Secondary Subfertility Research Articles

Hysterosalpingographic Pattern of Primary Sub-fertility and Secondary Sub-fertility in Women of Reproductive Age

Objective: To evaluate the structural abnormalities of uterus and fallopian tubes in women diagnosed with primary and Secondary Sub-fertility using hysterosalpingogram. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul to Nov 2019. Methodology: This study investigated potential anatomical causes of primary and secondary subfertility in women of reproductive age. A total of 500 participants, referred from Gynecology and Obstetrics Departments, underwent hysterosalpingography during the pre-proliferative phase following comprehensive medical history assessment. Results: Out 500 women, 340(68.0%) had Primary Sub-fertility while 160(32%) had Secondary Sub-fertility. Mean age of presentation was 31.5±3.5 years. Bilateral free peritoneal spill was recorded in 340(68%) patients. Unilateral tubal blockage was present in 50(10%) patients while bilateral tubal blockage was observed in 40(8.0%) patients. Bilateral hydrosalpinx was present in 15(3 %) women. Patients with uterine congenital anomalies were also examined, and bicornuate uterus was seen in 25(5%) women and unicornuate uterus was noted in the same number, that is, 25(5%) women. Conclusion: Hysterosalpingography is a baseline assessment test done for evaluation of patency of uterus and uterine tubes. Positive hysterosalpingography cases were more prevalent in Secondary Sub-fertility. Tubal abnormalities were more commonly observed as compared to uterine cavity pathologies. Secondary Sub-fertility was found to be more associated with older age groups.

Association between anthropometric indices and infertility among subfertile women: Insights from a single-centre crosssectional study from Northern Sri Lanka

Background: Obesity is a global concern affecting female fertility, with 6% of never-pregnant women facing fertility challenges due to obesity. This study aims to assess the association between Anthropometric Indices and Infertility Among Sub-fertile Women.Methodology: This hospital-based cross-sectional study included 216 infertile women aged 18 years and above attending sub-fertility clinics at Teaching Hospital, Jaffna. Data collection consisted of an interviewer-administered questionnaire, anthropometric measurements, and statistical analysis using SPSS Version 26. Body Mass Index (BMI) was categorised according to Sri Lankan Obesity standards, and Waist-Hip Ratio (WHR) according to Asian women’s standards.Results: In our study, 72.2% had primary sub-fertility, and 27.8% had secondary sub-fertility. The average age was 33.7 years (SD=7.12), with 38.9% of them older than 35 years, and 56.9% of them seeking therapy within five years of marriage, while 43.1% delayed treatment. Age and sub-fertility types showed a positive association (P=0.003). The majority (70.3%) were overweight, pre-obese, or obese, with 66.7% at risk based on WHR. Primary sub-fertility cases had a higher prevalence of Polycystic Ovary Syndrome (PCOS). There were no significant differences in BMI between individuals with PCOS (M=26.473, SD=5.58) and those without PCOS (M=25.23, SD=4.79) (t(214) = 1.701, p=0.90). Similarly, there was no significant difference in WHR between individuals with PCOS (M=0.887, SD=0.65) and those without PCOS (M=0.882, SD=0.83) (t(214) = 0.473, p=0.637).Conclusion: Our findings shows that most participants have elevated BMI and WHR. Despite observed trends, the lack of significant association between PCOS and anthropometric indices indicates that lifestyle, genetics, and hormonal factors may play a huge role in excessive body weight. Achieving optimal body weight through lifestyle changes in reproductive-age women is a cost-effective way to enhance fertility in low-middle-income countries.

Hysteroscopic Removal of an Unwanted Remainder in the Uterus after Two Years of Caesarean Section: A Case Report of Gossypiboma

BACKGROUND: Retained surgical items (RSIs) constitute a rare complication arising after surgical procedures. Their occurrence may be averted through diligent precautionary measures. Perioperative counting of equipment and materials is the most common method of screening for RSIs. Subsequent confirmation of the diagnosis can be achieved through clinical examination and imaging studies. CASE: We report a case of successful hysteroscopic identification and retrieval of gauze inadvertently left within the uterine cavity, after a cesarean section two years back. The patient was later diagnosed with RSIs during routine evaluation for secondary subfertility and vaginal discharge. CONCLUSIONS: Despite the relatively low incidence of RSIs, they represent a significant and preventable source of patient harm, carrying the potential for fatal outcomes and resulting in substantial medical and legal expenditures.

Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh

BackgroundEndometriosis is a disease among women of reproductive age, which causes several health problems like dysmenorrhoea, dyspareunia and subfertility. It also increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of population completely different from Bangladesh. ObjectiveThe present study was conducted to identify the association between endometriosis and migraine among Bangladeshi population. Study DesignThis non-randomized case-control study was performed with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, we identified as cases of migraine in one group of respondents who were already diagnosed as patients of migraine and the others with complaints of headache were further confirmed by a medicine specialist. Patients were recruited from the department of obstetrics and gynaecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital & Ibrahim Medical College. The study was approved by the Ethical Review Committee of BIRDEM. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals. ResultsIn our study, out of the 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. We enrolled 190 confirmed endometriosis cases and an equal number of controls without endometriosis, maintaining the age distribution of the controls similar to that of the cases. The distribution of age, BMI, education and marital status of the patients with endometriosis were similar to that of controls. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than in controls (12% vs 0%). The odds of suffering from dysmenorrhoea and dyspareunia among the cases were 3.3 (P value <0.001, 95% CI: 2.66-4.15) and 9.5 (P value <0.001, 95% CI: 5.3-17.9) times higher than that of controls respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases compared to that of controls (OR = 0.4, P value <0.001 95% CI: 0.24-0.64). No significant difference was observed in having primary subfertility and secondary subfertility among the two groups of respondents. Univariate regression analysis showed patients with endometriosis have 6.13 times higher odds (P value <0.001, 95% CI: 2.5-18.4) of having migraine, 2-time higher odds for headache (P value = 0.01, 95% CI: 1.2-3.2) compared to control patients. Further, the age and BMI-adjusted multivariate model showed subjects with endometriosis have 5.4 times higher odds of having migraine compared to non-endometriosis patients (P value <0.001, 95% CI: 2.11-16.4). Also, the higher the age of reproductive age of women, the more the odds of having migraine. For one year increase in age increases the odds of having migraine by 23% (OR = 1.23. 95% CI: 1.13-1.16, p-value = <0.001). ConclusionThe study results support the association between endometriosis and migraine among the Bangladeshi population, which is similar to relevant studies conducted in other geographical locations. The groups of physicians who treat patients suffering from the two diseases, endometriosis and migraine, should keep this interrelationship in mind to ensure a better quality of a patient's life.

Study of Ovarian Reserve Parameters among Women Suffering from Secondary Subfertility Presenting in Infertility Clinic in a Tertiary Health Care Centre in Eastern India: A Prospective Observational Study

Study of Ovarian Reserve Parameters among Women Suffering from Secondary Subfertility Presenting in Infertility Clinic in a Tertiary Health Care Centre in Eastern India: A Prospective Observational Study

Spectrum of Radiological Findings in Hysterosalpingography for Female Subfertility: A Retrospective Cross-Sectional Study in a Tertiary Care Center of Nepal

Introduction: Hysterosalpingography (HSG) is a commonly used diagnostic procedure to investigate the causes of female subfertility. This study aimed to evaluate the range of findings observed in HSG examinations conducted for this purpose. Methods: A prospective cross-sectional study was conducted at the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, from December 2022 to April 2023. The study included 196 female participants who underwent HSG and met the inclusion criteria. Results: Out of the 196 participants, 127 (64.8%) were categorized as having primary subfertility, while 69 (35.2%) had secondary subfertility. The mean age of the participants was 30.61±5.623 years, with an age range of 20 to 45 years. Among the participants, 142 (72.4%) exhibited a normal uterus, 23 (11.7%) displayed left tubal occlusion, 17 (8.7%) showed right tubal occlusion, 13 (6.6%) had other findings, and 1 (0.5%) was diagnosed with uterine fibroids. Conclusions: This study demonstrated that approximately one out of every five HSG examinations performed to evaluate subfertility revealed tubal occlusion. Consequently, the high detection rate of uterine and tubal pathologies using HSG underscores its critical role as a diagnostic tool for assessing women with subfertility.

