European Journal of Molecular & Clinical Medicine

Diagnostic laparoscopy is a minimally invasive technique that provides information on the state of the uterus, ovaries, Fallopian tubes. It is considered as gold standard for diagnosing tubal and peritoneal diseases. Hysteroscopy helps in visualizing the uterine cavity and identifying the possible pathology in infertility. In combined hysterolaparoscopy complete evaluation and treatment is possible in the same sitting. Objective: To study the role of combined diagnostic hystero-laparoscopy in evaluation of female infertility.
Materials and Methods: This retrospective study was conducted in the Department of Obstetrics and gynaecology in a tertiary care centre in Chennai, Tamil Nadu from January 2017 to December 2017. Women aged 20-40 years with primary or secondary infertility with normal hormonal profile and without male factor infertility were included.
Results: In our study primary infertility was found in 75% of the 100 patients and secondary infertility in 25% of cases. Majority of patients of primary infertility (46%) and secondary infertility (44%) belonged to the age group of 25-30 years. The analysis of the duration of infertility showed that 66% of primary infertility cases had history of infertility between 1-5 years, 28% had infertility of 6-10 years. Among secondary infertility cases 64% had infertility between 1-5 years, 32% between 6-10 years. Abnormal laparoscopic findings were noted in 55% of cases of primary infertility and 52% in secondary infertility. Abnormal hysteroscopic findings were noted in 18% of primary infertility cases and 16% of secondary infertility. The most common laparoscopic findings in secondary infertility cases were adnexal adhesions (20%) and myoma (12%) and polycystic ovaries in primary infertility. In our study on chromopertubation 12% of primary infertility and 20% of secondary infertility patients had unilateral tubal block and 16% of primary infertility and 12% of secondary infertility patients had bilateral tubal block.
Conclusion: Hysterolaparoscopy is a minimally invasive, safe and effective procedure in comprehensive evaluation of female infertility as it helps in detecting tubal, peritoneal factors, endometriosis, adnexal adhesions and septate uterus. The above correctable abnormalities are missed by imaging procedures. Hysterolaparoscopy helps in formulating specific planning of management. While investigating the causes of female infertility combined simultaneous diagnostic laparoscopy & hysteroscopy should be performed in all infertile patients.

Introduction: Diminished ovarian reserve (DOR), defined by age specific follicle stimulating hormone (FSH) levels and/or Anti mullerian hormone (AMH) levels < 1.5 ng/ml is seen in 10% cases of infertility which occur due to ovarian failure. Dehydroepiandrosterone (DHEA) supplementation for treatment of infertility in such cases is a recent development. This study aimed to determine whether DHEA supplementation objectively improves ovarian reserve as assessed by AMH levels since AMH has been recently validated as a specific marker for ovarian reserve and also whether these values are predictive of the outcome of treatment in terms of number of patients who conceive.
Material and methods: The study was done on 50 patients who presented to the OPD of Obstetrics and Gynaecology at Santokba Durlabhji Memorial hospital in the age group of 20-40 years with primary or secondary infertility due to DOR as determined by AMH levels <1.5 ng/ml. They were given DHEA 25 mg three times daily for at least 1 month till they conceived or till 6 months (whichever was earlier).Patients above the age of 40 years, those with infertility due to causes other than ovarian, with polycystic ovarian disease, endometriosis, ovarian cancers ; with chronic diseases and who conceived within 1 month of starting the treatment were excluded.
Results: The mean age of the study population was 31.14±6.00 years, mean duration of infertility was 4.26±3.25 years and the mean baseline AMH level was 0.73±0.48 ng/ml. The conception rate in this study was 26%. Following treatment with DHEA, the AMH levels increased significantly with the mean AMH level after 1 month of treatment being 1.08±0.82 ng/ml (p=0.007 for patients who did not conceive and p<0.001 for patients who conceived) while that at the end of 6 months were 1.64±0.98 ng/ml (p<0.001 for patients who conceived and who did not conceive). Only pre treatment AMH was found to be an independent predictor of conception [odds ratio = 7.5533 (95 % CI 1.5499 to 36.8106)].
Conclusion: DHEA supplementation positively affects the ovarian reserve in patients with DOR and also leads to better pregnancy outcome. Hence DHEA can be a low cost option for treatment of infertility in patients with DOR.

