Treatment Seeking Practices and Etiology of Infertile Couples in Bangladesh

Infertility is a major reproductive health problem, at least in part, a cultural problem also. In developing countries like Bangladesh, infertility is a devastating experience for a couple, particularly in women. For this reason many women suffer from many social and medical consequences. Most of the infertile patients of Bangladesh have no access to adequate comprehensive treatment. Also due to lack of proper knowledge, some couples use varied traditional methods and religious practices. This study was done to assess the treatment seeking behavior of infertile couple and also to find out the gross causes of infertility of patients attending at Motherhood Fertility center, Dhaka, Bangladesh. This prospective study was done over 3 years from June 2016 to June 2019. Two thousand two hundred and fifty (2250) patients attending a secondary infertility center at Dhaka were included in this study. Out of 2250 infertile patients 56.00% were rural and 44.00% urban. Of 737 (58.49%) rural and 658 (66.46%) urban infertile patients had consulted with General practitioner and Gynae specialist before coming to secondary and tertiary care center. Out of 1260 rural, 463(36.75%) and 990 urban, 291 (29.39%) had visited the infertility center as the first choice for treatment. Still about 8.8% infertile couple visited quacks and traditional healers for solving infertility. The overall primary and secondary infertility were 67.69% and 32.31% respectively. In 12.57% couples, male factor was the obvious cause (azoospermia and abnormal semen parameters). In 27.43%, female factors and in 28.0% couples both male and female had obvious reasons responsible for infertility. Thirty two percent (32.00%) cases were unexplained infertility. Out of female factors 43.00% anovulation, 29.00% tubal factors, 11.00% endometriosis, 5.00% Uterine factors, 2.00% POF (premature ovarian failure) and 10.00% others (Thyroid disorder, DM, Hyper-prolactinemia, Luteal phase defect). Infertility is an important health problem in Bangladesh. Etiology of infertility varies from regional, social and cultural conditions so that it requires proper diagnosis and then treats this problem accordingly. It is necessary to build up proper referral system and also proper training should be needed to service provider and traditional healers. Reproductive technology should be widely available in our society where motherhood is one of the most desired stages of a women's life.

Frequency and Correlates of Albuminuria in Adult Bangladeshi Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is associated with various metabolic risks imparting a higher risk for cardiovascular diseases (CVD) in affected women. Urinary albumin excretion (UAE) is a marker of endothelial leakiness and reflects early endothelial damage; thus is used as an important cardiovascular (CV) risk marker. UAE as a CV risk marker in PCOS patients is less well established. This cross-sectional study was done in a tertiary hospital of Bangladesh from January to December 2018 and 95 consecutive adult PCOS patients were screened for UAE. Clinical and anthropometric data were collected, and oral glucose tolerance test (OGTT), fasting lipid profile, serum creatinine, urine routine examination, total testosterone, prolactin, and TSH were measured. The urine albumin-to-creatinine ratio (UACR) was measured in a random single-voided urine sample. UACR cutoff ≥30mg/g was used to define albuminuria. The mean age of the subjects was 22.5±5.0 years; 72.6% were overweight/ obese; 68.4% had abdominal obesity; 94.7% had dyslipidemia and 40% of them had metabolic syndrome. Albuminuria was observed in 21.1% of the subjects. A higher frequency of metabolic syndrome was observed in albuminuric subjects than non-albuminuric ones (45% vs. 38.7%), though the difference was not statistically significant (p=0.617). Albuminuric subjects had higher plasma glucose (PG) value at 2 hours of OGTT and a higher frequency of acne. Other clinical, biochemical and hormonal parameters were similar in the two groups. PG 2 hours after OGTT and serum triglyceride (TG) showed positive correlations and LDL cholesterol showed a negative correlation with UACR. Our study emphasizes the need for screening PCOS women for UACR which may be helpful in identifying those subjects with future high risk of CVD.

Feasibility and Safety of Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Thalassemia in Bangladesh

Thalassaemia is one of the commonest inherited disorders in Bangladesh. Since population is rapidly increasing in Bangladesh, therefore birth of large number of new cases is expected every year. Chorionic villus sampling (CVS) is an invasive diagnostic procedure done in early pregnancy to obtain fetal cells for the prenatal diagnosis of chromosomal and genetic disorders like thalassemia. To investigate the feasibility, safety, and outcome of transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of Beta Thalassemia, this retrospective analytical study was carried out on women who had undergone transabdominal CVS for prenatal diagnosis of Beta thalassemia. All CVS are done at Fetal Medicine Centre, Family Foundation, Green Road, Dhaka, Bangladesh from June 2013 to December 2016. A total of 236 couples who were referred for prenatal diagnosis of thalassemia (Beta thalassemia & Hb-E beta thalassemia) were studied. Transabdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. Most procedures were done between 11 and 13 weeks (range 11-14 weeks). All CVS were performed with the "2 operators" technique. The samples were sent for prenatal diagnosis by genetic analysis. Results were recorded and analyzed for descriptive statistics. Out of 236, 123 (52.1%) fetuses were diagnosed as trait (Beta trait or HbE trait), 64 (27.1%) as healthy fetuses and 49 (20.7%) as affected fetuses. A total of 236 CVSs were performed as outdoor basis. Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% & 1.3% respectively which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases. Transabdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis of beta thalassaemia in early pregnancy without significant risk to the mother and the fetus.

Assessment of Postnatal Depression by Edinburgh Postnatal Depression Scale in a Tertiary Care Hospital of Bangladesh

The objective of the study was to estimate the prevalence of post partum depression and its associated risk factors among the mothers in their immediate post natal period. This cross sectional study was carried out in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and a tertiary care centre in Dhaka, Bangladesh from July 2015 to December 2015. Total 145 post natal mothers were screened for postnatal depression from day 5-7 following caesarean section by the validated Bangla version of Edinburgh Postnatal Depression Scale. To find out the risk factors for depression baseline data included age, parity, socioeconomic conditions, educational level, and occupation, history of depression, social support, and marital support, gestational age at the time of delivery, weight and sex of the baby. Postpartum depression was noted among 12.4% cases. Maternal age, history of depression, lack of social support was found to be significantly associated with maternal depression. This small study reflected the facts that many of the postnatal mothers of our circumstances suffer from postpartum depression and needs medical attention. Screening of postpartum depression can be considered as a routine part of postpartum care.