Correlation between Seropositivity of Chlamydia Trachomatis and Tubal and/or Pelvic Pathology Detected by Diagnostic Laparoscopy in Subfertile Women

This prospective observational study was carried out in the Infertility Unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February 2011 to December 2013. Sixty-nine (69) subfertile women who were seropositive for Chlamydia Trachomatis were included in this study. Inclusion criteria was patients with sub-fertility having age between 22 and 40 years, seeking infertility treatment, normal ovarian function, all normozoospermic male partner, duration of infertility ranged from 1.5 to 14 years. Exclusion criteria were patients having sub-fertility with extensive pelvic and/or ovarian surgery, endometriosis, ablation of endometriotic spots, pelvic tuberculosis and history of ectopic pregnancy. Before laparoscopic evaluation, all study women were screened for Chlamydia Trachomatis Specific IgG & IgM antibodies using ELISA in the Microbiology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All the study women had positive results for IgG antibodies. All study women underwent diagnostic laparoscopy. During laparoscopy, we observed the condition of pelvic cavity, uterus, fallopian tubes, ovaries, peritubal adhesions, tubo-ovarian relationship, status of Pouch of Douglas (POD), fimbriae etc. During dye test procedure, dilute methylene blue dye was injected through the cervical canal and the dye spill out was observed to confirm the tubal patency or blockage or pattern of flow of dye. The results of laparoscopic findings demonstrated that mobility of uterus was restricted in 20(29%) cases, adhesion of uterus with peritoneum was in 8(11.6%) cases, uterine fibroid was present in 11(15.9%) cases, hydrosalpinx in right fallopian tubes were in 27(39.1%) cases, in left fallopian tubes were in 32(46.4%) cases and in both fallopian tubes in 16(23.2%) cases, inflamed right fallopian tubes in 32(46.4%) cases, inflamed left fallopian tubes in 36(52.2%) cases and inflamed both fallopian tubes in 26(37.7%) cases, adhesions in pouch of Douglas was in 4(5.8%) cases, collections in pouch of Douglas was in 7(10.1%) cases and obliterations in pouch of Douglas was in 5(7.2%) cases. Results of Dye test during laparoscopy were that right fallopian tube was blocked in 32(46.4%) cases, left fallopian tube was blocked in 32(46.4%) cases and both fallopian tubes were blocked in 21(30.4%) cases. This study shows that by laparoscopy, significant number of cases of tubal and pelvic pathology was diagnosed in the chlamydia trachomatis seropositive subfertile female. This indicates strong correlation between seropositivity of chlamydia trachomatis and/or pelvic pathology detected by diagnostic laparoscopy.

Role of Serum Follicle Stimulating Hormone, Luteinizing Hormone, Testosterone and Prolactin Levels in Azoospermic Male Partner of Subfertile Couple

This cross sectional study was carried out in the Infertility Unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2011 and June 2013. Eighty one (81) consecutive azoospermic male partner of married couple, aged 20-50 years with at least two years of subfertility and no known endocrinopathy and ejaculatory dysfunction were included in this study to find out their abnormal hormonal pattern. None of them had received any form of treatment within the last 3 months prior to hormonal evaluation. Men with hypertension, recent fever, chemo or radiation exposure were excluded from the study. Eight weeks interval two semen analyses were done in the Andrology Laboratory of above department following standard WHO guideline, 2004. Using standard ELISA technique, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and prolactin were measured/assayed/estimated. The results of this study demonstrated that 40 (49.4%) men had normal endocrine pattern against 51 (50.6%) with endocrinopathy. The former may be related to obstructive azoospermia, which needs further analyses. Both the increased FSH (>11.1mIU/ml) and LH (>7.6mIU/ml) were observed in 25 (30.9%) men, only elevated FSH (>11.1mIU/ml) in 9(11.1%), and only elevated LH (>7.6mIU/ml) in 7(8.6%). Low testosterone level (<270ng/dl) was observed in 11(13.6%), low TSH (<0.4μIU/ml) in 1(1.2%) and low prolactin (<2.5ng/dl) in 5(6.2%).

