Conscious sedation for oocyte retrieval: Experience at a tertiary health facility in North‑Central, Nigeria

Background: A variety of anesthetic techniques have been used to make transvaginal oocyte retrieval (TVOR) safe and efficient. The optimal anesthetic technique during TVOR should provide safe, effective analgesia, few side effects, a short recovery time, and be nontoxic to the oocytes that are being retrieved. The concept of conscious sedation is widely accepted for the short‑term management of pain.Objective: This study assessed patient’s perception of pain using conscious sedation and in‑vitro fertilization (IVF) outcomes.Materials and Methods: A cross sectional study of 71 eligible patients that underwent assisted reproduction program in our facility. All clients were treated with antagonist protocol for controlled ovarian hyperstimulation. Self‑administered questionnaires were used as the research instrument. Pain was assessed using a 10 cm visual analogue scale (VAS), while client’s overall satisfaction was rated using Likert scoring system.Results: Client aged 33.2 ± 4.2 years. Most of them had primary infertility with mean duration of 4.5 ± 2.9 years. Unexplained infertility was the commonest cause of infertility. The pregnancy rate per embryo transfer was 47.9%, miscarriage rate was 5.6%, while the live birth rate was 42.3%. The mean VAS scores at 1 h, 6 h, 24 h and at embryo transfer were 4.9 ± 1.7, 2.5 ± 1.2, 1.3 ± 0.9, and 0.5 ± 0.6, while the Likert score was 3.8 ± 1.1.Conclusion: Conscious sedation with Midazolam and Pethidine is a safe, effective, and acceptable method of analgesia/anesthesia for TVOR. However randomized prospective studies with larger sample sizes are recommended. Key words: Conscious sedation; Nigeria; oocyte retrieval; tertiary health facility

Mullerian agenesis with primary amenorrhea: A case report of a normal phenotypic female

Meyer–Rokitansky–Kuster–Hauser syndrome is a rare congenital abnormality occurring sporadically in females. It is the most common cause of primary amenorrhea. Affected persons usually appear normal on physical examination. This is a case of a 25-year-old woman who presented with primary amenorrhea and, subsequently, had diagnostic laparoscopy to confirm the diagnosis of Mullerian agenesis

Evaluation de l’impact du contrôle des naissances sur le taux de fécondité en Afrique subsaharéenne

Using a cross-country data drawn from 40 countries and a multiple regression analysis, this paper examines the impact of birth control devices on the rate of fertility in sub-Saharan Africa. Our a-priori expectations are that the more women used birth control devices, the less will be the fertility rate in sub-Saharan Africa. The result obtained from the study indicates that except for withdrawal method that fall contrary to our expectation other variables (methods) like the use of pills, injection, intra uterine device (IUD), condom/diaphragm and cervical cap, female sterilization and periodic abstinence/rhythm fulfilled our a-priori expectations. These results notwithstanding, the paper suggests measures, such as the need for massive enlightenment campaign on the benefit of these birth control devices, the frequent checking of the potency of the devices and good governance in the delivery of the devices (Afr J Reprod Health 2009; 13[4]:137-145).Cette étude examine l’impact des méthodes du contrôle des naissances sur le taux de fécondité en Afrique subsaharéenne à l’aide des données à travers champs recueillies dans 40 pays et d’une analyse de la régression multiple. Nos espérances a priori sont que plus les femmes emploient les méthodes du contrôle des naissances, plus le taux de fécondité en Afrique subsaharéenne baissera. Le résultat obtenu montre qu’à part la méthode du coϊt interrompu qui a baissée contrairement à ce que nous nous attendions, les autres variables (méthodes) comme l’emploi des pilules, l’infection, le dispositif intra-utérin (DIU), le préservatif, la stérilisation féminine et l’abstinence périodique/le rythme ont satisfait toutes nos espérances a priori. Malgré ces résultats, l’étude propose des mesures telles la nécessité de lancer une grande campagne de sensibilisation sur les bienfaits de ces méthodes du contrôle des naissances, la vérification fréquentes de l’efficacité des méthodes et la bonne gouvernance en matière de la prestation de ces méthodes (Afr J Reprod Health 2009; 13[4]: 137-145)

Duration of labor with spontaneous onset at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background/Objective: Duration of labor varies from one pregnancy to another and a period of less than 12 hours is regarded as normal. Modern obstetric practice involves active management of labor with the aim of preventing prolonged labor and its sequelae. The main objective of this study was to determine and compare the average duration of labor of spontaneous onset between nulliparas (Po) and multiparas (P 65 1) and to determine factors affecting duration of labor. Materials and Methods: This study was a prospective study carried out between 15 May and 14 June 2004 at the Labor Ward of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Two hundred and thirty-eight women who satisfied the inclusion criteria were studied. The inclusion criteria were term pregnancy with vertex presentation, labor with spontaneous onset, live fetus at presentation and spontaneous vertex delivery. Results: The mean \ub1 SD admission-delivery interval in labor ward was shorter (3.77 \ub1 2.88 hours) among multiparas than that of nulliparas (5.00 \ub1 3.17 hours) (P = 0.235). The mean \ub1 SD duration of labor (from the onset of labor to delivery) was shorter among multiparas (8.73 \ub1 4.17 hours) than that of nulliparas (11.23 \ub1 4.29 hours) (P = 0.426). The differences were not significant (t-test, P > 0.05). Maternal age and individual parity had significant correlation with the duration of labor in this study (Pearson correlation = 120.019, 120.027, respectively, P < 0.05). Conclusion: Interestingly, duration of labor was not significantly different among multiparas and nulliparas although it was shorter. Correlation existed between duration of labor and maternal age and individual parity

Assisted reproduction technology: Comparison of clinical outcomes between day 3 and day 5 embryo transfers

BACKGROUND: Embryo transfer (ET) is a critical step in in vitro fertilization (IVF). Selecting the day of transfer for achieving the desired outcomes has been a great challenge. AIMS AND OBJECTIVES: The aim of this study was to compare the pregnancy rates of day 3 and day 5 ET in assisted conception. MATERIALS AND METHODS: This is a longitudinal prospective study of 122 eligible patients that underwent assisted reproduction program in our facility. All patients had controlled ovarian hyperstimulation using antagonist protocol. Patients with four or more zygotes were randomly allocated on day 1 to either day 3 or 5 transfers (58 vs. 64 patients). Fertilization was achieved through conventional IVF. Zygotes were kept in a single-step medium (Global total ®) for day 3 and 5 transfers, respectively. The morphologically best two or three embryos or blastocysts were chosen for transfer in both groups. RESULTS: The overall clinical pregnancy and live birth rates for both groups were 40.2% and 33.6%. There was no statistically significant difference between day 3 and day 5 transfer regarding clinical pregnancy rates (36.2% vs. 43.8% [P = 0.51]), live birth rates (27.6% vs. 9.1% [P = 1.0]), twinning rates (18.8% vs. 20% [P = 1.0]), and rates of early pregnancy loss (8.6% versus 4.7% P = [0.2]). CONCLUSION: In this study, the clinical outcomes of blastocyst transfer are similar to day 3 ET. This underscores the need for patient selection for the choice of days of ET. Further controlled randomized prospective studies with larger sample sizes are recommended