changing face of medicine in the 21st century: the example of infertile clomid failed insulin

The outcome of metformin administration in insulin resistant infertile polycystic ovary syndrome [PCOS] patients who had failed clomid. The research was conducted at the University Assisted Reproductive Techniques [ART] Institute in Pakistan - a developing country with a high prevalence of diabetes. 166 PCOS patients submitted to ART out of 277 referrals [59.9%]. Of these 78 [47%] achieved pregnancies with 75.6% take home babies and 24.4% reproductive failure prior to ART, Intra Cytoplasmic Sperm Injection [ICSI] and In Vitro Fertilization [IVF]]. The total healthy take home baby rate was 47% of the 166 patients. These seventy eight [78] patients became pregnant prior to ART after starting metformin for insulin resistance. 88 required ART and 19 of these delivered a healthy baby. Metformin [500 to 2500 mg daily] was started prior to pregnancy and continued throughout pregnancy. Metformin 1500 mg daily for 3 months resulted in 59 live and well neonates averaging 3.1kg. Metformin <1500 mg daily and / or administration for less than 3 months prior to Pregnancy resulted in 18 abortions and 1 intrauterine death at 30 weeks gestation with no live neonate. Almost 50% became pregnant without ART. When ART was needed 19 out of 88 patients delivered a live baby. Almost 50% of patients with failed ART elsewhere became pregnant on this regime with take home healthy babies and 6 did not require ART. Metformin 1500mg daily administrated for at least 3 months prior to pregnancy and continued throughout pregnancy had an uncomplicated neonatal outcome in 59 patients compared to lower doses or shorter duration of administration in 19 patients who had a uniformly poor pregnancy outcome. The European Society of Human Reproduction and Embryology [ESHRE] and American Society for Reproductive Society [ASRM] guidelines are biologically and statistically flawed. In South Asia infertile PCOS patients require a long term life cycle approach. Early insulin resistance should be evaluated and metformin is the drug of choice in our hands. This has major implications for the life cycle of the patient, particularly as type II diabetes is now considered to be reversible

Obesity and insulin resistance among infertile women with polycystic ovarian syndrome

To find out the frequency of obesity and insulin resistance among infertile women with polycystic ovarian syndrome [PCOS]. Descriptive case series. Baqai Institute of Reproduction and Developmental Sciences [BIRDS], from July 2012 to June 2013. Women who had PCOS were selected on the basis of Rotterdam criteria between the ages of 16 to 40 years. Detailed history, physical examination, transvaginal ultrasound and hormone profile were done. Women who had other endocrinological problems like thyroid disorder, hyperprolactinemia, diabetes mellitus, Cushing syndrome and androgens producing tumours were excluded from the study. A total of 318 [35.49%] infertile women were diagnosed as PCOS out of 896 women who visited BIRDS during the study period. Majority [n=178 - 55.97%] of the women were between 21-30 years of age. Oligomenorrhea was the commonest menstrual irregularity found in 203 [63.83%] women. Mild hirsutism was noted in 204 [64.15%] women. On transvaginal scan PCO were observed in 298 [93.71%] women. Class I obesity was observed in 64 [20.12%], while 8.49% [n=27] had class II obesity. Class III obesity was found in 2[0.62%] women only. The number of overweight women was 132[41.50%]. High LH/FSH ratio was found in 185 [58.17%] women. Insulin resistance was observed in 201[63.20%] women. All manifestations of PCOS were more frequent and severe in obese patients

Psychological morbidity amongst infertile couples

To assess psychological morbidity amongst infertile couples. Cross-Sectional study. This study was carried out at MAS Infertility Clinic, Rawalpindi from August 2010 to January 2011. A total of 30 subjects [15 couples] were included in the study. After taking an informed consent, they were asked to complete a questionnaire. Depression, Anxiety and Stress Scale [DASS] questionnaire was used for this study. Data was analyzed using SPSS version-14 and t-test was applied to see the significance in differences. Majority of couples were over 30 years of age and were married for more than 5 years. Vast majority [73.3%] were living in joint family system. Psychological morbidity, particularly anxiety and depression affected significantly [p=0.05] female partner. However no significant relationship was observed between the cause of infertility or duration of infertility and psychological manifestations. This study presents pragmatic evidence regarding the psychological health of infertile couples in our society. Findings suggest that high levels of stress and depression exist in these couples, which not only affects their physical health, but also their psychological well being. It highlights the importance of providing psychotherapeutic help along with treatment for the cause of infertility

Heterotopic pregnancy ending in IUD and A subsequent successful pregnancy

A case of heterotopic pregnancy in a 25 years old, 0+0 is reported after clomiphene citrate. This was misdiagnosed by 2 early ultrasound reports, but diagnosed on clinical ground and confirmed on ultrasound at 8 weeks of gestation. Successful Laparotomy for removal of ruptured tubal eetopic was performed saving a viable intrauterine pregnancy. Fetal demise at 28 weeks occurred because of intrauterme growth restriction starring at 25 weeks of gestation. The next spontaneous conception was intrauterme within 1 year and progressed normally till 34 weeks, when caesaream section was performed for decreased fetal movements. An alive male of 2.2 kg delivered and managed in NCU for pre-maturity