Cases Of Secondary Infertility Research Articles

Successful Outcome of Secondary Infertility with Multidrug Therapy in a Long-Standing Case of multisystem involvement

A case of secondary infertility with multisystem involvement is being presented herewith. Secondary infertility indicates previous pregnancy but failure to conceive subsequently. Numbers of secondary infertility are growing day by day. Many factors like age, unwholesome lifestyle, disturbed schedule, diet, stress is accountable for it. Due to involvement of these all factors sometimes a female may expose to multiple metabolic disorders resulting into infertility. Aim: To study the outcome of Ayurvedic treatment in management of secondary infertility. Objective: To access the role of Ayurvedic management in secondary infertility. Methodology: It is a single case study of secondary infertility due to multiple metabolic disorders. Case description: A female aged 31years, had pain during menstruation and regular cycles with history of left tube removal due to ectopic pregnancy visited for wants to conceive. She had history of treatment at various private centers and had multisystem metabolic disorders. She was advised Ayurvedic oral medications along with yogabasti. Outcome: After Ayurveda interventions she conceived. Conclusion: Ayurvedic management by improving the health and reproductive ability of a woman may help to conceive. The probable mechanism for the efficacy of multidrug therapy in multisystem disorders gives ray of hope to numerous. Keywords: Infertility, Conception, Menstrual Cycle, Hydrosalpinx

A Retrospective Study of Leparoscopic Evaluation of Tubal Factors in Case of Infertility

Background: Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The aim of this study was to determine the role of leparoscopic evaluation of Tubal factors in case of infertility. Methods: A retrospective study was carried out at Department of Gynae and Obstetrics UHC, Dhamrai, Dhaka, Bangladesh from January to December 2023. 55 patients were selected for laparoscopic evaluation. Inclusion criteria were patients with no prior pelvic surgery, normal bimanual pelvic examination, normal semen parameters of partner and no ovulatory dysfunction. After obtaining thorough history & detailed examination, patients were informed about the procedure and written informed consent was taken. Results: 55 patients underwent laparoscopy during the study period. Most patients 10 were in the age group of ˂20 yr, 15 were between 21-30 yr & 20 were 31- 40 yr of age and 10 were between 36 – 40 yrs of age. Among these 55 patients 24 patients had primary infertility while 31 had presented with secondary infertility. Diagnostic laparoscopy revealed normal pelvic organs in 9 (16.3%) cases, Chronic pelvic inflammatory disease in 3 (5.4%), endometriosis in 13 (23.6%) and congenital anomalies of uterus in 1(1.8%) cases. 7.2% cases had bilateral tubal block, 27.3% had unilateral block and in 7.2% cases though the tubes were found patent significant peritubal adhesions were noted. Tubal pathology was detected in 55.5% cases of primary infertility and 42.1% cases of secondary infertility. Among those who had tubal pathology, nonspecific pelvic inflammatory disease was noted in 33.3% and genital tuberculosis was diagnosed in 2.7% cases. The most common complications were pyrexia, shoulder tip pain, nausea and vomiting. Conclusion: Laparoscopy is a safe and effective diagnostic tool in evaluating tubal status of infertile patients. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor.

Secondary infertility due to necrospermia in men with autosomal-dominant polycystic kidney disease: a report of two cases.

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease characterized by the formation of numerous cysts in organs other than the kidneys. Although female patients with ADPKD do not have direct fertility problems, infertility in male patients may arise following the formation of cystic lesions in the lower seminal tract, which impair the function of spermatozoa. Generally, the treatment strategy for necrospermia depends on the severity of sperm viability, and intracytoplasmic sperm injection may be offered to patients with necrospermia. We report two cases of secondary infertility in men with ADPKD. These men experienced an inability to reproduce naturally after the previous birth of a child, suggesting a progressive deterioration of semen quality. Semen analysis showed necrospermia in both patients, and transrectal ultrasound revealed marked dilatation of the seminal vesicles bilaterally. The main cause of secondary infertility in male patients with ADPKD is sperm death resulting from progressive dilatation of seminal vesicles. Further research is needed on the appropriate follow-up schedule for men with ADPKD who desire to reproduce naturally.

