International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Three cases of primary amenorrhoea
Get PDFThree interesting series of cases in young ladies who reported with history of primary amenorrhoea with surprisingly different presentation, symptoms, clinical signs and findings requiring two entirely different algorithms which this article attempts to explain to emphasize the art of history taking and clinical examination in women. This article attempts to present the importance of effective communication to the patient and understand different concerns in different women, communities, age groups and a plethora of presentation
The influence of thyroid hormone replacement on endometrial receptivity in infertile women
Get PDFBackground: Infertility affects 10–15% of couples worldwide, with thyroid dysfunction-especially hypothyroidism-recognized as a significant modifiable contributor. Thyroid hormones influence reproductive health by regulating ovulation, endometrial receptivity, and hormonal balance. This study aimed to assess the impact of thyroid hormone replacement (levothyroxine) on endometrial receptivity and conception outcomes in infertile women diagnosed with clinical or subclinical hypothyroidism.
Methods: Conducted as a prospective observational study at GS Medical College and Hospital, Hapur (2023–2025), it included 60 women aged 21–40 years with clinical or subclinical hypothyroidism. Participants underwent detailed clinical assessments, hormonal profiling (TSH, T3, T4, prolactin), and pelvic ultrasonography. Levothyroxine therapy was initiated and adjusted over a 3–12-month follow-up. Outcomes measured included hormonal normalization and pregnancy (via urine pregnancy test).
Result: Results showed a significant decline in TSH (12.07±8.4 to 6.26±2.96 mIU/l) and prolactin (13.9±5.67 to 10.9±3.96 ng/ml) levels post-treatment (p<0.001). Conception occurred in 61.5% of women with subclinical and 57.1% with clinical hypothyroidism, with no significant difference (p=0.956). Maximum conception was noted in women with mid-range TSH (6.5–10 mIU/l). Levothyroxine therapy improved hormonal profiles and supported conception across both groups.
Conclusion: The study concludes that early diagnosis and treatment of even mild hypothyroidism can enhance fertility outcomes, underscoring the importance of routine thyroid screening in infertility evaluations
Comparison of butorphanol-drotaverine versus tramadol-drotaverine as labour analgesics: an observational comparative study
Get PDFBackground: Labour pain is a significant challenge in obstetric care, with effective pain management being essential for maternal well-being and labor outcomes. Epidural analgesia, the gold standard, is often inaccessible in resource-limited settings. Parenteral opioids like butorphanol and tramadol, combined with drotaverine, may provide an effective, low-cost alternative. To compare the effectiveness of butorphanol-drotaverine versus tramadol-drotaverine as labour analgesics in terms of maternal pain relief, labour outcomes and fetal outcomes.
Methods: This observational, prospective, single-center study was done on 300 low-risk primigravid women in active labor where Butorphanol 1 mg+Drotaverine 40 mg was given to 150 patients (Group B) and Tramadol 100 mg+Drotaverine 40 mg was given to another 150 patients (Group T). Maternal pain was assessed using the Visual Analog Scale (VAS) at various time intervals. Labor progress, mode of delivery and side effects were monitored, along with fetal outcomes including Apgar scores and NICU admissions.
Results: Both analgesic combinations provided effective pain relief, with Butorphanol providing quicker pain relief while as more sustained pain reduction was obtained with Tramadol. However, there were no significant differences in labor duration, mode of delivery or neonatal outcomes. Nausea was more common in the Tramadol group. Both drugs were well-tolerated, with minimal adverse effects.
Conclusions: Both Butorphanol and Tramadol are effective for labor analgesia, with Butorphanol providing faster pain relief. These opioids offer a cost-effective alternative to epidural analgesia, especially in resource-limited settings, ensuring access to pain relief for all women during labor
Optimizing sperm function: examining the correlation between sperm preparation techniques and membrane integrity plus capacitation dynamics
Get PDFBackground: Sperm preparation is a critical step in Assisted Reproductive Technology (ART) that significantly impacts sperm quality and fertilization potential. Membrane integrity and capacitation are the most significant parameters to assess sperm function, but methods like Swim-Up (SU) and Density Gradient Centrifugation (DGC) could influence these values by inducing mechanical damage.
Methods: Ninety normozoospermic semen samples were obtained from ART patients and randomly divided into three groups (n=30 per group). Samples were processed by SU, DGC, or Microfluidics (MF) techniques. Initial motility and post-processing membrane integrity were evaluated according to routine protocols, including the Hypo-Osmotic Swelling Test. Statistical analysis was done with one-way ANOVA.
