Online ISSN: 2515-8260

Keywords : Infertility


Comparative study of pipelle device versus conventional dilatation and curettage for endometrial sampling in diagnosis of endometrial pathology causing abnormal uterine bleeding or infertility in women > 25 years of age

Dr. Samita Bhat, Dr. Rooma Sinha, Madhumati Sanjay, Bana Rupa, Dr. Fozia Jelani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1588-1596

Background: Abnormal Uterine bleeding (AUB) is a cause of significant healthcare burden for the women, common methods for endometrial assessment are USG, hysteroscopy, D&C, however multiple newer outpatient method are becoming popular due to their ease of application and cost effectiveness. Present study was aimed to compare the diagnostic accuracy and histopathological success of Pipelle verses conventional curettage in diagnosing endometrial pathology in AUB cases.
Material and Methods: Present study was single-center, Prospective and comparative single blind study, conducted women aged 25 years, with complaints of abnormal uterine bleeding with or without infertility. Initially, endometrial sample was collected by pipelle sampler in the outpatient department followed by endometrial biopsy by curettage under general anesthesia.
Results: Out of 106 patient’s majority were from 40-60 years age group, had 2 or more parity. Majority had abnormal uterine bleeding alone (77.36%), infertility alone (10.37%) & infertility with abnormal uterine bleeding (12.26%). Common USG findings were endometrial polyp (19.81%), fibroid uterus (10.38%), adenomyosis (3.77%), cystic endometrium (3.77%) and Thickened Endometrium (1.89%). In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%. In the premenopausal women the sensitivity, specificity, NPV & PPV are all 100% for Pipelle sample as compared to curettage. In the postmenopausal women, specificity & PPV was 100%, however sensitivity was 66% and NPV was 95.2%.
Conclusion: In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%.

A STUDY ON ROLE OF DIAGNOSTIC HYSTERO- LAPAROSCOPYIN EVALUATION OF FEMALE INFERTILITY AT TERTIARY CARE CENTRE

Vege Vishnu Santhi, Sajana Gogineni, K.B. Gayathri

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11771-11779

Background:Living as an involuntarily childless woman is challenging for feminity and female roles in society. Infertility affects about 10-15% of reproductive age couples. WHO estimates that 60-80 million couples worldwide currently suffer from infertility. The causes of female infertility are multifactorial and necessitate comprehensive evaluation. Laparoscopy with chromopertubation is viewed as the “gold standard” test for tubal assessment. Adding Hysteroscopy to the procedure allows for concomitant evaluation of intrauterine cavity. With this preview, my study aims at evaluating the role of diagnostic hystero-laparoscopy as a safe & cost- effective tool for assessment of unexplained female infertility.
Materials and Methods: An observational hospital based study on 260 patients was carried out in a tertiary care centerDr. PSIMS &RF, Vijayawada, Andhra Pradesh, India -over a period of 2.5 years from October 2019 to April 2022. Women aged 18-40yr with normal hormone profile without male factor infertility were included.
Results: Out of 260 cases, 60.93% patients had primary infertility. PCOS was found to be the most commonly associated with primary infertility. Whereas the most common causes of secondary infertility were found to be PID, endometriosis and endometrial polyps each respectively. Hysterolaparoscopy revealed intrauterine lesions and therapeutic measures like ovarian drilling, lysis of intrauterineadhesions, cystectomy, polypectomy and septal resection were carried out.
Conclusion: Hysterolaparoscopy is an effective diagnostic tool for evaluation of correctable tuboperitoneal pathologies like endometriosis, polycystic ovaries, adnexal pathologies and subseptate uterus which are usually missed by other imaging modalities. When done by a trained and experienced investigator and with proper selection of patients, hysterolaparoscopy proves to be a definitive investigative procedure for evaluation of female infertility. It also helps in formulation of a treatment modality.

A prospective assessment of the suitability of Letrozole as ovulating induction agent in patients with PCOS induced infertility

Dr. R Swapna, Dr. Akila Sree Gowri

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1404-1409

Aim: to evaluate Letrozole as suitable ovulating induction agent in patients with PCOS induced infertility. Material & Method: The main source of data for this study are the women with primary and secondary infertility with anovulation attending the Department of Obstetrics & Gynecology, RVM Institute of Medical Sciences and Research Centre, Siddipet, Telangana, India. This is a prospective study with a total of 200 women satisfied the inclusion and exclusion criteria of the study. The present study consists of cases of infertility due to anovulation which were thoroughly evaluated before the diagnosis of anovulation was confirmed. Results: In this study mean age of the patients were 28.0 years and mean age of husbands were 32.4 year. 105 patients underwent diagnostic hysterolaparoscopy with chromopertubation + ovarian drilling. Conclusion: Letrozole can be considered as suitable ovulating induction agent in patients with PCOS induced infertility. It is a better drug in terms of mono follicular ovulation and better endometrial thickness than other ovulation induction agents. It has high ovulation rate with significant conception rate, with only drawbacks being miscarriages.