Prevalence of primary and secondary subfertility and its associated factors in Regional Director of Health Services area in Colombo district Sri Lanka: A community-based cross-sectional study

Introduction: Subfertility is a major life issue that affects the quality of life. Most of them are residing in developing countries. The prevalence of subfertility is an essential element to identify the magnitude of the problem in each country.Objective: To assess the prevalence of primary and secondary subfertility and its associated factors in the Colombo district, Sri Lanka.Methodology: This cross-sectional study used a stratified cluster sampling method to recruit 3104 married women aged between 15-49 in 38 urban and rural clusters in the Colombo district, Sri Lanka. The study was conducted in 2018-19 and used a structured questionnaire based on the clinical definition of subfertility.Results: The point prevalence of primary subfertility was 6.08 (95% CI:5.3-7.0). A significantly high prevalence of primary subfertility was reported among female partners with tertiary education (aOR:2.80; 95% CI:1.08-7.39) compared to primary or no education and employed women (aOR:1.88; 95% CI:1.37-2.57) compared to unemployed women. The point prevalence of secondary subfertility was 8.40 (95% CI:7.4-9.4). A significantly high prevalence of secondary subfertility was reported among female partners with tertiary education (aOR:2.55; 95% CI:1.16-5.59) compared to primary or no education, unemployed women (aOR:1.65; 95% CI:1.25-2.19) compared to employed women and women of other ethnic groups (aOR:1.97; 95% CI:1.13-3.32) compared to Moor ethnic group.Conclusion: The prevalence of both primary and secondary subfertility was 14.5% (95% CI:13.3-15.7) among the married women aged between 15-49 years in the Colombo Regional Director of Health Services area. The development of effective and rational public health policies for the prevention of subfertility and increased availability of advance reproductive technology facilities should be considered.

P-753 Preferences in subfertile women for hysterosalpingography or transvaginal hydrolaparoscopy in the fertility work-up: a labelled discrete choice experiment.

Abstract Study question What aspects do subfertile women prefer for hysterosalpingography (HSG) or transvaginal hydrolaparoscopy (THL) to assess their Fallopian tubes? Summary answer The chance of a false negative result, failure rate, and waiting time are attributes that impact women’s preference for tubal patency testing strategy. What is known already THL and HSG are commonly used diagnostic tests for tubal patency testing, both with different features. HSG is a radiological procedure whit contrast to evaluate tubal patency, whereas THL is a procedure where access to the pouch of Douglas is obtained with an endoscope and the tubes are tested with methylene blue. THL was found non-inferior to HSG as a first-line test in terms of conception leading to live birth. Until now, limited research has been performed to study the values and preferences of subfertile women in the diagnostic work-up. Study design, size, duration We conducted a labelled discrete choice experiment (DCE), which is an attribute-based survey method for measuring preferences. This DCE consisted of 2 questionnaires with each 12 different choice sets. Women with an indication for tubal patency testing were included in the study between September 2021 and January 2023 in two Dutch hospitals. They were randomly assigned for questionnaire 1 or 2. Participants/materials, setting, methods Attributes were defined based on literature review, structured patient interviews and expert focus groups. This resulted in five final attributes: the chance of having a “false negative” result, complication rate, failure rate, subsequent management after a failed procedure and waiting time. Women were asked to choose between choice sets with hypothetical scenarios of two tubal patency tests with different levels of the attributes. Data were analysed by using multinomial logistic regression. Main results and the role of chance The questionnaire was returned by 75 out of 80 women. Mean age was 31.8 years and mean duration of subfertility was 23.5 months. 65 women experienced primary subfertility vs 10 who experienced secondary subfertility. For THL women preferred a lower chance of a false negative result (p &amp;lt; 0.001), a lower failure rate (p = 0.008) and a shorter waiting time (p = 0.003). Outcomes for chance of complications and management after a failed procedure were not significant. Only for the group of women with primary subfertility, if a THL is not conclusive or if there is a failure to reach the pouch of Douglas, women prefer to have a conventional laparoscopy over expectant management (p = 0.01). Women choosing HSG preferred a lower chance of a false negative result (p &amp;lt; 0.001), a shorter waiting time (p = 0.02) and a lower chance of complications (p = 0.001). Because of the labelled design we performed, we saw that women chose for THL significantly more than for HSG; 83% vs 17% (P = 0.03). This may be caused by way of counselling and the fact that these medical centres are one of the few centres in the Netherlands that perform the THL. Limitations, reasons for caution Our analysis with 78 women, showed significant outcomes in terms of preference on specific attributes, but it is possible that we would have found stronger associations with a larger sample size. Wider implications of the findings These results provide more insight in the perspective of subfertile women about the aspects of tubal patency testing in the fertility work-up and they enable informed decision making. Further research is needed to compare our findings to the other forms of tubal patency testing in the fertility work-up. Trial registration number N20.009