Background: To assess risk factors, clinical presentation and management of ectopic pregnancy.
Materials and Methods: One hundred ten ectopic pregnancies were selected for this study. Parameters like risk factors, symptoms, signs, USG findings and management were studied.
Results: Symptoms observed were pain abdomen in 93, bleeding PV in 45, amenorrhea in 81, syncope in 12, vomiting in 30, shoulder tip pain in 7 and fever in 4 patients. The difference was significant (P< 0.05). Signs observed were abdominal tenderness in 54, fullness in fornix in 12, tenderness in fornix in 48, cervical motion tenderness in 32, adnexal mass in 6 and abdominal distension in 4 patients. The difference was significant (P< 0.05). Risk factors observed were ART in 8%, infertility in 4%, previous abdominal surgery in 52%, spontaneous abortion in 12%, previous ectopic pregnancy in 3% and dilatation and curettage in 2% cases. The difference was significant (P< 0.05). USG findings were adnexal mass in 45%, gestational sac in 17%, cardiac activity in 2%, free fluid in POD in 68% and normal in 5% cases. The difference was significant (P<0.05). Management done was salpingectomy in 90, salpingectomy and metroplasty in 12 and salpingo-oophorectomy in 8 cases. The difference was significant (P< 0.05).
Conclusion: Common risk factors observed were ART, infertility, previous abdominal surgery, spontaneous abortion, previous ectopic pregnancy and dilatation and curettage. Management done was salpingectomy, salpingectomy and metroplasty and salpingo-oophorectomy.

Aim: The aim of the present study was to determine the HSG findings of genital TB in infertile women.
Methods: The present study was conducted in the Department of obstetrics and Gynecology, Advanced Maternity Fertility Centre Janm IVF, Bhagalpur, Bihar, India of 100 women who had a proven genital TB.
Results: The mean age was 26.6 ± 4.4 years, mean body mass index was 24.8 kg/m2, and mean duration of infertility was 6.08 years. Primary infertility was seen in 33 (66%) women, while secondary infertility was seen in 17 (34%) women. Normal cycles were seen in 50 women, menorrhagia in 10, hypomenorrhea in 30, oligomenorrhea in 5, primary amenorrhea in 3 and secondary amenorrhea in 2 women. There was no difference in the serum FSH concentration levels. However AMH and AFC were significantly lower.
Conclusion: Both laparoscopy and molecular tests are complementary tests and together can effectively confirm the diagnosis of Genital TB. Very often, it is the HSG finding that alerts the clinician as to the presence of GTB. Though imaging findings may be highly suggestive of TB, some of the features such as tubal block and hydrosalpinx are not specific for TB and may be seen in other infective causes of tubal damage also.

Introduction: Endometriosis is a state of chronic inflammation in the pelvis and is characterised by endometrial-type tissue outside of the uterus. Although exact prevalence of endometriosis is unknown, it roughly affects 2 to 10% of the female population, but 30 to 45% of females with infertility [1] Pelvic endometriosis commonly involve the ovaries, and bilateral involvement occurs in one third to one half of cases [2,3 ]. Ovarian endometrioma rarely exceeds 10–15 cm in diameter [2,3].
 
Case summary: A 25 Female, Nulligravida with married life of 3 years presented to the OBGY OPD   anxious to conceive since 1.5 years. She also complains of intermittent Pain in lower Abdomen during menses since 1 year, aggravated during menses and relieved on medication.. She had a history of irregular cycles lasting 3-5 days between 28-60 day intervals with dysmenorrhea.Per abdomen was soft, non tender with no other significant findings. Speculum examination revealed white foul smelling discharge. On per vaginal examination, B/L fornices were found to be full but with no tenderness. White discharge noted as well. Radiological investigation was advised and a 3D ultrasound was done. Patient had mild adenomyosis with B/L bulky ovaries and multiple endometriomas with left hydrosalphinx. Patient was posted for a video 
hysterolaparoscopy during which B/L endometriomas noted with kissing ovaries appearance. Bowel was adhered to the endometriomas and left hydrosalphinx noted along with endometriotic patches on POD. B/L endometriomas drained and hydrosalphinx excised. Adhesiolysis done. Patient withstood the procedure well and discharged two days later and asked to follow up in the OPD after full recovery for further infertility evaluation.
 
Conclusion: Endometriosis affects day to day life of a woman and fertility by making the in vivo environment harmful for an oocyte or an embryo. Theoretically, surgical treatment of endometriosis could create a more favorable environment for successful conception and relief of symptoms.
 