Serum Prolactin Level of Subfertile Women

Subfertility is a major reproductive health problem all over the world as well as Bangladesh, and the problem is increasing day by day. This study was done to estimate the serum prolactin concentration in primary and secondary subfertile women. Laboratory investigation included serum prolactin level, as well as LH, FSH, TSH blood glucose (2 hours after 75 gm glucose load) of 50 women who attended infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2009 and February 2010. In most cases, common age group 26-30 years (52%), primary subfertility (74%), duration of marriage >5 years (60%), trying to conceive duration ≤5 years (54%), BMI >25 kg/m² (60%), menstrual cycle regular (58%), history of abortion absent (90%), and history of menstrual regulation absent (94%). Common investigation findings was normal serum follicle stimulating hormone (FSH) 1.0-10.0 mIU/ml in 82%, normal serum luteinizing hormone (LH) 1.0-10.0 mIU/ml in 50%, normal serum prolactin 1.9-25.0 ng/ml in 36%, normal serum thyroid stimulating hormone (TSH) 0.4-4.0 μIU/ml in 56%, and normal blood glucose level (2 hours after breakfast) (<7.8 mmol/) in 66% women. Ultrasonographic finding of lower abdomen was normal in 14% women. Common finding of semen analysis husbands of the study women was normozoospermia in 88% cases. Serum prolactin concentration may have role to play in subfertility of women.

Pregnancy outcome following myomectomy

In developing countries, abdominal myomectomy is still a modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility and preserve uterus. In order to assess the outcome of pregnancies after myomectomy, a prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 1999 and June 2011. Study included 40 married women of reproductive age, suffering either from primary or secondary subfertility, and who had uterine fibroid and strongly wished to conceive shortly after myomectomy using microsurgical procedure with no existence of other male and female subfertility factor. These women were followed up at 3, 6, 12 and 24 month intervals over telephone and outdoor visits. Data were recorded on preformed questionnaires. Post myomectomy hysterosalpingography was done at about 16 weeks after myomectomy. Patients were advised to try for pregnancy after 16 weeks of operation. Maximum number of women belonged to age group 31-35 years (n=14, 35%); primary subfertility was 67.5% and secondary 32.5%; in maximum number of cases duration of subfertility was 2-5 years (n=22, 55%); type of fibroid were solitary (52.5%) and multiple (47.5%); type of myoma were intramural (75%), submucous (2.5%) and combined (22.5%); location of myoma were fundal (5%), anterior wall (25%), posterior wall (20%) and combined (50%); diameter of removed myoma were <5cm (2.5%), 5-8cm (67.5%), >8-10(20%) and >10cm (10%); uterine size before myomectomy were (in weeks) <12(22.5%), 12-14 (27.5%), 15-20 (32.5%), 21-25 (15%) and >25 (2.5%). Hysterosalpingography was done in 16(40%) cases, and the findings were both tube patent (62.5%), unilateral tubal block (31.2%) and bilateral tubal block (6.2%). Menorrhagia after myomectomy was present only in 5% cases. After uterine myomectomy, 14(35%) women conceived, common time interval between myomectomy and conception was 1-2 years (42.9%), conception was spontaneous in 71.4%. Out of 14 who conceived after myomectomy 12(85.7%) delivered live babies by LUCS, and most of the babies weighed >3kg (58.3%).

Outcome of metformin treatment in polycystic ovary syndrome

The polycystic ovary syndrome (PCOS) is a clinical diagnosis. During one year period, 50 women suffering from PCOS were treated with either 850 mg/twice daily or 500 mg/thrice daily along with clomiphene citrate and/or letrozole, with advice for exercise and dietary therapy. Diagnosis of the PCOS patients was made by the presence of two out of the following three criteria: (a) oligo and/or anovulation, (b) hyperandrogenism (clinical and/or biochemical), and (c) polycystic ovaries, with the exclusion of other aetiologies. The mean±SD age of our patients was 26.74±3.85 years, BMI 26.64±2.64 kg/m2, pulse 80.56±4.61 b/min, systolic blood pressure 113.80±4.40 mmHg and diastolic blood pressure 76.10±4.77 mmHg, duration of marriage 6.19±3.20 years, and parity was 43(86%) nulliparous and 7(14%) primiparous. Oligomenorrhoea was present in 100%, hypomenorrhoea in 38%, secondary amenorrhoea in 28% and acne in 70% women. Results showed that 92% women followed advice on exercise and dietary therapy, in maximum number of women progesterone level was 31.40 nmol/L (66%), weight loss was 2 kg (44%), menstrual cycle regular (90%) and pregnancy test negative (90%). Only in 5 cases (10%) pregnancy test was positive.