Factors Affecting the Success Rate of Intrauterine Insemination in the Treatment of Subfertility Following Controlled Ovarian Hyperstimulation

Objectives: To determine the success rate of Intrauterine Insemination following Controlled Ovarian Hyperstimulation inpatients with subfertility and to determine the frequency of prognostic factors affecting the success rate of this treatment modality.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics &amp; Gynecology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, rom Feb to Aug 2019.&#x0D; Methodology: A total number of 135 sub-fertile patients, aged 18 to 40 years, with a duration of subfertility &gt; 2 years, were included in the study. Couples with bilateral tubal blockade, smoking, combined male and female factor infertility and previous ovarian surgery were excluded. Controlled ovarian hyperstimulation was done with Clomiphene Citrate for five days, followed by ovulation triggered by recombinant human chorionic gonadotropin (HCG) and standard insemination with a prepared sample of the husband’s semen after 36 hours.&#x0D; Results: Success of the procedure was seen in 23(17.04%) patients, while the remaining 112(82.96%) were unsuccessful. The mean age was 29.20±4.90 years. Of 135 patients, 83(61.48%) had primary subfertility, and 52(38.52%) had secondary subfertility. The mean duration of subfertility was 5.60±3.35 years. The mean basal FSH was 5.76±2.54 IU/l. The mean number of IUI cycles was 1.39±0.49.&#x0D; Conclusion: This study concluded that the success rate of intrauterine insemination following controlled ovarian hyperstimulation in the treatment of subfertility was 17.04%, and the duration and type of subfertility, aetiology of subfertility, basal Follicle-stimulating hormone levels and the number of Intrauterine insemination cycles are the prognostic factors affecting the success of the procedure.

ROLE OF GENITAL TUBERCULOSIS IN SUB-FERTILE WOMEN

OBJECTIVE: To evaluate role of Acid fast bacilli culture (AFB) in sub-fertile women undergoing laparoscopy and dye test with endometrial biopsy. METHODS: This cross-sectional study was conducted from 1st January 2020 to 30th April 2021, on 108 cases of subfertility, enrolled through non-probability consecutive sampling technique, for diagnostic laparoscopy &amp; dye test with endometrial biopsy for AFB culture. We included all women of reproductive age with ≥2 years of subfertility, normal menstrual history, hormonal assay and normal male-factor. All women with comorbidities, women having contraindications for anaesthesia &amp; couple with male-factor subfertility were excluded. Data analysis was done by SPSS version-20. RESULTS: Seventy-two (66.7%) women had primary and 36 (33.3%) had secondary subfertility. Duration of subfertility was &gt;5 years in 63 (58.3%) cases. Ninety-seven (89.8%) patients had bilateral patent tubes. Majority of patients (n=46/108; 42.6%) were aging 32-38 years. Endometrial biopsy of 22 (20.4%) cases were positive for AFB culture. Out of AFB-positive cases, 17 (77.3%) had primary and 5 (22.7%) had secondary sub-fertility. All AFB-positive cases had patent tubes (unilateral n=5/22; bilateral n=17/22). Common laparoscopic findings were tortuous tubes (n=30; 27.8%) and clumped end fimbrial (n=24, 22.2%). CONCLUSION: In our study, endometrial sampling of 20.4% cases were positive for AFB culture. Although female genital tuberculosis constitutes a small proportion of extra-pulmonary tuberculosis, but it has an immense effect on fertility. Thus without challenging the superiority of laparoscopy, AFB culture could be considered a judicious part of subfertility workup in low resource countries carrying high burden of disease.