Secondary Infertility (Kakvandhya)-A Single Case Study

Vandhyatwa (infertility) is the burning challenge in front of todays fastest and behind the money society. Approximately 8%-10% couples will suffer from infertility worldwide in between that 15-20 million cases are present in India alone. 57.33% are the primary infertility cases and 42.66% are secondary infertility cases observed in 26-30 years age group in India recently. Vandhyatwa is explained by ayurveda scholars in their own way but Aacharya Harita specifically mentioned total 6 types of Vandhyatwa in detail which covers all types of infertility according to modern science. As it is mentioned as lifestyle disorder by medical science, ayurveda plays key role to successful treatment of this. In present article the single case study of Kakvandhya (secondary infertility ) is explained.

ROLE OF TRIVIDHA AUSHADHA IN THE MANAGEMENT OF INFERTILITY DUE TO BILATERAL TUBAL BLOCKAGE AND ABNORMAL ENDOMETRIUM RECEPTIVITY ALONG WITH THE PREVENTION OF CONGENITAL ANOMALY: A CASE STUDY

Introduction: Infertility is the failure to naturally conceive a child even after one or more years of regular unpro-tected coitus. Primary infertility (absence of prior conception) and secondary infertility (infertility following at least one previous conception) are two categories under which infertility can be classified. Here, it is the case of secondary infertility caused by tubal and endometrial factors. Tubal factor and Endometrial factor come under four essential factors for conception described by Acharya Sushruta, i.e. Ritu, Kshetra, Ambu, Beeja as if the Kshetra is not formed correctly, it causes vandhyatva. In this case study, Ayurvedic management successfully treated secondary infertility caused by tubal and endometrial factors. Main clinical finding: A married Hindu female patient of 29 years of age visited OPD of the National Institute of Ayurveda, Jaipur, on 3 March 2021 with a chief complaint of wants issue since 1-year Diagnosis: Her HSG scan on 25 Feb 2021 suggestive of bilateral fallopian tube blockage. Her USG scan is suggestive of a simple cyst in her right ovary of size 31x19mm and endometrium thickness of 4mm on the 12th day of menses. Inter-ventions: Treatment given was Daivavyapashraya, Yuktivyapashraya (Ksheera basti, Uttarbasti and Yoga basti along with oral medication), and Satvavajaya. Outcome: She conceives after taking 20 months of treatment and delivered a healthy male child of weight 3.04kg on 21 July 2023 without any congenital anomaly. Conclusion: This case study shows the efficacy of Uttar Basti for treating bilateral tubal blockage and Ksheera Basti for en-hancing endometrial receptivity. It also highlights the significance of Daivavyapashraya, Yuktivyapashraya, and Satvavajaya Chikitsa in the management of infertility and the prevention of congenital anomalies.

P-526 Modified Applebaum uterine scoring system to predict uterine receptivity in frozen embryo transfer(FET) cycles

