Pattern of semen analysis at andrology lab of Bangabandhu Sheikh Mujib Medical University: Findings and the shortcomings to overcome

Background: The Infertility wing dept. of gyne & obst at BSMMU provides services to the infertile couples who are referred from primary care levels and who cannot afford the expensive private facilities. The semen analysis is performed for the male partners of infertile couples at the Andrology Lab of BSMMU for detecting male factor abnormalities. Objectives: The objective of the study is to find out the pattern of semen parameters in our population and to find out the frequency and type of abnormal semen parameters. Methods: This is a retrospective descriptive study of the semen analysis performed at the Andrology Lab of BSMMU during the year 2011. A total of 200 consecutive samples were analysed. The procedure and reference values were according to the WHO guidelines 1999. Results: Semen parameters were abnormal in 38.5% of semen analysis. Severe male factor abnormality (azospermia and severe oligospermia combined) was in 28%. Sperm concentration had the highest variability followed by motility and morphology respectively in the n01moozospermic males. Conclusion: Severe oligospennia and azospermia are the most common abnormali­ties among the infertile men presenting at the Infertility unit ofBSMMU. It is recommended that the service at the Infertility wing of BSMMU should be more focused on these male factor abnormalities

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

Myomectomy at the Time of Cesarean Section: A Prospective Multicentre Study

Objectives: To assess the safety and efficacy of myomectomy during cesarean section. Methods : The study design was a prospective multicentre study done in three tertiary care hospitals in Dhaka city. The subject were 30 pregnant women underwent elective or emergency myomectomy during cesarean section. All cesarean section myomectomy were performed by consultant. Intra-operative and post-operative complications such as change in haematocrit, length of operation, blood loss were estimated. Length of hospital stay was also recorded. Results : 50 Fibroid of various sizes (2-6cm) were removed from 30 women. Fibroid were on the anterior uterine wall with most being subserous and intramural. Four patients had one unit of whole blood transfusion in post-operative period. No hysterectomy was done at the time of cesarean section. There was no significant frequency of blood transfusion; incidence of post- operative fever and duration of operation. The mean duration of post operative hospital study was 7.3±1.2 days. Two patients subsequently became pregnant, were also underwent repeated cesarean section in the study period. Conclusion : In selected cases myomectomy during cesarean section does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity if performed by an experienced practitioner. Cesarean myomectomy is a safe surgical options with no significant complications. Keywords : Cesarean section; myomectomy; uterine myoma. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8639 BSMMU J 2011; 4(2):102-10

Myomectomy at the Time of Cesarean Section: A Prospective Multicentre Study

Objectives: To assess the safety and efficacy of myomectomy during cesarean section. Methods : The study design was a prospective multicentre study done in three tertiary care hospitals in Dhaka city. The subject were 30 pregnant women underwent elective or emergency myomectomy during cesarean section. All cesarean section myomectomy were performed by consultant. Intra-operative and post-operative complications such as change in haematocrit, length of operation, blood loss were estimated. Length of hospital stay was also recorded. Results : 50 Fibroid of various sizes (2-6cm) were removed from 30 women. Fibroid were on the anterior uterine wall with most being subserous and intramural. Four patients had one unit of whole blood transfusion in post-operative period. No hysterectomy was done at the time of cesarean section. There was no significant frequency of blood transfusion; incidence of post- operative fever and duration of operation. The mean duration of post operative hospital study was 7.3±1.2 days. Two patients subsequently became pregnant, were also underwent repeated cesarean section in the study period. Conclusion : In selected cases myomectomy during cesarean section does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity if performed by an experienced practitioner. Cesarean myomectomy is a safe surgical options with no significant complications. Keywords : Cesarean section; myomectomy; uterine myoma. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8639 BSMMU J 2011; 4(2):102-10

Organoleptic qualities and proximate composition of fish grown in good aquaculture practice-based carp fattening pond

Organoleptic qualities and proximate composition of fish grown in carp fattening pond were studied under three treatments of feed and fertiliser management. Treatment T1 was designed with the use of organic fertiliser and stocking of silver carp, T2 with both organic and inorganic fertilisers and silver carp and T3 with both organic and inorganic fertilisers but excluding silver carp. One day in a week feeding restriction was followed in all the treatments.  Fishes were stocked with a stocking density of 2470 fishes ha–1. Three fishes (Gibelion catla, Labeo rohita and Cirrhinus cirrhosus) were selected for organoleptic and proximate assessment. Cyanobacteria along with total phytoplankton cell density was significantly higher at treatment T2 followed by T3 and T1. However, in terms of productivity (Chl-a) treatment T2 was 27.1 and 13.3% higher compared to T1 and T3 respectively. Parameters assessed for proximate composition analysis did not vary across treatments and organoleptic test revealed comparatively higher acceptability of fishes collected from treatment T1 followed by T2 and T3 for all the fishes. Overall acceptability was higher for L. rohita from treatment T1. This study concluded that, inorganic fertilisation along with silver carp can improve the organoleptic properties of carps in pond