Results: Initial motility was uniformly high across all groups (SU: 99%, DGC and MF: 100%). However, post-processing membrane integrity varied significantly (p<0.0001), with MF showing the highest integrity (86.03±1.98%), followed by SU (78.44±2.70%) and DGC (67.52±3.72%). Microscopic analysis corroborated these findings, indicating superior morphological preservation in the MF group.
Conclusion: Microfluidics significantly outperforms traditional sperm preparation methods in preserving sperm membrane integrity at the cost of no motility compromise. Its adoption into ART protocols can potentially enhance sperm selection and deliver better treatment outcomes for fertility treatment
The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding
Get PDFPostmenopausal bleeding (PMB) is a clinically relevant symptom that should be evaluated promptly due to its linkage to endometrial pathology, including endometrial cancer. For women who present with PMB, transvaginal ultrasonography (TVUS) has become a first-line, non-invasive imaging method for assessing the endometrium. The objective of this review article is to compile the most recent data regarding the diagnostic utility, uses, limitations, and technological advancement of transvaginal ultrasonography in evaluating endometrial pathology in postmenopausal women. Recent clinical research, case reports, and multicentre trials were thoroughly examined with an emphasis on the use of TVUS in the diagnosis of endometrial atrophy, hyperplasia, polyps, fibroids, and cancer. Further assessment was conducted on its usefulness in specific groups, including women on hormone replacement therapy (HRT) and those experiencing recurrent PMB. With a cut-off value of less than 4 mm, TVUS has a good negative predictive value for endometrial cancer and is useful for evaluating endometrial thickness. It greatly lessens the need for invasive procedures in low-risk patients, but it cannot replace a histopathology. Diagnostic accuracy has increased due to recent advancement including 3D imaging, Doppler flow analysis, and artificial intelligence integration. Its usefulness in directing therapeutic management and enhancing early diagnosis is supported by case studies and clinical trials. For the first assessment of postmenopausal bleeding, transvaginal ultrasonography is an essential, safe, and cost-effective procedure. Its increased usage in gynaecologic diagnostics is supported by its high sensitivity and recent technological advancements, but histological confirmation is still necessary in cases where questionable results are found
Study of fetomaternal outcome in oligohydramnios in term pregnancy and its correlation with non-stress test
Get PDFBackground: A reduced volume of amniotic fluid, known as oligohydramnios, complicates about 1-5% of pregnancies and is frequently linked to poor perinatal outcomes. A diagnostic criterion for oligohydramnios is an amniotic fluid index (AFI) of ≤5 cm. The AFI is used to quantify the volume of amniotic fluid. The purpose of this study was to examine the perinatal outcomes in term pregnancies with oligohydramnios and compare them to the findings of the non-stress test (NST), a test used to evaluate the health of the fetus.
Methods: A tertiary care hospital held this prospective observational study. One hundred pregnant women with singleton term pregnancies (≥37 weeks gestation) who have been diagnosed with oligohydramnios (AFI≤5 cm) are included in this study. Demographic information, NST results, delivery method, and perinatal outcomes were gathered and analyzed using the proper statistical techniques.
Results: The study population's mean age was 25.12. Women who were multigravida made up 71% of the participants. Fetal distress was the main indication (56%), and the rate of lower segment cesarean section (LSCS) was 43%. A higher rate of LSCS (87%), low birth weight (<2.5 kg) (69.6%), and NICU admission (26%) were all substantially correlated with a non-reactive NST.