Abstract Study question To evaluate modified Applebaum uterine scoring system in predicting the uterine receptivity and clinical pregnancy rate? Summary answer The modified version of Applebaum uterine scoring system has sensitivity of 0.9411 and specificity of 0.5869 in predicting the uterine receptivity in embryo transfer cycle. What is known already The endometrial receptivity have been accepted to be major limiting factors in the establishment of pregnancy. Different techniques have been developed to evaluate endometrial receptivity, such as endometrial receptivity array or histological dating. The advantage of Ultrasound is it’s non-invasiveness, repeatability, real time monitoring and predictability. Study design, size, duration It is a prospective observational study. Study group comprises of 200 female with primary infertility over a period of 6 month. Participants/materials, setting, methods Exclusion criteria was patients associated with male sub-fertility or having uterine anomalies. The study was conducted at D.Y.Patil fertility centre, unit of Bloom IVF. All the patients were given uterine scoring before FET based on Endometrial thickness, morphology, vascularisation, myometrial echogenicity, uterine artery PI and EDF, myometrial blood flow. Main results and the role of chance The overall pregnancy rate was 54%. A perfect score of 20 was associated with 97.4% pregnancy rate. Scores of 17 to 19 was associated with the pregnancy rate of 85.4% and scores of 14 to 16 was associated with the pregnancy rate of 28.6%. Score less than 13 is not associated with any pregnancy. The Modified Applebaum scoring system showed the sensitivity of 0.9411 and specificity of 0.5869 in predicting the outcome of the cycle. On an individual basis, endometrial morphology, end diastolic blood flow(EDF) and Pulsatility index(PI) of uterine artery and myometrial blood flow were found to be significant for a pregnancy on the basis of Z score and p value of < 0.01 Limitations, reasons for caution As there were no case of secondary infertility, Grade III/IV endometriosis, endocrine disorder and uterine anomalies. The scoring system might not replicate the same results. Wider implications of the findings As the sensitivity and specificity of this uterine scoring system is quite good. It could be a good tool in assessing endometrium before embryo transfer. Trial registration number Not applicable

HYSTEROLAPROSCOPIC EVALUATION OF INFERTILE FEMALES IN A TERTIARY CARE HOSPITAL

Background: Childbearing and raising are extremely important events in every human's life and are strongly associated with the ultimate goals of happiness and family integration. Infertility is a major health problem. As commonly used investigations are unable to detect majority of pelvic pathology in infertile women, DHL has become an essential part of infertility evaluation. Objective: To evaluate various factors causing primary and secondary infertility by Diagnostic Hysterolaproscopy. Materials and Methods: This was a cross sectional, observational study which included 100 females with primary and secondary infertility during 1 year study period fullling the inclusion and exclusion criteria. Intraoperative ndings were noted and cause of infertility was assessed. Results: Out of 100 patients included in the study, 68 presented with primary infertility and 32 presented with secondary infertility. Majority of primary infertility group (66.2%) belonged to 21 -25 years of age and 50.0% of secondary infertility cases presented in 26-30 years of age. Hysteroscopy showed abnormal ndings in 32% cases. In our study, Laproscopy revealed that the tubal factor was the most common cause contributing to 58% of infertility. ovarian factors were diagnosed in 41%,peritoneal factors were present in 37% and uterine factors contributed 23%. Conclusion: Comprehensive evaluation of infertility has been made easy by using safe and effective hysterolaproscopy technique. It helps in diagnosing and treating various conditions in same sitting

Osseous metaplasia of the uterus: an interesting presenting complaint and case of secondary infertility: case report.

The authors present a case of a woman with the feeling of a foreign body in the vagina and a long-standing history of secondary infertility of unknown cause. She was found to have osseous metaplasia of the uterus with spontaneous expulsion of the bony fragments from the uterus into the cervical canal, creating the sensation of foreign body in the vagina. She was treated with hysteroscopic resection. Fertility returned 3 months post procedure. This case provides a valuable reminder that osseous metaplasia can have a varied clinical presentation and requires a careful history and examination. This case reinforces the importance of a thorough diagnostic assessment in the woman presenting with foreign body in the vagina/cervix and /orsecondary infertility. This rare but important diagnosis can have a lasting impact on a woman's reproductive health if left untreated.

Correlation of Socio Cultural Factors in Patients of Pelvic Inflammatory Diseases