Analysis of Effectiveness of Fertility Promoting Laparoscopy Surgery: An Institutional Based Study

Avantica Agarwal, Shiv Lahari Agrawal, Lokesh Kumar Aggarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5263-5267

Background: Infertility is a major cause of morbidity in women with different pelvic
pathologies (like fibroid, endometriosis, tubal defects, etc.). The present study was
conducted to analyze the effectiveness of fertility promoting laparoscopy surgery.
Materials and Methods: 400 cases of operative laparoscopies were performed for
correction of pelvic pathology by single surgical team over a period of 2 year. Routine
preoperative investigations, checkup and preparations for laparoscopy were
undertaken. Laparoscopic or open myomectomy is to be decided according to situation.
The pregnancy outcome following surgical corrections was noted.
Results: A total of 400 cases of laparoscopic surgeries performed in infertile women. It
was observed that tubal defects were found in in 195 out of 400 cases i.e., 48.75% (minor
tubal defects were 65 out of 195 i.e., 16.25% and 130 out of 195i.e., 32.5% women had
major defects). Ovarian pathologies were found in 78 out of 400 (19.5%) women
followed by endometriosis which were found in 58 out of 400 (14.5%)infertile women. It
was observed that the pregnancy rate after laparoscopic surgery remained 7.69% (5 out
of 65) in major tubal defects and 15.39% (20 out of 130) in minor defects. Pregnancy
rate after laparoscopic surgery was maximum in women who recovered from adhesions
in POD (44.44% i.e., 8 out of 18) followed by women with ovarian pathology (29.48%
i.e., 23 out of 78).
Conclusion: The present study concluded that pregnancy rate after laparoscopic
surgery was maximum in women who recovered from POD followed by women with
ovarian pathology.

A study on relation between hormonal parameters and risk markers in infertility

Dr. Arun William, Dr. Viji Krishnan, Dr. Dinesh Roy D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2033-2037

One in every four couples in developing countries is affected by infertility. The magnitude of the problem calls for urgent action, particularly when the majority of cases of infertility are avoidable. Of 60-80 million couples suffering from infertility every year worldwide, probably between 15 and 20 million (25%) are in India alone. A case-control study layout was adopted for the present study on relation between hormonal parameters and risk markers in infertility the test subjects were referred from various infertility clinics were chosen for the study. Out of 150 study subjects, 100 infertile women showed increased FSH concentration and they revealed increased MDA concentration, mean b/c value and mCBMNF. Infertile women with low concentration of estradiol demonstrated an elevated MDA concentration, mCBMNF and mean b/c value than others with increased level of estradiol. Out of 150 study subjects, 115 individuals showed an increased PRL concentration and they revealed increased values of MDA concentration, mCBMNF and mean b/c value.

An Epidemiological Study of clinic-demographic Profile of Patients with Infertility in Tertiary Hospital of North India

Yati Tiwary, ShailendraPratap Singh, Tripti Gupta, Nitu Chaudhary, Disha Bansal, Ananya Katyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2719-2723

Background:Infertility is not merely a health problem, it is also a social injustice and inequality. Infertility have a serious impact on both the psychological wellbeing and the social status of the women in the developing world. Objectives: to find out clinic-demographic characteristics of patients with infertility attending Obstetrics and Gynaecology OPD of RMCH Bareilly.
Materials and Methods: This was a one-year hospital based cross-sectional comparative study carried out in Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly, a tertiary care and teaching hospital in western Uttar Pradesh from 1st November 2019 to 31st October 2020 in women with age group 18-45 years presented with indications of primary and secondary infertility and the estimated sample size was 50.
Results: Highest percentage of cases (48%) have been reported for 21-30 age group, followed by 31-40 (38%), above 40 (12%) and below 20 age group (2%). The mean + SD value has been calculated as 31.96 + 7.77. Incidence among patients in high school is highest (34%), followed by primary school (32%), illiterate (22%), post high school (8%) and patients with graduate level education have reported lowest cases (4%).  Homemaker profession has the highest percentage of cases (72%), followed by daily wage worker (14%), other professions (8%) and working women (6%). Class III SES represents the highest percentage (48%), followed by Class IV (40%), Class V (6%), Class II (4%) and Class I represents the least percentage (2%). Most common symptom is menstrual dysfunction (40%), followed by abnormal vaginal discharge (28%), pelvic pain (16%), Fever/Malaise/loss of weight (8%) and very few have been asymptomatic (4%).
Conclusion: There is urgent need of regular health checkups and appropriate preventive, promotive and therapeutic interventions.