Laparoscopic Evaluation of Tubal Factors in Female Subfertility

Objective: The objective of this study was to evaluate frequency of tubal factors as a cause of female subfertility using laparoscopy. Study design: It was a cross-sectional study Setting: This study was conducted at Obstetrics and Gynecology department, Arif Memorial Teaching Hospital Lahore / Rashid Latif Medical College Duration of study: Study was done in 6 months [June 4, 2022 till December 4, 2022] Methodology: Using non probability consecutive sampling 179 females with primary and secondary subfertility who fulfilled the inclusion and exclusion criteria were enrolled in the study. Detailed demographics were recorded after taking informed written consent. Results: The mean age of participants was 29.12 ± 4.04 years with minimum and maximum age between 19 and 42 years. The mean duration of marriage was 7.13 ± 3.66 years with minimum and maximum duration of marriage between 3 and 17 years. The mean duration of subfertility was 5.32 ± 3.26 years with minimum and maximum duration of subfertility between 2 and 18 years. There were 137(76.5%) of the cases who had primary and 42(23.5%) females had secondary subfertility. A total of 56(31.2%) females had tubal factors and 123(68.7%) females did not have tubal factors as cause of subfertility. There were 39(21.8%) females who had Peri tubal adhesion, 17(9.5%) females had tubo ovarian mass. Among the 56 participants who had tubal factor presents 40 (22.3%) had bilateral blocked tubes Conclusion: Through the findings of this study , we concluded that 31.2% females had tubal factors subfertility, including 21.8% females with peri tubal adhesion and 9.5% females with tubo ovarian mass. 22.3% of the participants had bilateral blocked tubes. Hence proper evaluation of the female partner in a subfertile couple should be done by laparoscopy which is a superior tool for diagnosing tubal factors responsible for subfertility and tubal patency should also be confirmed before prescribing treatment such as ovulation induction. Keywords: Infertility, diagnostic laparoscopy, tubal factors, peri tubal adhesion, tubo ovarian mass, blocked tubes

A novel approach using vaginal natural orifice transluminal endoscopic surgery to repair a symptomatic uterine isthmocele

To describe the first case of using a vaginal natural orifice transluminal endoscopic surgery approach to repair a uterine isthmocele. Stepwise explanation of the surgical technique using original video footage. This study was exempted from requiring hospital Institutional Review Board approval. Hospital. A 30-year-old (gravida 2, para 2) patient presented with symptoms of intermenstrual bleeding and secondary subfertility following 2 uncomplicated cesarean section deliveries (elective for breech and repeat). The patient had a transvaginal ultrasound (US) demonstrating an isthmocele with a defect of 8.1 × 7.0 mm with a myometrial thickness of 2 mm over the defect and proceeded to undergo surgery because of persistent symptoms. An anterior vaginal incision is made on the cervix from the 3 o'clock to 9 o'clock position after local anesthetic and adrenaline infiltration of the tissue. The vaginal epithelium was carefully dissected cephalad, although an attempt was made to maintain the uterovesical space and fold. A small (7 cm) V-path gel port was inserted into this uterovesical space and the gel port was affixed with a port connected to an insufflation stabilization bag to minimize the pressure fluctuations within the confines of a small operative space and help maintain visualization throughout. Under endoscopic view, the site of the isthmocele was identified using an endoscopic US probe and confirmed on 2 dimensional imaging. A monopolar hook with an inbuilt aspirator and suction function was used to incise over the isthmocele with a grasper used to dissect into this space. A Hegar dilator was used to delineate the cervical canal. Once the isthmocele was excised, the defect was reinforced and obliterated with a barbed suture whereas the Hegar dilator was in place to prevent inadvertent canal occlusion during suturing. Continuous suturing took place from the cephalad to the caudal directions in 2 layers. Once hemostasis was confirmed, the gel port was removed, and the vaginal epithelium was closed with interrupted sutures using a braided absorbable suture. The perioperative course and care were uneventful with the Foley catheter being removed 3 hours after surgery. The patient was discharged within 24 hours. A follow-up organized 6 weeks after surgery demonstrated obliteration and repair of the previously detected uterine isthmocele on the pelvic US scan. The patient also reported a resolution of symptoms at this postoperative visit. N/A. N/A. Uterine-conserving surgical approaches to an isthmocele have been described, including vaginal, hysteroscopic, and laparoscopic (with and without robotic assistance) approches and laparotomy, with no single approach deemed to be superior to the others. The existing evidence is limited by the lack of uniformity in the definition and diagnosis of uterine isthmocele, consistency in indication for surgery, and small case numbers in published surgical series. Vaginal natural orifice transluminal endoscopic surgery provides a novel approach to this type of surgery, which may be potentially less invasive as the procedure is conducted outside the peritoneal cavity and combines the best vaginal approach to the surgical site with endoscopic magnification and capacity for microscopic dissection. This approach should be considered new and only in a clinically appropriate and carefully counseled patient.