Majority of the patients of PID are from low socio economic status. Unhygienic delivery, post partum infection,unsafe abortion procedures are observed to be linked to pelvic infection.The sequele to PID include chronicabdominal pain, infertility, ectopic pregnancy, etc. PID is the most serious complication of Sexually TransmittedDiseases. It is also related to the number of sexual partners. Social factors are very important in PID like age,educational status, marital status,socio economic status, religion, type of family etc. The present cross-sectionalstudy was conducted in Gynaecological OPDs of the Department of Obstetrics and Gynaecology, Rural and UrbanHealth Training Centres (R.H.T.C & U.H.T.C) of the Department of Community Medicine in JN Medical College,AMU, Aligarh.The study was carried out for a period of one year, from 1st August 2001 to 31st July 2002. A totalof 350 ever married females were selected on the basis of history of PID elicited. The aim of this study was to findthe correlation of socio cultural factors in patients of PID. This study reported that unhygienic deliveries may giverise to more chances of pelvic infection. It also reported that abortion rate is more in lower social classes(III-V). Themaximum cases of infertility were seen in the age group 25-29 years (37 cases).There were 51 cases presenting withprimary infertility and 9 cases of secondary infertility. Damage to the female reproductive tract from PID is usuallyirreversible; therefore, prompt antibiotic treatment is necessary to prevent any scarring of the reproductive tract.

Evaluation of Laparoscopy in Diagnosis of Female Infertility in Females- A Retrospective Study

Introduction: Infertility, one of the most common conditions confronting gynecologists, is defined as inability to conceive after 1 year of regular unprotected sexual intercourse. Infertility is a problem of global proportion. In recent years, laparoscopy has been considered as important tool in diagnosis and treatment of infertility. Objective: To detect the diagnostic efficacy of laparoscopy in uterine, tubal and ovarian pathologies. Material and Methods: This was a retrospective study carried out in Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from July to December 2022 in collaboration with Department of Radiodiagnosis & Department of Pathology. Study included sixty one cases of both primary and secondary infertility in women. We included only those infertile ladies whose husbands showed normal semen analysis. A detailed clinical history especially marital and obstetric history of the patients was taken. Through gynaecological examination was done and all necessary investigations (baseline endocrinal investigations, post coital study, cervical mucus study, ovulation study, post menstrual HSG) were done before laparoscopic examination. Written consent form was taken from all the patients. Results: Among 61 patients, 39 (63.9%) belonged to primary infertility and 22 (36.1%) were of secondary infertility. In primary (58.9%) and secondary infertility (59.1%) maximum number of patient belonged to age group of 21-25 years followed by 21-25 years age group in primary infertility and 31-36 years age group in secondary infertility. Peritubal or peri-ovarian adhesions were present in 15 cases of primary infertility and 5 cases of secondary infertility. Thirty four patients (56.67%) had normal ovaries. Conclusion: Due to safety and cost effectiveness, laparoscopy is considered as important diagnostic tool for evaluation of cause of infertility in women and for effective treatment decisions.

A case of secondary infertility and understanding evolutionary Materia Medica of Naja Tripudians from life space of the case

Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Treatment for infertility is mainly based on the cause, but in some cases there is no obvious cause for infertility, still women cannot conceive which is known as unexplained infertility, contributes 10-20% incidence. In such cases also, individualized homoeopathic treatment proved useful. This article contains such case report, where Homoeopathy showed its efficiency in treating infertility, and also an attempt is made in this article to understand evolution and rubrics of Naja Tripudians through case analysis.

Modern approaches to the surgical treatment of varicocele in childhood

In the structure of male infertility, varicocele is being detected in 30–40 % cases of primary infertility, and in 80 % cases of secondary infertility. At the age of 10 years during the screening, only 1 % of boys have a varicocele, but in the pubertal period this figure increases to 15–20 %. Indications for surgery in childhood differ from those in adults, since grade III varicocele must be associated with ipsilateral testicular atrophy more than 20 % compared to contralateral, or combined with pain. Surgical methods of varicocele treatment are different. Discussions are ongoing regarding the choice of ligation of the internal spermatic vein. There is no general agreement on the technique of surgical intervention. There are about 100 different methods of internal spermatic vein ligation in the world, the most popular of which are the retroperitoneal approach according to Palomo, transinguinal access according to Ivanissevich, subinguinal ligation according to Marmar, vascular embolization and laparoscopic suprainguinal approach. Currently, there is no gold standard for surgical treatment of varicocele in pediatric surgery in contrast to adulthood, where microsurgical subinguinal varicocelectomy has already become a classic method of intervention. This is due to a lower complication rate compared to high ligation. Subinguinal varicocelectomy can sometimes lead to testicular atrophy due to damage to the testicular artery, which is difficult to visualize during surgery. In childhood, Marmar operation is complicated by the small size of the spermatic cord structures, which requires the search for new methods of intraoperative visualization of vascular structures. In this article, intratesticular injection of 1% methylene blue was used for lymphatic vascular contrast and indirect visualization of the testicular artery, which allows for the use of subinguinal varicocelectomy in adolescents.