APOBEC3G and APOBEC3F Act in Concert To Extinguish HIV-1 Replication

ABSTRACT The multifunctional HIV-1 accessory protein Vif counters the antiviral activities of APOBEC3G (A3G) and APOBEC3F (A3F), and some Vifs counter stable alleles of APOBEC3H (A3H). Studies in humanized mice have shown that HIV-1 lacking Vif expression is not viable. Here, we look at the relative contributions of the three APOBEC3s to viral extinction. Inoculation of bone marrow/liver/thymus (BLT) mice with CCR5-tropic HIV-1 JRCSF (JRCSF) expressing a vif gene inactive for A3G but not A3F degradation activity (JRCSFvifH42/43D) displayed either no or delayed replication. JRCSF expressing a vif gene mutated to inactivate A3F degradation but not A3G degradation (JRCSFvifW79S) always replicated to high viral loads with variable delays. JRCSF with vif mutated to lack both A3G and A3F degradation activities (JRCSFvifH42/43DW79S) failed to replicate, mimicking JRCSF without Vif expression (JRCSFΔvif). JRCSF and JRCSFvifH42/43D, but not JRCSFvifW79S or JRCSFvifH42/43DW79S, degraded APOBEC3D. With one exception, JRCSFs expressing mutant Vifs that replicated acquired enforced vif mutations. These mutations partially restored A3G or A3F degradation activity and fully replaced JRCSFvifH42/43D or JRCSFvifW79S by 10 weeks. Surprisingly, induced mutations temporally lagged behind high levels of virus in blood. In the exceptional case, JRCSFvifH42/43D replicated after a prolonged delay with no mutations in vif but instead a V27I mutation in the RNase H coding sequence. JRCSFvifH42/43D infections exhibited massive GG/AG mutations in pol viral DNA, but in viral RNA, there were no fixed mutations in the Gag or reverse transcriptase coding sequence. A3H did not contribute to viral extinction but, in combination with A3F, could delay JRCSF replication. A3H was also found to hypermutate viral DNA. IMPORTANCE Vif degradation of A3G and A3F enhances viral fitness, as virus with even a partially restored capacity for degradation outgrows JRCSFvifH42/43D and JRCSFvifW79S. Unexpectedly, fixation of mutations that replaced H42/43D or W79S in viral RNA lagged behind the appearance of high viral loads. In one exceptional JRCSFvifH42/43D infection, vif was unchanged but replication proceeded after a long delay. These results suggest that Vif binds and inhibits the non-cytosine deaminase activities of intact A3G and intact A3F, allowing JRCSFvifH42/43D and JRCSFvifW79S to replicate with reduced fitness. Subsequently, enhanced Vif function is acquired by enforced mutations. In infected cells, JRCSFΔvif and JRCSFvifH42/43DW79S are exposed to active A3F and A3G and fail to replicate. JRCSFvifH42/43D Vif degrades A3F and, in some cases, overcomes A3G mutagenic activity to replicate. Vif may have evolved to inhibit A3F and A3G by stoichiometric binding and subsequently acquired the ability to target these proteins to proteasomes

Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Background: Laparoscopic ovarian drilling (LOD) is an alternative method for ovulation induction in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients instead of gonadotropins. Objective were to identify the changes in clinical and biochemical profiles and the ovulation and pregnancy rate following LOD in CC resistant PCOS patients.Methods: It was an interventional study infertility unit, department of obstetrics and gynecology, Bangabandhu Sheikh Mujib medical university, Dhaka, between from July 2014 to June 2015. Changes of the above-mentioned parameters were recorded during follow up of patients after LOD. The information is collected and recorded in the preset questionnaire.Results: The characteristics of study population were same before LOD and following LOD. Before LOD, infrequent menstruation was present in 83.3% patients whereas regular menstruation was found in 58.3% patients after 6 months following LOD. Endometrial thickness ≤8 was found in 100.0% in before LOD and endometrial thickness >8 was found in 70.0% after 6 month following LOD. Ovulation was found in 25.0% in after 3-month LOD and was found in 70.0% after 6 months following LOD. Pregnancy was found in 20.0% after 3 months following LOD and 50.0% in after 6 months following LOD. Ovulation and pregnancy outcome was significantly higher in after 6 months following LOD.Conclusions: LOD produces long-term improvement in menstrual regularity and reproductive performance. A sustained improvement observed in acne and BMI. Ovulation and pregnancy were found in 70% and 50.0% respectively after 6 months following LOD

Intrauterine instillation of granulocyte colony stimulating factor for infertile women with thin endometrium in intrauterine insemination cycle: a non-randomized clinical trial