Secondary subfertility following caesarean section: The value of hysterosalpingography in demonstrating potential causative factors

Category: Gynaecological radiology

O-182 No higher prevalence of metabolic dysfunction among subfertile women in an urban population

Abstract Study question What is the prevalence of metabolic dysfunction, like insulin resistance, hyperglycaemia, hypertension, and/or dyslipidaemia, among subfertile women compared to healthy controls? Summary answer Signs of metabolic dysfunction were not observed more frequently in subfertile women than in controls. Overweight and obese patients were at risk for metabolic dysfunction. What is known already Metabolic dysfunction is known to impair female fecundity as it is linked to a longer time-to-pregnancy and to subfertility. Three times as many PCOS patients are diagnosed with metabolic syndrome than age matched controls. Moreover, a recent study showed a higher prevalence among the entire subfertile population. Metabolic disorders have been connected to the impairment of normal ovarian function and pituitary-hypothalamic axis. Obesity is correlated with menstrual irregularities, ovulation disorders and infertility. On top, it can increase risk of miscarriage and reduce chances with assisted reproductive technologies. Therefore, metabolic dysfunction might also be a driving factor behind unexplained subfertility. Study design, size, duration This cross-sectional observational case control study was performed in a secondary and tertiary care fertility clinic (MUMC+, Maastricht, The Netherlands). Patients were referred to the fertility clinic with either primary or secondary subfertility (inability to conceive after one year of regular unprotected intercourse), controls were healthy, parous women. All participants were aged between 18 and 41 years at time of inclusion. 119 patients and 68 controls were included over a time span of 3 years. Participants/materials, setting, methods A basic medical history was collected using questionnaires. Physical examination included measurement of weight, height, waist and hip circumference, blood pressure and pulse. Venipuncture was performed after an overnight fast on cycle day 2-4; including insulin, glucose, triglycerides, high-density lipid cholesterol, total cholesterol, glomerular filtration rate, urea, uric acid, creatinine, follicle stimulating hormone, estradiol and anti-Mullarian hormone. Urine was collected to measure protein and creatinine. Metabolic syndrome was diagnosed according to Adult Treatment Panel-III guidelines. Main results and the role of chance Body weight and BMI were similarly distributed between patients and controls. Main causes of subfertility comprised male factor (12%), anovulation (20%) and unexplained subfertility (47%). Comparing patients to controls, unexplained subfertility only had slightly higher HDL cholesterol levels (p = 0.046). Anovulatory patients showed 2% higher glucose (p = 0.003) and 133% higher AMH levels (p &amp;lt; 0.001). Metabolic syndrome was diagnosed in 6% of unexplained subfertility patients, in 4% of male factor patients and in 5% of anovulatory patients. No controls were diagnosed with metabolic syndrome. In a comparison of overweight and obese patients to normal weight patients we observed resp. 16% and 37% higher waist circumference (p &amp;lt; 0.001), 7% and 11% higher waist-to-hip ratio (p &amp;lt; 0.01), 37% and 197% higher fasting insulin (p &amp;lt; 0.01), 30% and 198% higher HOMA-IR (p &amp;lt; 0.02) and 8% and 24% higher uric acid levels (p &amp;lt; 0.03). Concomitantly, obese patients showed dyslipidemia with 98% higher triglyceride levels (p &amp;lt; 0.001) and 24% lower HDL cholesterol (p &amp;lt; 0.01). 181% higher AMH levels were found in obese patients (p &amp;lt; 0.01). Metabolic syndrome was diagnosed in 1% of normal weight patients, 4% of overweight patients and in 25% of obese patients. Limitations, reasons for caution Participants were young and remarkably healthy, which might account for the low prevalence of metabolic disorders. It is known that the prevalence of metabolic dysfunction is strongly dependent on socioeconomic and geographic determinants in various populations. Our findings apply to a largely ethnically homogeneous Caucasian female population in the Netherlands. Wider implications of the findings We found that the presence or specific cause of subfertility per se, cannot be regarded as a reliable and strong predictor of metabolic dysfunction, even in anovulatory subfertility. As can be expected, metabolic dysfunction is highly associated with BMI and obese patients should consider lifestyle intervention to prevent future complications. Trial registration number Not applicable

First Use of a Novel Barrier Film in an Infertile Woman with Severe Asherman's Syndrome

A 38-year-old woman Gravida 6, Para 0 was referred with oligomenorrhea and secondary subfertility. A diagnostic hysteroscopy revealed dense intrauterine adhesions (IUAs) at the cervical isthmus, lateral uterine walls, and in front of both tubal ostia. Hysteroscopic adhesiolysis was performed using a Versapoint resectoscope, restoring the normal cavity. Hyaluronic acid (HA) gel was injected as an adhesion prevention barrier. A 6-month follow-up diagnostic hysteroscopy revealed recurrence of dense IUAs.