Role of diagnostic hysterolaparoscopy in the evaluation of infertility among the patients attending one of the tertiary care centers of Ahmedabad, Gujarat

Background: Reproduction is the basic expectation of human life. There is worldwide increase in incidence of infertility due to many factors such as delaying child-bearing, increase in lifestyle disorders, and stress to achieve personal and professional goals. The incidence varies between 5 and 15%. Aims and Objectives: The aims of this study were to evaluate the factors responsible for infertility using diagnostic hysterolaparoscopy among the patients attending tertiary care hospital. Materials and Methods: It was a prospective study conducted from December 2018 to May 2022 in Obstetrics and Gynecology Department of GCS Medical College, Ahmedabad. Around 150 patients were included in study. All patients of primary and secondary infertility whose hormonal profile was normal were included in the study. Results: In the present study, primary infertility was present in 73% of cases where as 27% were having secondary. Majority (43%) of patients of the primary infertility belonged to age 26–30 years and 29% of secondary infertility cases were in the age group 31–35 years. Tubal factors were highest (32%), followed by ovarian factors (29%), peritoneal factors (11%), and uterine factors (9%). Among tubal factors, bilateral block was present in 19% and unilateral tubal block in 11%; among ovarian factors, polycystic ovary syndrome was highest (18%) and in peritoneal factor, endometriosis was seen in 6%. In uterine factors, fibroid was present in about 8% of cases. Conclusion: Diagnostic hysterolaparoscopy provides reliable information in evaluation of infertility and determining various causes such as tubal, ovarian, peritoneal, and uterine.

Evaluation of Female Infertility Factors Through Diagnostic Laparoscopy: a Cross Sectional Study

Aim: To evaluate the factors behind primary and secondary infertility in females through diagnostic laparoscopy. Study design: Cross sectional study Place and duration: This study was conducted at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020 Methodology: The present study is a cross sectional study conducted at at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020. A total of 115 females were included in the study and they all underwent diagnostic laparoscopy after setting strict inclusion criteria. Data was recorded on proforma and analyzed on IBM SPSS version 22. Primary and secondary infertility frequency was calculated and analyzed. Result: A total of 115 infertile women were considered in the study and results were recorded after performing diagnostic laparoscopy on all of the participants. Total 74 (64.35%) had primary infertility and 41 (35.65%) reported secondary infertility. Total 19 (25.67%) participants of primary infertility and 5 (12.19%) participants with secondary infertility showed no abnormality. The most common abnormality found was tubal blockage in 17 (22.97%) women of primary infertility and 13 (31.70%) women of secondary infertility. Total 11 (14.86%) patients of primary infertility were diagnosed with polycystic ovaries (PCO). PCO was absent in patients with secondary infertility. Total 9 (12.16%) cases of primary infertility and 5 (12.19%) cases of secondary infertility were diagnosed with Endometriosis. Total 2 (2.7%) cases of primary infertility and 7 (17.07%) participants with secondary infertility presented with Pelvic Inflammatory disease (PID). A total of 6 (8.10%) cases having primary infertility were observed with periovarian adhesions and Peritubal adhesions, whereas, 9 (21.95%) cases of secondary infertility were seen with these issues. Conclusion: Tubal occlusion, periovarian adhesions, peritubular adhesions, and endometriosis were the most common factors behind infertility in both primary and secondary infertility. Ovarian cyst and polycystic ovarian disease were only present in patients with primary infertility. Keywords: Diagnostic Laparoscopy, Primary infertility tubal occlusion, Secondary infertility