Laparoscopic findings of subfertile female patients in a tertiary hospital

Sub-fertility affects approximately 15% of couples. Approximately 40% of cases involve a male factor, 40% involve a female factor and the remainder involves both sexes. The polycystic ovary syndrome (PCOS) is one of the most common causes of sub-fertility due to anovulation in women. Treatment of sub-fertility in female partners mainly depends on the laparoscopic findings of patients with PCOS, pelvic inflammatory disease (PID), endometriosis and fibroid uterus. Between February 2007 and April 2009, 73 subfertile women with PCOS were evaluated on their laparoscopic findings in a tertiary hospital in Dhaka city. Mean±SD age was 28.55±3.98 years and primary sub-fertility was 68.5% vs. secondary 31.5% (p<0.01). In most cases, uterine size and position was normal (91.8%, p<0.001 and 89%, p<0.001) and 78.1% mobile. In most of the cases pouch of douglas was normal (78.1%, p<0.001) and adhesion absent (72.6%, p<0.001). In majority of the cases both right and left fallopian tubes were patent (80.8% vs. 75.3%) and ovary healthy (65.8% vs. 64.4%). Positive dye test of right and left fallopian tubes was significantly high (p<0.001). Careful evaluation of laparoscopic findings, are likely to help appropriate treatment modalities for desired outcome.

Role of magnesium sulphate in the treatment of hypomagnesaemia in eclamptic patients

Hypomagnasaemia has been identified as one of the main causes of eclampsia and preeclampsia which causes maternal and fetal/neonatal morbidity and mortality. In spite of wide difference of opinion about the best anticonvulsant, magnesium sulphate, diazepam and phenytoin are currently the mostly widely used anticonvulsants. The present study tried to find out the role of MgSO4 in correcting hypomagnasaemia in eclamptic women in Bangladesh. The study included 60 healthy (non eclamptic) 60 eclamptic women and was carried out in two hospitals of Dhaka city, during January 1999 to June 2000. Required tests were done in the Department of Biochemistry, BSMMU. Comparison of pretreatment clinical parameters between the two study groups showed highly significant (p<0.001) differences, MgSO4 level, pulse rate, systolic and diastolic blood pressure, and respiratory rate. After the case group of women was treated with MgSO4, the clinical parameters, pulse rate, systolic and diastolic blood pressure, and respiratory rate, between control and case groups showed no significant differences. However, serum magnesium level in case group increased to 3.41±0.21 mg/dl from pretreatment level of 1.02±0.26 mg/dl, and when compared to control (2.25±0.26 mg/dl), the increase was highly significant (p<0.001). It may be concluded that correction of hypomagnesemia may help to improve eclamptic situation.

Male sub-fertile patients in a tertiary hospital

Estimated prevalence of subfertility is 10% of couples; 35 40% male, 40 50% female and remainder involve both sexes. We analyzed semen of 50 sub-fertile male subjects attending infertility unit outpatient department, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, between July 2007 and December 2008, to establish cause of their problem and initiate treatment regimen to correct their problem. Mean age was 32.68 years, known medical disorders was present in 6(6% history of mumps, 4% history of orchitis, 2% diabetes), 28% were smokers, and none was drug addict. Semen analysis: mean±SD semen volume 1.94±1.08 ml, concentration 19.43±25.18 106/ml, motility 24.04±26.49%, rapid linearity 13.10±15.74%, slow linearity 8.16±8.65%, non-progressive 2.74±6.23%, immotile 33.68±33.06%, morphology 21.62±26.15%, head abnormality 21.06±24.72%, midpiece abnormality 14.04±17.12%, and tail and other abnormalities 10.90±17.28%. Agglutination was seen in 2%. Diagnosis was 42% azoospermia, 4% normozoospermia, 12% oligoasthenozoospermia, 10% asthenozoospermia, 18% oligozoospermia, 10% oligozoospermia with reduced motility, 2% each oligozoospermia with infection and astheno and teratozoospermia.

[Using a compression method after surgical treatment of hemorrhoids]

A compression method was used as a final stage of surgical treatment of hemorrhoids which was performed with a specially worked out compressing probe (two latex cuffs were mounted on the three-lumen rubber tube). The internal and external hemorrhoids were compressed after introduction of the probe into the anal canal and blowing up the cuffs. Comparative results of 103 operations are shown: in 67 patients the operation was finished with the introduction of an ointment tampon, in 36--with a compressing probe. Postoperative results judged by such symptoms as postoperative pains, bleedings, adaptation of the operation wound edges, retention of urine etc. showed that the compression method had considerable advantages over the control group.