Correlation of serum thyroid hormones and prolactin levels to female infertility

Background: Infertility is defined as inability to conceive after one year of regular intercourse without contraception. Thyroid dysfunction is known to interfere with several aspects of reproduction and pregnancy. Hyperprolactinemia also adversely affects the fertility potential by affecting pulsatile secretion of Gonadotropin releasing hormone (GnRH) and hence interfering with ovulation. Measurement of these hormones is considered an important component of female infertility work up.Methods: 100 infertile women are recruited into the study (Study group). 100 healthy fertile women were taken as controls (control group). Thyroid and Prolactin levels estimated in both groups.Results: Among the study group, 81% were with primary infertility and 19% were with secondary infertility. The mean age of the study group was 25.95±3.79.  26% of infertile women with primary infertility were in overweight and obese groups. 3% with secondary infertility were overweight. 34% of women with primary infertility were with Thyroid problems.18% of the hypothyroids were in the overweight and obese groups. Prevalence of hyperprolactinemia was 34% in study group with mean Prolactin levels of 21.84±15.65. 15% of women with hyperprolactinemia were overweight. 62.5% of hyperprolactinemics with associated hypothyroidism the rest with hyperthyroidism. These values when compared with controls showed significant p value 0.012.Conclusions: Identifying and treating hypothyroidism and hyperprolactinemia at an early stage can have potentially great preventive value in the screening of all infertile females hence should be included in the primary workup of the infertility female

Gestational diabetes mellitus-universal versus selective screening

Background: The prevalence of diabetes mellitus is increasing globally and Indian population is found to be ethnically in high risk group. Gestational diabetes mellitus (GDM) offers a unique and valuable opportunity for the development and implementation of clinical strategies for future prevention of diabetes. There is immense need for optimal screening strategies to spot out women with gestational diabetes.Methods: Prospective case study.1000 pregnant women were recruited into the study at an early gestational age (26 years. labor outcome by caesarean section in GDM cases was up to 60% and 51.3% being elective sections. On the whole neonatal outcome was satisfactory.Conclusions: As Indian population are ethnically more prone for diabetes, there is immense need to adopt universal screening for GDM in pregnancy. Thus, a timely action can be taken as depicted in the present study by screening all pregnant women, irrespective of the presence/absence of risk factors

Isosexual precocious puberty with primary hypothyroidism: an interesting case report

Isosexual precocious puberty in a girl child is defined as thelarche before 6 years in African–Americans and 7 years in Caucasians and menarche before the age of 9 years. In 1960, Van Wyk and Grumbach first described a syndrome characterised by breast development, uterine bleeding and multicystic ovaries in the presence of long standing primary hypothyroidism. We describe an interesting case of 8 year old girl presented with the complaint of abdominal mass with history of premature menarche and breast development. She is found to have gross hypothyroidism, hyperprolactinemia, prepubertal LH levels, multicystic ovaries and delayed bone age. Thyroid replacement amazingly settled her problems bringing her to normalcy.

Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition

Comparative study of induction of labour with dinoprostone gel versus mechanical dilatation in unfavorable cervix (low Bishops Score)

Background: Induction of labour is defined as initiation of uterine contractions before spontaneous onset of labour. This observational study compares the effect of prostaglandin E2 (PGE2) and extra amniotic saline infusion (EASI) for pre-labour ripening of unfavourable uterine cervix. Methods: This is a prospective and randomised study was conducted in the Department of Obstetrics and Gynaecology, in a tertiary care teaching hospital over a period of six months. Patient admitted for induction of labour were randomized to receive intravaginal dinoprostone or intracervical Foley’s catheter. Patient not entering active labour and having rupture membranes or arrest of dilatation received IV oxytocin. Results: A total of 140 women with gestational ages of 37-42 wks were enrolled in this study. Of the 140 pregnant women, 70 were assigned to the PGE 2 group and 70 to the foley’s group. Baseline characteristics of both groups were similar including age, gravidity, parity. The mean gestational age was statistically higher in the PGE2 group; however, this was clinically not significant. Overall indication for induction were also similar across intervention apart from more small for gestational age (SGA) or IUGR induction being performed with Foleys catheter. Additionally, cervical station at the time of induction did not differ across intervention group. Conclusions: Group A was associated with more rapid cervical ripening, shorten induction to vaginal delivery interval and greater no. of vaginal deliveries within 24 hours