Background: Endometrial thickness is one of the major factors for a receptive endometrium and successful implantation. Thin endometrium, generally measuring <7 mm are thought to be less able to support implantation and pregnancy. Several adjuvants have been investigated for their efficacy on thin endometrium in assisted reproductive technology. Granulocyte colony stimulating factor (G-CSF) is a glycoprotein that promotes endometrial stromal cell decidualization via cyclic adenosine monophosphate mediator and induces endometrial proliferation and differentiation. This study was done to evaluate the effect of G-CSF in improving endometrial thickness and pregnancy rate in infertile patients undergoing stimulated IUI (intrauterine instillation) having thin endometrium.Methods: This was a non-randomized clinical trial done among 40 infertile patients with thin endometrium (<7 mm) on the day of ovulation trigger in stimulated IUI patients. Study subjects were non randomly allocated into 2 groups. In group A 20 patients received intrauterine instillation of G-CSF (300 mcg/0.5 ml) via intrauterine catheter on triggering day and in group B another 20 patients received intrauterine instillation of 0.5 ml normal saline in the same procedure. After 48 hours endometrial thickness was measured in both groups. IUI was done on the same day. Pregnancy was detected by serum beta hCG level after 14 days of IUI.Results: In both groups most of the respondents were aged between 30-34 years, 14 (70%) in group A and 11 (55%) in group B. The mean±SD of age 32.4±3.1 in group A, 32.2±3.4 in group B and P value was 0.9. In group A the minimum endometrial thickness on day of ovulation trigger was 4.4 mm and after 48 hours of treatment with G-CSF, it was found 6.3 mm. The maximum endometrial thickness recorded in group A was 6.9 mm and it also increased to 8.7 mm after G-CSF treatment and followed by in group B min thickness 4.8 mm increase to 5.2 mm and max thickness 6.8 mm increased to 8.7 mm. The mean±SD of ET (mm) on the day of ovarian trigger was 5.8±0.8 which increased to 7.4±0.8 in group A and followed by 5.9±0.6 to 7.1±0.9 in group B. ET mean change (mean±SD) for group A was 1.6±0.7 which was greater than the group B 1.3±0.8. Pregnancy rate was 2 (10%) in group A and 1(5%) in group B.Conclusions: Mean increase in endometrial thickness and pregnancy rate was higher in G-CSF group than normal saline group, but the difference was not statistically significant

Association of kisspeptin in patients with poly cystic ovarian syndrome

Background: Poly cystic ovarian syndrome (PCOS) is a complex multifactorial disorder, affecting millions of women worldwide. Kisspeptin, a hypothalamic peptide encoded by the KISS1 gene, is widely reported as a key factor in the regulation of luteinizing hormone (LH)/follicular stimulating hormone (FSH) secretion, which may be potentially involved with the development of PCOS. The aim of the study was to estimate the serum kisspeptin level in PCOS patients and evaluate the association of kisspeptin with other biochemical, and hormonal parameters in women with PCOS. Methods: This case-control study was conducted at the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from August 2020 to July 2021. A total of 90 patients between age 18-30 years were enrolled in this study. Data was collected on variables of interest by using the structured questionnaire designed for interview, observation, clinical examination, and biochemical investigation of the patients and analyzed by using the t-test, non-parametric test (Mann-Whitney U test) and chi-square test as appropriate. Results: We found no significant difference between PCOS & control group, but acanthosis nigricans (AN), waist hip (W:H) ratio were statistically significant in PCOS group. We found serum LH (11.98±6.29 mIU/ml), LH: FSH (1.71±0.92), AMH (10.09±3.8 ng/ml), fasting insulin (26.53±28.34 µU/ml), ovarian volume (16.91±4.57), was significantly higher in PCOS patients. Kisspeptin value in PCOS patients was 85.92±56.59 pg/ml and control group was 63.74±43.16 pg/ml. In the PCOS group, there was a positive correlation between kisspeptin and LH, AMH, and ovarian volume. Conclusions: Serum kisspeptin levels were similar in women with or without PCOS but positively correlated with ovarian volume, serum LH and AMH in PCOS patients

Improvement of semen quality after treatment with folic acid and zinc in subfertile men in a tertiary hospital

Background: The 50% of all male infertility is idiopathic, and there is currently no recognized treatment. The effectiveness of a nonprescription nutraceutical comprising eight nutrients on sperm quality in males with idiopathic infertility was studied. The aim of the study was to evaluate improvement of semen quality after treatment with folic acid and zinc in subfertile men. Methods: This prospective observational study was carried out in the infertility unit, department of obstetrics and gynaecology, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, Bangladesh from January 2018 to June 2020. Approval from local ethics committee was obtained for this study.Results: One hundred and twenty-five male subfertile patients were included in this study. Most men, 99 (79.2%) belong to more than 30 years, followed by 26 (20.8%) less than 30 years, range was 25 to 50 years. Mean ± SD age was 35.3±5.1 years. Rapid linear (RL) before treatment were 16.06±14.46 (mean ± SD) and after treatment were 22.82±13.40 (mean ± SD). Slow linear (SL) before treatment were 17.56±12.06 (mean ± SD) and after treatment were 19.75±9.25 (mean ± SD). Non progressive (NP) before treatment were 10.82±8.95 (mean ± SD) and after treatment were 10.12±7.34 (mean ± SD). Morphology of the sperm before treatment were 19.43±15.48 (mean ± SD) and after treatment were 30.18±19.12 (mean ± SD).Conclusions:  Our research findings fully correspond to the above research results, so it can be said that treatment of subfertile men with micronutrients like folic acid and zinc sulfate causes increase of semen quality and thus plays a key role in treatment of male subfertility