THE IMPACT OF LARGE VOLUME LIPOSUCTIOM WITH ADRENALINE ONLY ON THE PREGNANCY AND AESTHETIC OUTCOMES OF INFERTILE OBESE WOMEN

Background: Obesity dysregulates the hypothalamic-pituitary-ovarian axis resulting in ovulatory dysfunction and subsequent infertility. Tumescent liposuction comprised injection of a large volume of lactated Ringer's solution or normal saline, containing super-diluted epinephrine and lignocaine, in the subcutaneous fat. Even though this procedure accomplished accepted results as a body contouring surgery, the association between large-volume liposuction and infertility outcomes was not examined yet. Objectives: To reveal the aesthetic and reproductive outcomes of obese infertile female patients with established underlying hormonal irregularities and submitted to large-volume tumescent liposuction with the use of adrenaline only. Patients and Methods: The present prospective cohort study was conducted at Al-Azhar University Hospitals throughout September 2015 and August 2020. Obese or overweight infertile women within the reproductive age with menstrual irregularities, for at least one year were eligible for inclusion in the present study. These abnormalities were confirmed based on laboratory, and radiological evaluation. The procedure was done under general anesthesia and sterilization with betadine with small stabs in targeted areas. Post-operative pain was assessed using Visual analogue scale (VAS). Results: A total of 18 female patients with established infertility of more than one-year duration were included in this study. Patients were furtherly assorted based on fulfilling Rotterdam criteria into two groups: Group (A) including 10 patients with polycystic ovarian syndrome (PCOS), and group (B) encompassing eight patients without. Clinically, three cases of secondary infertility get pregnant after the procedure, one case get pregnant after eight months and two of them after one year. Furthermore, two cases of primary infertility with PCOS get pregnant after six months and the other after one year. Seven cases of secondary infertility developed dramatic improvement in hormonal profile preparing them for conception without pregnancy. Patients experienced a statistically significant decline in the body mass index (P<0.001, t=61.3). As for patients’ satisfaction, 15 (83.33%) gave a 4 or 5 score to their general appearance. This was reflected in the quality of life in which 13 (72.22%) patients were highly satisfied. No patient complained of uncomfortable postoperative pain. Conclusion: Large-volume tumescent liposuction with use of adrenaline only was a safe, effective, and promising procedure in amending the negative reproductive and aesthetic repercussions of obesity among infertile obese women. These findings were associated with satisfactory pregnancy and cosmetic outcomes, which reflected on patients’ satisfaction. No patient in our cohort experienced discomfort pain despite xylocaine non-use.

STUDY OF DISTRIBUTION OF REPRODUCTIVE TRACT ANOMALIES IN INFERTILE WOMEN THROUGH HYSTEROSALPINGOGRAPHY IN CENTRAL INDIA

Context:Infertility has risen to be a public health problem in India, National Family Health Survey (NFHS) – 4 estimates showing 5.2% of the women in reproductive age group to be infertile. Infertility can be due to male factors, female factors and in some cases unexplained; female factors comprising of 40-45% of the total cases. Amongst the female factors anatomical congenital anomalies as well as acquired abnormalities of the reproductive tract may cause primary or secondary infertility. Aims: This study aimed at looking at the distribution of congenital anatomical anomalies of the uterus and fallopian tubes as well as the distribution of anatomical changes in uterus and fallopian tubes due to pathological conditions through Hysterosalpingograhy (HSG) in infertile women. Methods &amp; Materials: 103 women attending Obs. and Gyneac. OPD for diagnosis and treatment of infertility in a tertiary care hospital in Central India were selected in this observation study. Sampling was purposive. HSG was performed and the data was obtained from the department of radiology. Descriptive analysis was done, and where applicable bi-variate analysis was done with chi-square test. Results:There were 63 cases of primary (mean age = 25 years ± 3.2) and 40 cases of secondary infertility (mean age = 30 years ± 2.9). 24% of the total cases had tubal occlusion, 16.5% had hydrosalpinx, 4% had arcuate and bicornuate uterus each and 1 % had unicornuate uterus, lling defects in uterus, deviation of uterine cavity, T-shaped uterus and sub-mucous broid each. 47% of the cases had normal HSG ndings. Conclusions: The results show that acquired causes of tubes were most common ndings in HSG of infertile women, pointing to preventable and easily manageable cases of infections of reproductive tract. Timely management of such cases at primary health care level can help reduction of infertility cases.