An Epidemiological Study of clinic-demographic Profile of Patients with Infertility in Tertiary Hospital of North India.

Yati Tiwary, ShailendraPratap Singh, Tripti Gupta, Nitu Chaudhary, Disha Bansal, Ananya Katyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2756-2760

Background:Infertility is not merely a health problem, it is also a social injustice and inequality. Infertility have a serious impact on both the psychological wellbeing and the social status of the women in the developing world. Objectives: to find out clinic-demographic characteristics of patients with infertility attending Obstetrics and Gynaecology OPD of RMCH Bareilly.
Materials and Methods: This was a one-year hospital based cross-sectional comparative study carried out in Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly, a tertiary care and teaching hospital in western Uttar Pradesh from 1st November 2019 to 31st October 2020 in women with age group 18-45 years presented with indications of primary and secondary infertility and the estimated sample size was 50.
Results: Highest percentage of cases (48%) have been reported for 21-30 age group, followed by 31-40 (38%), above 40 (12%) and below 20 age group (2%). The mean + SD value has been calculated as 31.96 + 7.77. Incidence among patients in high school is highest (34%), followed by primary school (32%), illiterate (22%), post high school (8%) and patients with graduate level education have reported lowest cases (4%).  Homemaker profession has the highest percentage of cases (72%), followed by daily wage worker (14%), other professions (8%) and working women (6%). Class III SES represents the highest percentage (48%), followed by Class IV (40%), Class V (6%), Class II (4%) and Class I represents the least percentage (2%). Most common symptom is menstrual dysfunction (40%), followed by abnormal vaginal discharge (28%), pelvic pain (16%), Fever/Malaise/loss of weight (8%) and very few have been asymptomatic (4%).
Conclusion: There is urgent need of regular health checkups and appropriate preventive, promotive and therapeutic interventions.

Infertile Women Seeking Conception Through Assisted Reproductive Technology Have Different Lipid Profiles and Atherogenicity Indices

Subasis Mishra, Mousumi Acharya, Subhra Samantroy, Anamika Mishra .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3204-3210

Infertility in women is common over the world, and lipid abnormalities are thought to play a role. The goal of this study was to determine the plasma lipid profile and atherogenicity indices among infertile women who visited assisted reproductive technology clinics. In 140 infertile women and 50 healthy age-matched women of proven fertility, the serum lipid profile (total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and computed indicators of atherogenicity) was assessed.Using reagents provided by Randox Laboratories, Crumlin, Antrim, UK, the lipid profile was determined using the spectrophotometric method. The unpaired Students' test was used to compare the mean values of measured parameters between cases and controls. Age (p<0.001), total cholesterol, triglycerides, low-density lipoprotein, AIP, certain cardiac risk ratios, and atherogenic coefficients were considerably greater (p<0.001) in infertile women than in control participants, but high-density cholesterol was significantly lower (p<0.001). The difference in mean BMI between the patients and controls was not statistically significant. Except for the high density/low-density ratio, all atherogenicity indices were considerably greater in infertile women seeking assisted reproductive technology for conception than in control participants. This group of people has greater atherogenicity indices, which may predispose them to cardiovascular disease. As a result, it is recommended that lipid profiles and atherogenicity indices be evaluated on a regular basis.