Prevalence of High Prolactin Levels in Subfertile Females of South Punjab, Pakistan

Objective: To find out the prevalence of hyperprolactinemia in subfertile females attending outpatient department (OPD) in a tertiary care hospital of South Punjab, Pakistan Design: Cross sectional Setting: Gynaecological outpatient department (OPD) Nishtar Hospital Multan, Pakistan Duration of study: Six months Subjects and methods: After approval from the hospital ethical committee, 379 patients, who meet the set standards, having primary and secondary subfertility, were included from Gynae outpatient department (OPD) of Nishtar Hospital Multan. After informed consent, serum prolactin level was measured of all selected women. Data was entered into a computer using SPSS version 10 for Windows. Results: Most women (39.05%) were 26-30 years old and were nullipara. BMI &gt; 30 was observed in 21.89% of cases. Majority of patients (66.75%) were having primary subfertility. Secondary subfertility was reported in 33.24% of cases. Duration of subfertility was &lt; 5 years in 63.06% of patients and in 36.93% of cases duration of subfertility was ≥5 years. Frequency of hyperprolactinemia in subfertile women was 29.28%. Conclusion: Hyperprolactinemia causes anovulatory cycles because of suppression of endogenous gonadotrophins and it is commonly encountered in patients who primarily find unable to conceive as compared to those who have previously conceived. Keywords: High prolactin levels, primary infertility, secondary subfertility, prolactinoma.

Etiological Factors and Clinical Patterns of Subfertility among the Couples Attending in a Tertiary Care Hospital in Bangladesh

Subfertility, a global health issue is defined as the failure in pregnancy after one year of unprotected intercourse. It affects approximately 10%-15% of the couple in developed country1. It is not merely a health problem but also a matter causing social instability, marital disharmony and many disgraceful conditions. Regarding causes of subfertility, female factor, male factor, combined male and female factors and sometimes unexplained factors are responsible.&#x0D; Objective: The aim of the study was to find out the etiological factors and the patterns of subfertility among the couples attending the infertility clinic and outpatient department (OPD) of Kurmitola General Hospital of Bangladesh.&#x0D; Methods : This cross-sectional study was done at the OPD and infertility clinic of Kurmitola General Hospital during the period of January 2019 to- December 2019. Total 140 couples with necessary investigations were interviewed by structured questionnaire. Data analysis done under SPSS method.&#x0D; Result : In this study total number of 140 couples were studied. The frequency of primary and secondary subfertility was 55% and 45% respectively. Among 140 couples mean age of female was 32.6 year and mean age of male was 36.4 year. The mean duration of the subfertility among the couples was 7 year. Concerning the contribution of male and female factor among 140 couples, female factor was responsible in 55% case and male factor was responsible in 20% cases, 10% had combined male and female factor and in 15% couple causes of subfertility was unexplained. Regarding the etiology of subfertility among women, different factors included. Polycystic ovarian syndrome (PCOS) 46.15%, tubal factor 31.86%, endometriosis 8.79%, among hormonal disorder hypothyroidism was responsible in 5.49% and hyperprolactinemia in 2.19 % cases, and ovarian cause like poor ovarian reserve was responsible in 4.39% cases and uterine factor was responsible in 1.09% cases. To detect the male factors of subfertility semen analysis report was done., among male partner 69.04% had oligospermia, 16.66% show asthenospermia, another 9.52% show teratospermia. Azoospermia was detected in 4.76% cases.&#x0D; Conclusion: Bangladesh is a developing country where population burden is a big concern. On the other hand, reproduction is a basic human right. As the subfertility leads to physical, psychological and social problems so government needs to take care of this subfertility issue. This study gives us the idea of the needs and further demands of the services in our country to identify social cultural and economic factors associated with subfertility and interventions needed to overcome the current situation.&#x0D; Sir Salimullah Med Coll J 2021; 29(2): 136-140

