Subdermal contraceptive implant in post partum women: a prospective study in a single tertiary centre in Pahang, Malaysia: a preliminary study

Objective: The aim of the study was to evaluate the menstrual patterns and the effects of subdermal contraceptive implant, implanon®on breast feeding in post partum women during the first six months of insertion. Materials and methods: A prospective study was conducted over a one year period, from 1st July 2010 untill 30th June 2011 at outpatient gynecology clinic, Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Thirty-three post partum patients requested for implanon as contraceptive method participated in the study. All patients had implanon inserted between 4 to 10 weeks of pospartum and were follow-up after 3 months and six months after the insertion. Results: There were 33 women enrolled in the study. Mean age of the patients was 30 years (range 24-41 years). Of those, 17 patients delivered by caesarean section while 16 patients had vaginal delivery. During first visit, 57.6% had amenorrhoea, 21.2% had prolonged bleeding while the incidence of normal, and irregular bleeding were 15.1% and 6.1% respectively. In second visit, 63.6% had amenorrhoea, 6.1% had prolonged bleeding while the incidence of normal and irregular bleeding were 21.2% and 9.1% respectively. Only two patients seek medical treatment due to prolonged bleeding. 28 patients continue to breast fed their babies while 5 patients stopped breast feeding while on implanon. The majority of women expressed satisfaction to her implanon® use, only three patients were not satisfied mainly due to side-effects of prolonged or irregular bleeding. There was no removal after six months follow-up Conclusions: Implanon® is a good, well accepted long-term contraceptive method for post partum women and lactating mothers. Dissatisfaction of its use is mainly due to abnormal menstrual bleeding pattern

The outcome of the seminal fluid parameter collected via coitus interruptus versus mastubation

A one year study was carried out to determine the outcome of the seminal fluid parameters collected via masturbation and coitus interruptus in 151 patients who were undergoing intrauterine insermination (IUI) and patients who came for seminal analysis. There were no statistically significant difference in terms of volume, concentration, progressive motility and normal morphology from specimens collected via coitus interruptus compared to specimens collected via masturbation. Pregnancy outcomes were also comparable

Evaluation of bleeding pattern,side effect and satisfaction with subdermal contraceptive etonogesterel implant(implanon): a comparison between postpartum and non postpartum user

Objective : The aim of this study was to compare the bleeding pattern, side effects and level of satisfaction between postpartum and non post partum Implanon® users. Study design : A prospective study was conducted from July 2010 till June 2012 at Hospital Tengku Ampuan Afzan, Pahang. A total of 110 women ( 60 postpartum and 50 non postpartum women ) who had Implanon inserted, were followed up at 3 and 6 months after insertion. The bleeding pattern, side effects and satisfaction level were analyzed and compared accordingly. Result : The mean age for postpartum group was 31.2 and for non postpartum group was 33.6.There was no difference in body mass index and parity between these two groups. Majority of the Implanon® users were using Oral Contraceptive Pills as previous method of contraception. There was no difference in bleeding pattern at 3 months between postpartum and non postpartum women. However there was significant difference at 6 months for amenorrhoea and infrequent bleeding pattern (p value of 0.005 and 0.024 respectively). About half of the users from each group had the side effects of weight gain ( 53.3% postpartum vs 56.0% non postpartum ) There was significant difference of side effects of headache and acne between postpartum and non postpartum women. Despite the side effects, majority of the users from both groups satisfied with this method of contraception ( 93.3% of postpartum and 88.0% of non postpartum ). Conclusion : Implanon® is a highly effective long acting reversible hormonal contraception. Weight gain was the most common side effect reported. There was significant difference in bleeding patterns and non menstrual side effects between post partum and non postpartum users of Implanon® in the first six months of usage. The overall satisfaction was high among most users

Acupressure only as pain relief for patient with multiple drug allergies undergoing oocyte retrieval