Impact of socio-economic status on ovarian reserve markers

Background: Fertility rates have started declining in India in the last few decades. The total fertility rate, which was 3.5 in 93-94 declined to 2.5 in 2005-6. Researchers attribute this fertility transition to concomitant socio-economic development. Decreasing ovarian reserve is an important contributor for age related infertility. Objectives: The objective of this study was to assess the association of ovarian reserve with socio-economic status (SES) with the available clinical ovarian reserve markers in reproductive age women. Materials and Methods: A total of 160 married women in the age group of 20-35 years, belonging to all three socio-economic strata were assessed for ovarian reserve using the clinical ovarian reserve parameters Antimullerian hormone (AMH), Antral follicle count (AFC) and follicular stimulating hormone (FSH). Analysis of variance was used to see the association of ovarian reserve with SES. Results: Both the ovarian parameters AMH and AFC have shown a significant association with SES (P = 0.000 for AMH and P = 0.023 for AFC). The association between FSH and SES was not significant (P = 0.147). Conclusions: Higher SES in this study was seen to be associated with better ovarian reserve as assessed by the available clinical ovarian reserve markers

Knowledge and Attitude Among Para-Medical and Non-Medical Staff in a Tertiary Care Teaching Hospital on Cervical Cancer Screening and Diagnosis

Introduction: Cervical cancer is the fourth most common cancer and also the fourth leading cause of cancer-related deaths in women globally. To improve the participation of women in the cancer screening program.Materials and methods:This Questionnaire based observational cross-sectional study was conducted in Department of Obstetrics and Gynaecology at a tertiary care teaching hospital. These individuals working in the hospital are in constant access to health-related information and are a bridge between the health care and society.The subjects were asked to fill a pre-planned questionnaire. The questionnaire included demographic enquiries and twenty questions regarding knowledge and attitude about cervical cancer screening and diagnosis. A verbal questionnaire was read out to subjects who were unable to comprehend the question and then responses were recorded verbatim immediately.The responses were analysed using descriptive analysis regarding their knowledge and attitude about cervical cancer, its associated problem, its screening and diagnosis.Conclusion: It is also alarming that a very small proportion of the participants had correct information regarding the age group and the sex to be vaccinated. The results of our study demonstrate a need for increased awareness of Human papillomavirus (HPV) and the HPV vaccine to increase vaccine uptake rates. Continuing medical education programs for health professionals; doctors and nursing staff should be conducted at the hospital level to spread knowledge about cervical cancer prevention

Correlation of serum thyroid hormones and prolactin levels to female infertility

Background: Infertility is defined as inability to conceive after one year of regular intercourse without contraception. Thyroid dysfunction is known to interfere with several aspects of reproduction and pregnancy. Hyperprolactinemia also adversely affects the fertility potential by affecting pulsatile secretion of Gonadotropin releasing hormone (GnRH) and hence interfering with ovulation. Measurement of these hormones is considered an important component of female infertility work up.Methods: 100 infertile women are recruited into the study (Study group). 100 healthy fertile women were taken as controls (control group). Thyroid and Prolactin levels estimated in both groups.Results: Among the study group, 81% were with primary infertility and 19% were with secondary infertility. The mean age of the study group was 25.95±3.79.  26% of infertile women with primary infertility were in overweight and obese groups. 3% with secondary infertility were overweight. 34% of women with primary infertility were with Thyroid problems.18% of the hypothyroids were in the overweight and obese groups. Prevalence of hyperprolactinemia was 34% in study group with mean Prolactin levels of 21.84±15.65. 15% of women with hyperprolactinemia were overweight. 62.5% of hyperprolactinemics with associated hypothyroidism the rest with hyperthyroidism. These values when compared with controls showed significant p value 0.012.Conclusions: Identifying and treating hypothyroidism and hyperprolactinemia at an early stage can have potentially great preventive value in the screening of all infertile females hence should be included in the primary workup of the infertility female

Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section