The aim of this study is to study Role of ultrasound and MRI in evaluation of pelvic inflammatory disease. Patients with clinically suggested pelvic inflammatory disease who were referred to the Department of Radio Diagnosis are included in this study. After obtaining permission from medical research ethics committee and informed consent from the patients, they were subjected to transvaginal ultrasonography and MRI scan.
Result: Free fluid is most common finding which is seen in 22 patients out of 100 patients. Cervicitis and pyosalpinx were seen in 18 and 17 patients respectively. Tubo-ovarian abscess was finding in 15 patients. Pyometra and hydrosalpinx as findings were seen in 11 patients each. Salpingi-Oophoritis as MRI findings was seen in nine (09) patients. Other findings seen on MRI included: salpingitis (06), endometritis (06), tubal torsion (05), endometrioma (03), free fluid in Pouch of Douglas (03), no gynecological disorder (02), simple cyst (02), peritonitis (02), and dermoid cyst (01) patients respectively. Both TVS and MRI was positive in 80 patients. TVS had findings of pelvic inflammatory disease in four (04) patients with no findings on MRI. The difference was found to be statistically significant (p = 0.00) by using Fisher’s Exact test.
Sensitivity of TVS for diagnosing PID who are truly having it was 91.9% while specificity was 69.2% in ruling out PID in those who didn’t have the disease in question. Similarly, the positive predictive value (PPV) for TVS was 95.2% and negative predictive value (NPV) was 56.2%. Overall, the accuracy of TVS for PID was 89%.
Conclusion: In women of reproductive age, pelvic inflammatory disease (PID) is a prevalent and significant disorder that can cause infertility, ectopic pregnancy, and chronic pelvic pain. Lower abdomen pain, fever, an elevated blood C-reactive protein level, and adnexal tenderness are common symptoms in patients, however the clinical diagnosis of PID has major drawbacks due to the wide range of symptoms and potential for atypical symptoms. PID may mimic gastrointestinal issues, urinary tract infections, and other gynecologic issues. Thus, making a clinical diagnosis of PID based solely on symptoms and physical characteristics is frequently incorrect. The danger of long-term problems rises when treatment is postponed. PID is becoming more common, especially in developing nations where there is a lack of understanding and hazardous sexual behavior.

Aim: Female genital tuberculosis (FGTB) is a major cause of infertility in low and middle-income countries despite the availability of highly effective treatment. Asymptomatic latent cases are more common in genital TB hence difficult to measure true incidence and prevalence. Data on the Indian population is scanty due to its subtle presentation. So, this research was planned to evaluate the epidemiology of genital tuberculosis in the Indian population.
Material & Method: A prospective cross-sectional study was organized in a medical college-associated hospital in Northern India. Female patients with infertility between 18 to 45 years of age were included in the study. A detailed clinical assessment and routine investigations were done in each case. In suspected cases, pelvic ultrasound, endometrial culture, polymerase chain reaction, and laparo-hysteroscopy were conducted. 
Results: In this study, 100 infertile women were enrolled. Genital tuberculosis was diagnosed in 18 Women (18%). The most common abnormal laparoscopy findings were adhesions followed by hydrosalpinx, tubal mass, and tubo-ovarian mass.
Conclusion: Genital tuberculosis is an important etiology of infertility in India. Genital tuberculosis is diagnosed by a detailed history, clinical examination, and multiple investigations, including pelvic ultrasound, endometrial culture, polymerase chain reaction, andhistopathology.
Clinical significance: Infertility due to genital tuberculosis is an important public health problem in India. Early diagnosis by multiple modalities and complete treatment is required. The conception rate after complete treatment is still low but newer assisted reproductive techniques like IVF-ET can be useful in-patient with fallopian tube blockage with healthy endometrium

Infertility is defined as 1 year of regular unprotected intercourse without conception. . Eighty percent of the couples achieve conception if they so desire, within one year of having regular intercourse with adequate frequency (4–5 times a week). Another 10 percent will achieve the objective by the end of second year. As such, 10 percent remain infertile by the end of second year. For evaluating infertility TVS, HSG and hysteroscopy are recommended.
Objective- To Assess the Diagnostic value of Transvaginal sonography and hysterosalpingography (HSG) and hysteroscopy In Female Patient With Infertility Having Uterine Pathology
Design- Prospective Comparison Study
Method- This study was carried out in the Department of Obstetrics and Gynaecology INDEX MEDICAL COLLEGE AND HOSPITAL Source of the Patients: All the patients Attending Sterility Clinic at IMCHRC, INDORE, was include under the study. Result- We identified infertility patients prior to initiation of assisted reproductive technology who had baseline TVS, HSG, and HSC within 180 days of each other. From medical record review, we compared frequencies of each finding between modalities. Of the 45 patients who received a baseline TVS over one year, 30 had TVS and HSG within 180 days and 25 patients had TVS, HSG and HSC. Of the , TVS detected fibroids more often than HSG and adenomyosis more often than HSG .HSG detected tubal obstruction more often than TVS

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.

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 1^st November 2019 to 31^st 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.

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 1^st November 2019 to 31^st 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.

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.

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.

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.

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%.

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.

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.

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.

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.

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.

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.

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.