STUDY OF LAPAROSCOPIC EVALUATION OF FEMALE FACTORS IN INFERTILITY AT ANMMCH, GAYA, BIHAR

Objective:To nd out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. Study Design:Acase series. Place and Duration of Study: Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, August 2018 to July 2019. Methodology:All infertile women underwent diagnostic laparoscopy for primary and secondary infertility during the study period were included. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Data were collected on a proforma, and analysed on SPSS package for windows version 10. Frequencies were calculated for laparoscopic ndings regarding primary and secondary infertility. Results: Fifty infertile women underwent laparoscopy during the study period, 32 (64%) had primary infertility while 18 (36%) secondary infertility. Eight (25.0%) patients with primary and 2 (11.1%) patients with secondary infertility had no visible abnormality. The common nding was tubal blockage in 7 (21.9%) and 6 (33.3%) cases of primary and secondary infertility respectively. Five (15.6%) cases of primary infertility were detected as polycystic ovaries (PCO) which was not found in cases of secondary infertility. Endometriosis was found in 4 (12.5%) cases with primary infertility and 2 (11.1%) cases with secondary infertility. Pelvic inammatory disease (PID) was found in 1 (3.1%) and 2 (16.7%) cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 2 (6.3%) cases with primary infertility and 4 (22.2%) cases with secondary infertility. Fibriod was found in 2 (6.3%) and 1 (5.6%) cases of primary and secondary infertility respectively. Ovarian cyst detected in 2 (6.3%) cases with primary infertility while none was found in cases of secondary infertility. Conclusion: Most common causes responsible for infertility were tubal occlusion, endometriosis, peritubal and periovarian adhesions. Ovarian causes were seen in primary infertility only

The Etiology of Infertility in the Western Region of Libya

Aim: The aim of this study is to investigate the etiology of infertility in couples seeking medical help from the Infertility Clinics and gynecological departments in hospitals in Western Libya. Patients and Methods: Data were collected directly from patients' medical records. However, additional data were collected through interviews. Results: The total number of couples recruited was 135. Men (mean ± standard deviation of age = 41.7 ± 7.0 years) were significantly older than women (35.2 ± 6.5 years) (P = 0.001). Women were more likely to marry younger than men (mean difference = 6.5 years, 95% confidence interval [CI] =5.1–7.8 years) and the duration of all participant's marriages before the interviews was 9.0 ± 5.0 years. The causes of fertility were as follows: 33 (24.4%) (95% CI 17.16–31.64) cases were due to a female factor, 92 (68.1%) (95% CI = 60.24–75.96) cases were due to a male factor with 6 (4.4%) (95% CI 0.94–7.86) cases of combined male and female factor and 4 (3%) (95% CI = 0.12–5.88) cases without explained cause. Out of all patients, only 13 (4.8%) (95% CI = 2.25–7.35) were cases of secondary infertility and 257 (95.2%) (95% CI = 92.65–97.75) were cases of primary infertility. In females, the most common causes of infertility were ovulation disorders with 40 (23.4%) (95% CI = 17.05%–29.75%), polycystic ovary syndrome with 23 (13.5%) (95% CI = 8.38%–18.62%), irregular or no menstruation with 19 (11.1%) (95% CI = 6.39%–15.81%). The most frequent findings in males were 76 cases (31.0%) (95% CI = 25.21%–36.79%) asthenospermia, 75 cases (30.6%) (95% CI = 24.83%–36.37%) showing teratospermia and 56 (22.9%) (95% CI = 17.64%–28.16%) with oligospermia. Conclusions: Infertility due to male factor in Libya (approximately 70%), was very high compared to data from other regions of the world. Infertility due to the female factor is comparable to other regions of the world. The main cause for female factor infertility was ovulation disorders. Further research of infertility in other parts of the Middle Eastern and North African region is needed. This research must combine epidemiological, medical, and social investigations to find the main causes of infertility in the region.

