Efficacy of transvaginal sonohysterosalpingography for evaluation of infertile women

Background: Women with infertility may be benefitted from sonohysterosalpingography (SHSG), a transvaginal ultrasound procedure that uses a contrast medium to assess the endometrial cavity and tubal patency. It could be a safer and more viable alternative to radiographic hysterosalpingography (HSG). The aim of the study was to evaluate the uterine cavity and fallopian tube patency in infertile women by SHSG using transvaginal ultrasound.Methods: The prospective comparative study was carried out in a total of 35 cases of infertile women between the reproductive age of 20-40 years following the inclusion and exclusion criteria, from July 2016 to June 2017. Detailed history and physical examinations were carried out and appropriate management was instituted as per the needs of the individual patient.Results: In the present study, 41.2% of the women belonged to the age range of 25-29 years. Out of 35 women, 50% women were in the state of primary infertility and remaining were in a secondary infertility state. Holding the SHSG both tube blockage as positive findings the sensitivity of SHSG was found at 100%, specificity was 96.88% and accuracy was 97.14%, while positive predictive value was 80.49% and negative predictive value was 100%.Conclusions: Transvaginal SHSG as a first-line method for evaluation of endometrial cavity and tubal patency is effective and time convenient. Before going to the more invasive gold standard methods, i.e. Hysteroscopy and Laparoscopy, this may be a simple, safe, and well-tolerated technique with a low risk of adverse effects and severe complications

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

Lisinopril, an angiotensin converting enzyme inhibitor for the treatment of idiopathic oligospermia: a randomized controlled trial

Background: Oligospermia or low concentration of sperm is a common finding in male infertility. Alterations in the expression of angiotensin converting enzyme (ACE) may be one of the mechanisms underlying male infertility and ACE inhibitors may improve the sperm count. The objective was to compare the effects of lisinopril and zinc-folic acid with zinc-folic acid alone on idiopathic oligospermia in infertile males.Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology & Infertility of a medical university from March 2021 to February 2022. A total 78 diagnosed cases of infertile males with idiopathic oligospermia were selected for this study. Eligible men who gave their informed consent were randomly allocated to receive either a combination of low dose lisinopril (2.5 mg) and zinc-folic acid or zinc-folic acid alone for 12 weeks. Pretreatment and post treatment semen parameters, including sperm concentration, sperm motility and total motile sperm count were assessed.Results: There was significant rise in sperm concentration and total motile sperm count in both groups but the mean difference in sperm concentration (2.36±2.04 vs 1.53±1.8 million/ml) and total motile sperm count (11.64±8.28 vs 9.95±6.11 million) were higher in those receiving Lisinopril in addition to zinc folic acid. The percentage increase of sperm count was higher (22.65 vs 16.70 million) in this group. Normalization of sperm count (sperm count ≥15 million/ml) was also higher in this group (18.4% vs 8.3%) with relative risk 2.21, 95% CI (0.648-4.56 %).Conclusions: Lisinopril given orally at the dosage of 2.5 mg/day with zinc-folic acid for 12 weeks appears to be well tolerated among men with oligospermia and improves sperm count by a small margin when compared to zinc folic acid only

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

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.

Coenzyme q10 and letrozole versus letrozole alone for ovulation induction in polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is the largest single cause of anovulatory infertility. PCOS is associated with oxidative stress. Coenzyme q10 (Coq10) is an antioxidant that protects the mitochondria from damage caused by either insulin resistance or oxidative free radicals. The objective of the study was to compare the effect of combined Coq10 and letrozole than of letrozole alone for ovulation induction in women with PCOS.Methods: This open label parallel design randomized controlled trial study was conducted on 80 infertile women with PCOS selected for ovulation induction. Eligible women were randomized either to combined Coq10 and letrozole (40 patients, 83 cycles) or letrozole alone (38 patients, 91 cycles). The outcome measures were mature follicles, adequate endometrial thickness, ovulation and pregnancy.Results: Mature follicles (≥18-25 mm) were significantly higher in women given Coq10 at 2nd (74.2% vs 31.3%) and 3rd cycles (83.3% vs 28.6%). Adequate endometrial thickness was significantly higher in women given Coq10 in second (90.3% vs 56.3%) and third cycle (94.4% vs 47.6%). When Coq10 was added to letrozole, ovulation rates were significantly higher (87.1% vs 53.1% in second cycle), (83.3% vs 38.1%, in third cycle). Cumulative pregnancy was 2.37 times (95% CI 1.03-5.48) higher in women having Coq10 in addition to letrozole for ovulation induction. Conclusions: Coq10, as an adjuvant to ovulation induction with letrozole improves ovarian response, ovulation and pregnancy in PCOS women. Combination of Coq10 and letrozole can be tried successfully before a more complicated and expensive treatment such as gonadotrophins and laparoscopic ovarian drilling

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

Vitamin D Supplementation in women with Diminished Ovarian Reserve: A Randomized Controlled Trial

Background: Diminished ovarian reserve (DOR) predicts decreased ovarian response to stimulation. Low serum anti-Mullerian hormone (AMH) is associated with DOR. AMH is a marker of ovarian reserve and acts as a predictor of ovarian response to ovarian stimulation protocol. The AMH is up regulated by vitamin D via vitamin D response elements that bind the vitamin D receptor. Vitamin D supplementation has a role in increasing serum AMH. The objective was to compare the combined effect of vitamin D and DHEA vs DHEA alone on serum AMH in DOR.  Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib medical University (BSMMU), Dhaka, from March 2021 to February 2022. A total of 44 infertile women with DOR, 20 to 39 years were allocated into two groups, one received vitamin D plus DHEA for 8 weeks and the other received DHEA alone for the same duration. After 8 weeks of treatment, both groups had repeat assessment of AMH, FSH and transvaginal sonography for AFC. Results: There was no significant difference in serum AMH after vitamin D supplementation in women with DOR. But the spontaneous pregnancy during intervention was 2.57 times more in those given vitamin D supplementations in addition to dehydroepiandrosterone (DHEA).Conclusions: Short term vitamin D supplementation adds little to the effect of increasing AMH but favors spontaneous pregnancy in women with DOR