Conclusions: Oligohydramnios during term pregnancy is associated with a high incidence of LSCS. A non-reactive NST in the presence of oligohydramnios is a strong predictor of poor perinatal outcomes, such as increased rates of operative delivery, low birth weight, and NICU admission. As a result, careful fetal surveillance, including NST, is critical in managing such pregnancies in order to improve perinatal outcomes
Microbiome matters: the hidden influence of gut flora on male reproductive health
Get PDFMale infertility is a complex disorder that affects about half of all cases worldwide. An increasing amount of research shows that the human microbiome has a significant impact on male reproductive health. Current understanding of how the gut, semen, and testicular bacteria affect reproductive results is studied in this review. Although bacteriospermia and poor semen parameters were linked in early culture-based investigations, microbial cultivation limits forced the use of sophisticated molecular approaches. The previous presumption of sterility has subsequently been challenged by metagenomic sequencing, especially next-generation sequencing (NGS), which has shown complex microbial communities in semen and testes. Changes in microbial composition, particularly in semen samples linked to assisted reproductive technologies (ART) and idiopathic non-obstructive azoospermia (iNOA), indicate dysbiosis may jeopardise sperm quality and the effectiveness of ART. Furthermore, a reciprocal relationship impacting hormonal balance and fertility is highlighted by interactions between the gut microbiota and androgen metabolism via the brain–gut–testis axis. Although the exact mechanisms are yet unknown, prebiotic and probiotic treatments have demonstrated promise in enhancing sperm motility, morphology, and DNA integrity. Current research is hindered by uneven methodology, a dearth of longitudinal data, and a lack of functional evaluations of spermatozoa, despite promising results. To demonstrate causality and therapeutic promise, future microbiome research must include stringent controls, longitudinal sampling, and thorough fertility evaluations. Knowing how the microbiome affects male fertility may help develop new probiotic-based therapies and diagnostic biomarkers, especially for cases of idiopathic infertility
Ovarian torsion in early pregnancy: a rare case of twisted functional cysts with preserved pregnancy
Get PDFOvarian torsion during early pregnancy is a rare but critical surgical emergency. We present a case of a 28-year-old G6P4 patient at 7 weeks gestation who presented with acute pelvic pain and was diagnosed with bilateral ovarian torsion secondary to functional cysts. Ultrasound revealed two large cysts (57 mm and 49 mm) with characteristic "whirlpool sign." Emergency laparoscopic detorsion and cystectomy were performed, preserving ovarian tissue and maintaining the pregnancy. Postoperative management included progesterone support with favorable outcomes at 2-month follow-up. We review the pathophysiological mechanisms predisposing to torsion in early pregnancy, including β-hCG-induced cyst formation and increased adnexal mobility. The discussion emphasizes that ovarian preservation should be attempted even in cases of apparent ischemia, as functional recovery is often possible. This report adds to the limited literature on bilateral torsion in pregnancy and demonstrates that excellent outcomes can be achieved with timely, minimally invasive surgery combined with appropriate hormonal support
Uterine perforation in a 27-year-old woman, a rare complication of copper intra-uterine device: a case report
Get PDFUterine perforation by copper intra-uterine device (IUD) though rare presents as a management challenge to the clinician. A 27-year-old woman of African descent presented with missing strings of a copper IUD that was inserted 2 weeks ago. Ultrasonography (USG) showed device outside the uterus. The initially planned laparoscopic removal at a teaching hospital was unsuccessful due to diagnostic challenges. Copper IUD was successfully removed by laparotomy under USG guidance. Copper IUD is a safe and effective method of contraception. Uterine perforation is a rare complication. Early identification, counselling and prompt removal are necessary to avert further complications
Management options of uterine leiomyoma patients admitted to a tertiary care hospital
Get PDFBackground: Uterine fibroids (UFs), or uterine leiomyomas (UL), are the most common benign tumors of the female reproductive system, affecting a significant proportion of women of reproductive age. This study aims to evaluate the management strategies of UFs to optimize treatment approaches and patient outcomes.
Methods: This cross-sectional study observational study was conducted department of obstetrics and gynecology, Shaheed Suhrawardy medical college hospital, Dhaka, from January 2022 to July 2022. A total of 100 women with fibroid were considered as study subjects by purposive sampling technique. Data analysis was done by statistical package of social sciences (SPSS) version 20.0.
Results: The study highlights that UFs affect 20% to 80% of women by the age of 50, with an estimated global prevalence of 171 million cases. The incidence is 2 to 3 times higher among Black women than White women and first-degree relatives have a 2.2 times greater risk of developing fibroids. Imaging studies suggest that 3% to 7% of untreated fibroids in premenopausal women regress over 6 months to 3 years. Hysterectomy, the definitive treatment, accounts for 40% to 60% of all hysterectomies performed due to fibroids.
Conclusions: In this study, it is observed that women with leiomyoma present with variable signs and symptoms. Menstrual disturbance, dysmenorrhea, pain in the lower abdomen, and anemia were the common clinical features. Almost half of the patients were managed by medical treatment whereas the rest of the portion was managed by either medical or surgical management and a few cases were managed by both medical and surgical treatment