Different expression and localization of aquaporin 7 and aquaporin 9 in granulosa cells, oocytes, and embryos of patients with polycystic ovary syndrome and the negatively correlated relationship with insulin regulation

To investigate the expression of aquaporin 7 (AQP7) and aquaporin 9 (AQP9) in the granulosa cells of patients with polycystic ovary syndrome (PCOS) and healthy women and detect their localization in oocytes at the germinal vesicle (GV), metaphase I (MI), MII, embryo, and blastocyst stages and the invitro response to insulin stimulation. Randomized, assessor-blinded study. Reproductive medical center. A total of 40 women (aged 20-38 years) comprising 29 cases of primary infertility and 11 cases of secondary infertility, of whom 17 had an initial diagnosis of PCOS and three received a PCOS diagnosis after an infertility examination. Controlling different concentrations of insulin and different treatment times in cultures of normal human granulosa cells invitro. Expression of AQP7 and AQP9 genes and proteins in granulosa cells detected by real-time quantitative polymerase chain reaction, and localization in oocytes at the GV, MI, MII, embryo, and blastocyst stages by Western blot, immunohistochemical, and immunofluorescence assays, and concentrations of insulin in follicular fluid by enzyme-linked immunosorbent assay. The expression levels of the AQP7 mRNA and protein in the granulosa cells of patients with PCOS were higher than found in healthy controls. We found AQP7 protein expressed in human oocytes at GV, MI, MII, embryo, and blastocyst stages; it was mainly located in the nucleoplasm. In the PCOS group, the expression level of AQP9 mRNA and protein in granulosa cells was lower, and AQP9 protein was expressed in oocytes at the GV, MI, MII, embryo, and blastocyst stages; it was localized on the nuclear membrane. Compared with healthy women, the insulin expression in patients with PCOS was higher. In cultures of normal human granulosa cells invitro, the expression of AQP7 and AQP9 mRNA and protein decreased with the increase in insulin concentration; expression statistically significantly decreased when the insulin concentration was 100 nmol/L, and after 6 to 24 hours of exposure the lowest expression levels were found at 12 hours. The different localization and expression of AQP7 and AQP9 between the two groups suggests that they might be involved in oocyte maturation and embryonic development through different regulatory pathways. The expression levels of AQP7 and AQP9 were negatively correlated with insulin regulation, suggesting that insulin might affect the maturation of PCOS follicles by changing AQP7 and AQP9 expression.

MANAGEMENT OF FEMALE INFERTILITY DUE TO TUBAL BLOCKAGE BY AYURVEDIC TREATMENT PROTOCOL: A CASE REPORT

Motherhood is one of those transforming experience which can’t quite put into words. Infertility represents a major crisis for most couples, with both partners experiencing loss in ways that affect them as individu-als, as family members and as members of society as a whole. Tubal factor is second major cause of fe-male infertility. In Tubal factor, modern management are dependent on Tubal Surgery or IVF or Embryo Transfer. All these methods are the solution only for the anatomical aspect of the tube and no success in establishing the tubal function. The present case report revealed effect of Virechana and Uttarbasti karma in a known case of secondary infertility due to Fallopian Tube Blockage. Virechana is indicated in Vandhyatva and Yonivyapada chikitsa. Uttarabasti is a very important and unique Ayurvedic procedure, which is mentioned for the genito–urinary problems. Successful conception occurs after this treatment.