EVALUATION OF ROLE OF TRANSABDOMINAL ULTRASOUND IN UTERINE AND ADNEXAL FACTORS IN INFERTILITY

Dr Poonam Ohri, Dr Niveditha Basappa, Dr Kulwinder Kaur, Dr Manasi Kohli, Parushi Kohli, Dr Prabnoor Kaur

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 282-291

Background: The desire to procreate is universal phenomenon. Childlessness is considered
as a curse in many societies and is one of the causes of marital breakups. WHO has defined
infertility as ‘Failure to conceive over 12 months of uninterrupted sexual practice. USG has
become a well-established technique for imaging ovarian and uterine pathologies. Methods:
This is a hospital based cross sectional, observation study,included total of 51 cases. The
patients with chief complaints of infertility presenting to gynaecology OPDs were referred to
the department of Radiodiagnosis,Guru Nanak Dev Hospital, Amritsar and all patients were
subjected to transabdominal ultrasonography using 3.5 MHz sector transducer. Results: Out
of 51 cases studied, 35 were of primary infertility and 16 were of secondary infertility.
Duration of infertility varied from 1.75- 17 years in patients with primary infertility and 2-10
years in patients with secondary infertility,maximum cases between 2-4 years.. Nonspecific
enlargement of uterus on one case, 3 with fibroid, 3 with endometrial calcification, one with
infantile uterus and one bicornuate uterus. Ovaries were normal in 37 cases, abnormal in 9
cases, not visualized in 3 cases on left and 1 on right side. Left ovary enlarged in one case.
Ovarian cyst in 3 cases, T.O masses in 5 cases and PCOD in one case. Fluid in POD in 4
cases.Conclusion: It is concluded that ultrasound is very helpful in assessment of uterus and
adnexal pathologies. USG is non-invasive, cheap, acceptable, easily available modality. It can
diagnose structural abnormality and helps in making diagnosis of etiologic factor in patients
of infertility and also in management and follow up of patients of infertility.

Relationship between Female Infertility and PelvicInflammatory Disease

Azahir Kamil Elsharif; Mohamed El-Sayed Mohamed; Sabry Nossair Wael; Taha Abdel- Fattah Mustafa

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1007-1014

Infertility is a worldwide health problem among couples with approximately 15% current global infertility rate, translating to one in 6 couples suffering from this condition. The aim of the present study was to find the relation between infertility and pelvic inflammatory disease. Patients and methods: A cross-sectional case series study included 191 infertile women selected from the Outpatient Clinics of the Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University Hospitals. All women underwent general examination, local speculum examination, and abdominopelvic ultrasound. Also, we collected the data about past reports of all investigations, U/S, laparoscopic and HSG reports done during their journey on infertility assessment. Results: There was statistically significant difference between positive and negative PID patient's parity and social class. But regarding other variables, there was no statistically significant difference. There was statistically significant difference between positive and negative PID patients regarding methods of contraception, repeated history of PID and hospitalization due to PID. But regarding other variables, there was no statistically significant difference. There was statistically significant difference between positive and negative PID patients regarding WBCs and bacteruria. But regarding other variables, there was no statistically significant difference. There was statistically significant difference between positive and negative PID patients regarding using IUD as contraception. But regarding others, there was no statistically significant difference. Conclusion: Observed treatment of PID should be initiated in sexually active young women and others at risk for STIs if the following minimum criteria are present and no other cause(s) for the illness can be identified: lower abdominal tenderness or adnexal tenderness or cervical motion tenderness.

Role of MRI in detecting female infertility

Dr. A Antony Jean,Dr. K. Karthikeyan,Dr.Ajit Kumar Reddy, Dr.AnnithaElavarasi J

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3197-3201

To assess role of MRI in detecting female infertility.
Materials & Methods:Eighty- six women age ranged 20- 40 years were included in the
study. All underwent MRI using 1.5 Tesla unit equipped with a 32 phased-array surface
coil. Causes of female infertility was recorded.
Results: Age group 20-30 years comprised of 50 and 31-40 years had 36 patients. Various
causes of female infertility was PCOS in 12, tubal disease in 18, pelvic inflammatory
disease in 10, endometriosis in 8, leiomyoma in 6, adenomyosis in 12 and endometrial
polyps in 20 cases. A significant difference was observed (P< 0.05).
Conclusion: MRI is an excellent non-invasive, radiation-free modality for the evaluation
of female infertility; its superior soft-tissue contrast resolution and multiplanar evaluation
generate exquisite anatomical details.

