ABSTRACT
While the role of prostaglandin as a trigger in dysmenorrhea is well known, not many are aware that inflammation and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome are also implicated in primary dysmenorrhea (PD). Inhibition of NLRP3 inflammasome and inflammation pathways is an important approach to treating dysmenorrhea and also the symptoms of premenstrual syndrome. Mefenamic acid is an effective and selective inhibitor of the NLRP3 inflammasome, which can be considered the most important option for PD treatment owing to its action via various pathways. In this article, the authors have reviewed the role of inflammation and NLRP3 inflammasome in causing PD, how inhibitors of NLRP3 inflammasome can treat dysmenorrhea and the mechanism of action of mefenamic acid as NLRP3 inflammasome inhibitor and its role in PD.
ABSTRACT
Despite being one of the most common gynecological issues faced by women of reproductive age, dysmenorrhea largely remains an ignored, underdiagnosed and untreated condition. It continues to be a public health issue and has a significant impact on the quality of life of the affected women in terms of inability to lead routine activities, absenteeism from academic activities or work and reduced social activities. Currently, existing evidence correlates and implicates the excessive synthesis of prostaglandins with the menstrual pain. Hence, treatment approaches that can inhibit prostaglandins' production or already formed prostaglandins can provide relief in dysmenorrhea. In this review, the impact of dysmenorrhea on the quality of life of women, the role of prostaglandins in the pathogenesis of dysmenorrhea, and how nonsteroidal anti-inflammatory drugs (NSAIDs) like mefenamic acid can be safe and effective in managing dysmenorrhea are discussed.
ABSTRACT
Background: Circulating levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone (P4) in serum after administration of gonadotropin releasing hormone agonist (GnRHa) trigger for final oocyte maturation are found to be predictive of oocyte maturity. This prospective study was conducted at a tertiary care centre to evaluate relationship between serum LH, FSH and P4 levels at 12-h post-trigger and oocyte maturity rate and to predict which hormone has maximum sensitivity and specificity for appropriate oocyte maturation.Methods: Women at risk of ovarian hyper-stimulation syndrome who underwent either autologous or donor IVF cycle treated with flexible GnRH antagonist protocol were taken as participants of the study. GnRHa as trigger for final oocyte maturation was given. After 12 hours of agonist trigger, blood sample was drawn to assess LH, FSH and P4 levels in serum. Continuous variables were expressed as mean±SD. Independent sample t test was used for continuous variables which were normally distributed and Mann-Whitney U test for data not normally distributed. Main outcome measures were number of oocytes retrieved, oocyte maturity rate, fertilization rate, cleavage rate and grade of embryos.Results: There was a statistically significant reduction in number of retrieved oocytes, maturity rate, fertilization rate and grade 1 embryos with a concentration of serum LH and P4 less than the cut off value (p < 0.05).Conclusions: Serum LH and P4 level less than the cut off value at 12-hour post-trigger with GnRHa is associated with a dramatically less oocyte maturity rate and fertilization rate.
ABSTRACT
Background: The objective of this study was to analyze the incidence and the underlying mechanisms of empty follicle syndrome [EFS] occurring in gonadotropin releasing hormone agonist [GnRHa] triggered in in vitro fertilization [IVF] cycles with GnRH antagonist protocol in women with polycystic ovary syndrome [PCOS] of Indian origin. The study also intended to evaluate the cycle outcome following a rescue trigger
Methods: Retrospective cohort analysis of data was extracted from the hospital database of 271 PCOS patients who underwent IVF in antagonist protocol triggered with GnRHa from August 2014 to December 2016. All cases with failure to obtain oocytes following retrieval were analyzed. Continuous variables were expressed as mean+/-SD using t-test and Chi-squared test for categorical variables. A p<0.05 was considered statistically significant
Results: Incidence of EFS following GnRHa trigger was found to be 3.3%. False empty follicle syndrome [FEFS] accounted for majority of the cases [8/9=88.8%]. Of the nine EFS, six cases were salvaged with a rescue trigger, resulted in transfer of reasonably good quality embryos in a frozen-thawed embryo replacement cycle achieving clinical pregnancy in three cases [3/6=50%]
Conclusion: Our experience with EFS cases following GnRHa, albeit small, given the rarity of its occurrence, suggests that majority of EFS are of false forms and can be effectively salvaged which results in reasonably favorable outcome
ABSTRACT
Recurrent abortions are hisheartening to the couple and also to the treating clinicians. Miscarriage is the loss of pregnancy weighing 500 g or less. Recurrent miscarriage or habitual abortion is defined as three or more consective abortions. Important factors involved in recurrent early pregnancy loss are genetic factors, endocrine factors, anatomic factors, immunologic factors, infectious factors and environmental factors. The factors are described in a nutshell in the text. Any severe infection that leads to bacteraemia orviraemia can cause sporadic miscarriage. Congenital uterine abnormalities have been associated most often with second-trimestar pregnancy loss. As regarding management of recurrent pregnancy loss the clinician has limited options. The use of aspiration in low dose (75 mg) and heparin is beneficial in APS positive patients. Multivitamins and folic acid assume importance in thrombophilic disorders. Tender live care with regular antenatal check-ups go a great way in achieving live term pregnancy.