PREVALENCE OF DYSFUNCTIONAL UTERINE BLEEDING IN PATIENTS WITH SUB FERTILITY

&#x0D; Background: Dysfunctional uterine bleeding is the idiopathic complication in premenopausal females or females that have chance to get pregnancy. It can have significant impact on quality-of-life of female and also lead to several complications including subfertility.&#x0D; Objective: To determine the frequency of dysfunctional uterine bleeding in patients presenting with problem of sub-fertility.&#x0D; Study design: Cross sectional study.&#x0D; Setting: Department of Obstetrics &amp; Gynaecology, Lahore General Hospital, Lahore. Duration: 3 months (July to October 2020).&#x0D; Method: Sample size of 150 patients were enrolled in the study through Non Probability, Consecutive Sampling. Patients of age 20-40 years, presented with diagnosis of subfertility were included. Then females were evaluated for presence of dysfunctional uterine bleeding. Data was recorded on proforma and analyzed by using SPSS version 22.&#x0D; Results: The mean age of females was 32.56 ± 8.93 years. The mean BMI of females was 29.61 ± 12.43 kg/m2. The mean duration of marriage was 8.94 ± 3.47 years. There were 97 (65%) females with primary subfertility while 53 (35%) females had secondary subfertility. Out of 150 females, dysfunctional uterine bleeding was noted in 69 (46%) females while 81 (54%) females did not had dysfunctional uterine bleeding. In females with primary subfertility, dysfunctional uterine bleeding was observed in 38 (39.2%) females. In females with secondary subfertility, dysfunctional uterine bleeding was observed in 31 (58.5%) females. The difference was significant (p&lt;0.05).&#x0D; Conclusion: Though this study, we found significantly high frequency of dysfunctional uterine bleeding in females with subfertility. Also the frequency of dysfunctional uterine bleeding was significantly higher in females with secondary subfertility as compared to primary subfertility.

Comparison of Hysterosalpingographic findings in patients with Primary and Secondary Subfertility

Hysterosalpingography is a commonly used imaging modality to assess the pathology of uterine cavity and fallopian tubes of patient with infertility. Hysterosalpingography has an established role in the assessment of tubal factor in patients with subfertility. Objective: To compare hysterosalpingographic findings in patients of primary and secondary subfertility. Materials and methods: A prospective study spanning six months duration was carried out in radiology department of private clinic in Multan. A total of 602 patient both primary and secondary subfertility were included in the study. Clinical notes and x-ray findings were analyzed for demographic data such as age and duration of subfertility and tubal and uterine abnormalities. Results: Out of 602 patient 66.8% had primary subfertility and 33.2% were in the secondary subfertility group. Tubal blockage was most common abnormalities in both groups i.e. 21.1% of patients with primary subfertility and 27.5% with secondary subfertility had tubal blockage. Key words: Subfertlity, hysterosalpingography, tubal blockage

Frequency of endometriosis found on laparoscopic examination among females with subfertility.

Objective: To determine frequency of endometriosis and its staging found on diagnostic laparoscopy for subfertility among females. Study Design: Cross Sectional study. Setting: Department of Gynecology and Obstetrics, Jinnah Medical and Dental College and Hospital Karachi. Period: August 2020 to January 2021. Material &amp; Methods: Total 120 female cases were enrolled into the study who were admitted in the ward for diagnostic laparoscopy to determine cause of subfertility. All female patients in reproductive age having undiagnosed primary or secondary subfertility were selected using consecutive sampling technique. Those who had previously any abdominal surgery were excluded from the study. Data was analyzed using SPSS-20 software. Results were presented in the form of frequency, percentage, and mean ± standard deviation. Results: Endometriosis was diagnosed on laparoscopy in 29.1% cases as a cause of infertility. Age range of the patients in study group was 16-45 years with mean age of 27.42 ± 2.16 years. Infertility duration was ≤3 years in majority of cases (65%). Primary infertility was present in 65.7% and secondary infertility was found in 34.3% cases in study group. Most of the patients diagnosed for endometriosis were having age &gt; 30 years. Stage-4 endometriosis was found commonly in 42.8% cases. Conclusion: Laparoscopy is a best modality for diagnosing endometriosis and its effect on fertility in future. This facility should be available in all gynecological departments for timely diagnosing endometriosis and to treat it promptly.