6 months when cyst size &gt; 5 cm followed by cabergoline 0.5 mg twice weekly for 6 months, plus timed intercourse and ii) laparoscopic surgery followed by expectant management or ovarian stimulation with or without intrauterine insemination. The women were followed up for results. Results: A total of 18 participants opted for medical management and only 2 participants for surgery. All participants given medical management had reduction of pain, and all except one had reduction of cyst size. Pregnancy occurred in 2 out of 14 (14.3%) participants given medication. One woman with surgery had persistence of pain and recurrence of cyst. No one having surgery got pregnant during the study period. Conclusions: The infertile women with endometriosis prefer medical management over surgery. The medical management may be a better option for infertile women with endometriosis who do not plan in vitro fertilization in near future

Pre-treatment with cyproterone acetate plus ethinylestradiol enhances ovarian response in women with polycystic ovary syndrome

Background: Anti-mullerian hormone (AMH) and androgen levels are higher in women with polycystic ovary syndrome (PCOS) than norm-ovulatory women. Cyproterone acetate plus ethinylestradiol (CPA+EE) reduces AMH and free androgen level. The aim of the study was to determine if the pretreatment with CPA+EE before ovulation induction with letrozole improves ovarian response in PCOS women. Methods: The study comprised of 100 infertile PCOS women with serum AMH&gt;5 ng/ml. The study participants were randomly allocated into women given CPA+EE pretreatment cyclically for 3 months before ovulation induction with letrozole 5 mg from day 2-6 of a menstrual cycle, and women given only letrozole from day 2-6 without any pretreatment. Follicular growth was monitored by transvaginal sonography on day 12. Women who attained maximum follicular size (18-25 mm) were given 5000 IU HCG injection. Ovulation was confirmed by serum progesterone assay on day 21-23 and pregnancy was confirmed by serum β-hCG level or by pregnancy test kit. Results: Ovulation rate was higher (82.4%) in pre treatment group compared in letrozole only group to (43.0%) with relative risk 1.92. Pregnancy rate was higher in (23.5%) in pre treatment group than letrozole only (8.8%) with relative risk 2.68. Conclusions: Pretreatment with CPA+EE before ovulation induction with letrozole has better outcome in terms of ovulation and pregnancy than letrozole alone in PCOS women with high serum AMH.