In vitro fertilization (IVF) is associated with significant stress, which can affect the general wellbeing of the couple as well as the outcome of treatment. Oocyte retrieval (OR) is the fundamental step in the IVF/intracytoplasmic sperm injection (ICSI) cycle. Transvaginal ultrasound-guided OR (TVOR) is the most common method used in assisted reproductive technology (ART). However, even though TVOR is a short and minimally invasive procedure, it is stressful and undoubtedly painful. Such pain is due to the passage of a double-bore needle through the vaginal wall and ovarian capsule followed by mechanical stimulation within the ovary during the procedure

Back pain in pregnancy

Back pain or discomfort is common during pregnancy. It may be experienced during any point of pregnancy; even as early as the onset of pregnancy. However, the condition occurs most commonly later in the pregnancy as the weight of the baby increases. Berg and colleagues noted that about half of the 862 antenatal women developed some degree of low back pain. Seventy-nine women had severe enough low back pain stopping them to continue working and requiring referral to orthopaedic surgeon. Thus this condition should not be taken lightly- due to how common it is, and the fact that it can become severe.Women who are most at risk for back pain are those who are overweight or had back pain prior to pregnanc

IVF-ICSI split insemination reveals those cases of unexplained infertility benefitting from ICSI even when the DNA Fragmentation index is reduced to 15% or even 5%

The aim of the study was to assess the fertilization rate (FR) of randomized sibling oocytes inseminated by conventional IVF or ICSI in couples with unexplained infertility. Methods The 16-month study was conducted at an established private IVF facility. Oocytes recovered from couples with normal semen parameters and normal DNA fragmentation index (DFI; <30%), were randomly allocated to IVF or ICSI and the FR (2PN/MII) was assessed. Pregnancy outcome following embryo transfers were analyzed with regards to either IVF-embryo vs. ICSI-embryo, and in relation to DFI levels. Results Of 585 oocytes retrieved from 38 patients, 463 were mature (MII). The ICSI group generated a significantly higher number of 2PN embryos with a mean FR of 83.4% vs. 67.6% (p<0.05). There were no cases of complete fertilization failure (CFF) in the ICSI group, but there were 7.9% in the IVF group. The significant difference of FR was observed only when the DFI level was ≥ 15% and if such cutoff was applied, the CFF cases would be reduced to 2.6%. Of the 30 patients who had fresh embryo transfers performed, the ICSI group showed a higher pregnancy rate (69.2% vs. 58.8%; N.S.) with a significantly higher mean DFI value in the non-pregnant group (p<0.05). Conclusions IVF-ICSI split insemination can reveal those cases which will benefit from ICSI even where semen parameters and DFI are normal; however if the DFI is reduced to a 15% cut-off level, the rate of CFF will be minimized, but not completely excluded, even at 5%.

Unexpected ovarian malignancy after conservative laparoscopic surgery: five case series in a half decade of experience

Aims To analyse and describe cases of unexpected ovarian malignancy after conservative laparoscopic surgery for an apparent benign ovarian mass at our centre. Methods This retrospective study was performed by collecting data from records of premenopausal women who underwent conservative laparoscopic surgery for benign ovarian mass at Siriraj Hospital over a 5 year period from 2006 to 2010. The rate of unexpected malignancy, histopathological type of the ovarian neoplasm and follow-up after surgery were reviewed. Results During the study period, 1,161 patients underwent conservative laparoscopic surgery. Of these, five (0.43%) had ovarian malignancy which were diagnosed after reviewing histopathological report postoperatively. The histopathological diagnosis was borderline tumour in two patients, clear cell carcinoma, granulosa cell tumour and mucinous cell adenocarcinoma in the other three patients. All patients are alive after a mean follow-up of 9–60 months with two patients developed recurrence. Conclusion The main concern for laparoscopic management of ovarian masses is unexpected malignancy. However, with careful patient selection, proper technique and an experienced operator, laparoscopic treatment of ovarian masses is the best approach and should be implemented, with low risk of unexpected malignancy and recurrence