Infertility predictors for prolactin-secreting pituitary adenomas

Kh.K Nasirova; Z.Yu. Khalimova; Yu. M. Urmanova; G.D. Narimova

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 2488-2503

Abstract: Purpose of research - To improve reproductive outcomes of women with
prolactinomas by evaluating fertility predictors. Material and methods. We examined 250
women aged 17-35 years (average age 30.5 years) with endocrine infertility (EI) and
hyperprolactinemia. Of these, 71 (28.4%) patients with prolactinoma and endocrine
infertility were selected for an in-depth study. All patients underwent a complete clinical -
hormonal and visualization examination and were divided into patients with EI with
pituitary microprolactinomas (64.7%) and patients with EI with macroprolactinomas
(35.2%). Clinical, imaging, and hormonal studies have been performed. The basal levels of
the pituitary gonadotropic hormones — LH, FSH, as well as PRL, TH, peripheral gland
hormones cortisol (C), estradiol (E) and total testosterone (T), dehydroepiandrosterone
sulfate (DHEA-S), progesterone, inhibins A and B were determined , activin, antimuller
hormone. The research materials were subjected to statistical processing using the methods
of parametric and non-parametric analysis. Results. According to the objectives, the
functional state of the HPO system and the clinical characteristics of infertility in
prolactinomas were studied, an analysis of complaints and anamnestic data of patients
with EI with prolactinomas was made, depending on the size of the formation in a
comparative aspect. The state of ovarian reserve was assessed, with the determination of
FSH, activin, AMH, inhibin A and B in the blood serum. The inhibin A level in both Me
groups was 1.30 ng/ml, which significantly differed from the control group (p₂ ˂0.0001,
p₃ ˂0.0001). The level of inhibin B underwent significant changes in both groups. A
decrease in inhibin B and an increase in FSH can prove a decrease in ovulatory ovarian
reserve. The studied women with EI in both groups showed a decrease in AMH, in the
group with microadenomas ranged from 0.12 to 2.1 and averaged 0.75 ± 0.27 ng/ml, and in
the group with macroadenomas ranged from 0.09-2.2 and averaged 0.97 ± 0.49 ng/ml,
which significantly differed from the control group (p₁ ˂0.05, p₂ ˂0.001 p₃ ˂0.001). The
conducted Spearman correlation and regression analysis showed that between prolactin
and AMH (r = -0.4; p˂0.01), between prolactin and progesterone (21dMC) (r = -0.576;
p˂0.0001) as well as between prolactin and inhibin B (r = -0.67) there is a strong “-“
negative relationship and all indicators were statistically significant. Conclusions:
Endocrine disorders in women with prolactinomas are significantly increased in patients
with macroadenoma compared with microadenoma. Correlation-regression analysis found
a negative relationship between PRL and AMH (r = -0.4, P <0.0001), PRL and
progesterone (r = -0.57, P <0.0001). With an increase in PRL by 1 unit, there is a decrease
in AMH by 0.008 units (P <0.001), a decrease in inhibin B by 0.11 (P <0.001),
progesterone by 0.04 units (P <0.0001) and the degree of hyperprolactinemia and this all
can predict EI development.

Features of perinatal outcomes in women after supporting reproductive technologies

Shakhnoza F. Bakhodirova; Gulchekhra A. Ikhtiyarova; Aslonova M.J .; Salim S. Davlatov

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 6350-6356

Pregnancy conceived with assisted reproductive technologies (ART) has a higher risk of maternal and perinatal complications, and the overall risk of adverse outcomes requiring extended obstetric care has not been thoroughly studied. The review is devoted to the actual problem of the health status of children born after IVF. A systematic review of the health indicators of children conceived with IVF after the neonatal period was carried out versus natural, conceived.

EVALUATION OF PROLACTIN, FSH, LH HORMONES IN FEMALE INFERTILITY

Dr Saima Gayas, Dr Aasif Abdullah

European Journal of Molecular & Clinical Medicine, 2017, Volume 4, Issue 1, Pages 304-308

Background:Infertility is one of the most significant problems in gynaecology. The present study was evaluated FSH, LH and prolactin hormones in female infertility.
Materials & Methods: 72 females with infertility were enrolled in group I and age matched healthy controls were included in group II. The levels of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were measured with enzyme-linked immune-sorbet assay (ELISA) methods.
Results: Age group 20-30 years had 20, 30-40 years had 30 and 40-50 years had 22 subjects. The difference was non- significant (P> 0.05). The mean prolactin level was 18.1 ng/ml in group I and 12.5 ng/ml in group II. FSH level was 8.6 mIU/ml in group I and 6.1 mIU/ml in group II. LH level was 7.9 mIU/ml in group I and 5.8 mIU/ml in group II. The difference was significant (P< 0.05).
Conclusion: Infertile females exhibited higher prolactin, follicle stimulating hormone (FSH) and luteinizing hormone (LH)as compared to healthy females.