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

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 > 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

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

Zinc supplementation in male infertility

Background: Inferile males have been shown to have lower levels of seminal plasma zinc which have been associated with reduced levels of zinc in their blood. Supplementation improve semen parameters by improving zinc level in blood.  Objective: To fnd out whether zinc supplementation is effective in improving semen parameters in oligo­asthenozoospermic patients. Method: The study was carried out in the Infertility unit of the Dept of Obs & Gynae, BSMMU during the period of March 2011 to February 2012. Seventy five oligo-asthenozoospermic patients having no history of medical treatment were recruited for the study. The patients were divided into two groups by odd and even numbers. Odd numbers received tablet zinc 20 mg twice daily (Group A) and even numbers received placebo (Group B).Serum zinc level and seminal zinc level estimation were done by Graphite Furnace Atomic Absorption Spectropho­tometry and semen analysis was done according to WHO guidelines (1999). Data analysis was done using software SPSS (version 16) by applying ANOVA (PostHock) and Paired Student's 't' test. Results: Serum zinc level was low in oligo­zoospermic patients which showed significant improvement with zinc supplementation (A+ 197.83 mmol/1, P<0.01). Mean (±SD) seminal plasma zinc level showed significant improvement in group A following zinc supplementation (+942.39 mmol/L, P<0.001). The mean increase in sperm count, sperm motility, sperm rapid linear motility, sperm morphology in group A following zinc supplementation for 12 weeks was 14.83 million/ml (P<0.01), 16.30% (P<0.01), 11.96% (P<0.01), 4.26% (P<0.001) respectively, which was statistically significant. Conclusion: The study shows zinc deficiency affects sperm count, sperm motility, rapid linear motility and sperm morphology and with zinc supplementa­tion there can be significant improvement in semen parameters

Zinc supplementation in male infertility

Background: Inferile males have been shown to have lower levels of seminal plasma zinc which have been associated with reduced levels of zinc in their blood. Supplementation improve semen parameters by improving zinc level in blood. Objective: To fnd out whether zinc supplementation is effective in improving semen parameters in oligo­asthenozoospermic patients.Method: The study was carried out in the Infertility unit of the Dept of Obs &amp; Gynae, BSMMU during the period of March 2011 to February 2012. Seventy five oligo-asthenozoospermic patients having no history of medical treatment were recruited for the study. The patients were divided into two groups by odd and even numbers. Odd numbers received tablet zinc 20 mg twice daily (Group A) and even numbers received placebo (Group B).Serum zinc level and seminal zinc level estimation were done by Graphite Furnace Atomic Absorption Spectropho­tometry and semen analysis was done according to WHO guidelines (1999). Data analysis was done using software SPSS (version 16) by applying ANOVA (PostHock) and Paired Student's 't' test.Results: Serum zinc level was low in oligo­zoospermic patients which showed significant improvement with zinc supplementation (A+ 197.83 mmol/1, P&lt;0.01). Mean (±SD) seminal plasma zinc level showed significant improvement in group A following zinc supplementation (+942.39 mmol/L, P&lt;0.001). The mean increase in sperm count, sperm motility, sperm rapid linear motility, sperm morphology in group A following zinc supplementation for 12 weeks was 14.83 million/ml (P&lt;0.01), 16.30% (P&lt;0.01), 11.96% (P&lt;0.01), 4.26% (P&lt;0.001) respectively, which was statistically significant.Conclusion: The study shows zinc deficiency affects sperm count, sperm motility, rapid linear motility and sperm morphology and with zinc supplementa­tion there can be significant improvement in semen parameters

Zinc supplementation in male infertility

Background: Inferile males have been shown to have lower levels of seminal plasma zinc which have been associated with reduced levels of zinc in their blood. Supplementation improve semen parameters by improving zinc level in blood. Objective: To fnd out whether zinc supplementation is effective in improving semen parameters in oligo­asthenozoospermic patients.Method: The study was carried out in the Infertility unit of the Dept of Obs &amp; Gynae, BSMMU during the period of March 2011 to February 2012. Seventy five oligo-asthenozoospermic patients having no history of medical treatment were recruited for the study. The patients were divided into two groups by odd and even numbers. Odd numbers received tablet zinc 20 mg twice daily (Group A) and even numbers received placebo (Group B).Serum zinc level and seminal zinc level estimation were done by Graphite Furnace Atomic Absorption Spectropho­tometry and semen analysis was done according to WHO guidelines (1999). Data analysis was done using software SPSS (version 16) by applying ANOVA (PostHock) and Paired Student\u27s \u27t\u27 test.Results: Serum zinc level was low in oligo­zoospermic patients which showed significant improvement with zinc supplementation (A+ 197.83 mmol/1, P&lt;0.01). Mean (±SD) seminal plasma zinc level showed significant improvement in group A following zinc supplementation (+942.39 mmol/L, P&lt;0.001). The mean increase in sperm count, sperm motility, sperm rapid linear motility, sperm morphology in group A following zinc supplementation for 12 weeks was 14.83 million/ml (P&lt;0.01), 16.30% (P&lt;0.01), 11.96% (P&lt;0.01), 4.26% (P&lt;0.001) respectively, which was statistically significant.Conclusion: The study shows zinc deficiency affects sperm count, sperm motility, rapid linear motility and sperm morphology and with zinc supplementa­tion there can be significant improvement in semen parameters