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Background and objective: Intrauterine insemination (IUI) after ovarian stimulation with clomiphene citrate has been a mainstay of therapy for couples suffering from non-tubal infertility because IUI is a simple, non-invasive, and cost-effective technique. Pregnancy rates after IUI were 8% to 15% on the average. Although the number of available follicles was increased by ovarian stimulation, the results are still not very promise. Because the clinical pregnancy rate of IUI in Srinagarind Hospital was 3.08%. The new insemination method for improving the clinical pregnancy rate was considered to be an alternative way technique which could be reduced cost and duration of treatment and avoid complication of the assisted reproductive technology. A preliminary RCT compared the clinical pregnancy rate of IUTPI and IUI was the main objective of the study.Methods: The study was conducted from April 1, 2007 to March 31, 2008 at Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The volunteers were women with non-tubal infertility who met the inclusion criteria (unexplained infertility, minimal-mild endometriosis, mild oligozoospermia) and undergoing first treatment cycle were randomized to the study. Twenty eight women were randomized to the study and allocation to group A (IUTPI) or group B (IUI) on the day of insemination followed the ovarian stimulation with clomiphene citate (CC). On the day of 36-40 hours after hCG administration, IUTPI was performed by using a pediatric Foley's catheter size 8 F inseminating with 10 mL of sperm suspension and IUI was performed with 0.5 mL of sperm suspension by using the household IUI catheter.Results: A total of 28 cycles was completed treatment and followed up (16 IUTPI cycles and 12 IUI cycles).The clinical pregnancy rate per cycle was 6.3%(1/16) for IUTPI and 0%(0/12) for IUI, p=1.00. The ongoing pregnancy rate per cycle was 6.3%(1/16) for IUTPI and 0%(0/12) for IUI, p=1.00. No multiple pregnancy, ectopic pregnancy, ovarian hyperstimulation syndrome and infection were occurred.Conclusion: This preliminary result of IUTPI after ovarian stimulation with clomiphene citrate might not be advantage over the standard IUI for couples with non-tubal infertility on pregnancy rate.Keywords: Intrauterine tuboperitoneal insemination, intrauterine insemination, clinical pregnancy rate, ongoing pregnancy rate
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Laparoscopy is the useful diagnostic procedure for evaluation of pelvic organs pathology. Routine laparoscopy for evaluation of the patients who need tubal sterilization reversal has been used in some institutes. But it is an invasive and costly procedure, and some complications may occurred. Two hundred and thirty cases of women who underwent laparoscopy for preoperative evaluation of tubal sterization revesal were reviewed. The average age of these patient was 31.9 years with average number of pregnancies of 1.9 times and average duration of tubal sterilization of 6.8 years. The majority of these women 70.0 percent stated the reversal request because of remarriage. Laparoscopic finding revealed that Pomoroy’s technic of tubal sterilization at isthmus part of the fallopian tubes was commonly used and 85.2 percent of cases were operable. The most common cause of inoperable cases was bilateral salpingectomy, 7.4 percent and the second common was total tubal length on each side was less than 4 centimeters, 4.3 percent From this result, we concluded that laparoscopy has little benefit in the evaluation of candidates for sterilization reversal but had benefit in evaluation of prognosis and with the good counseling, in some cases, laparoscopy may be unnecessary.
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Twelve oligospermic patients were treated with long acting indomethacin (Indocid, MSD , 75 mg/day) for 3 months. Semen analysis was performed twice before treatment and once at 2,4 and 6 months after treatment , respectively. The result showed that the treatment increased sperm count and sperm motility (P \< 0.05) . One pregnancy was reported during treatment.
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Background : Laparoscopically surgery has become more and more popular during recent years. Srinagarind hospital has been offering laparoscopic hysterectomy since February 1996.Objective : To study patient profiles in the initial 10 cases of laparoscopically assisted vaginal hysterectomy (LAVH) at Srinagarind HospitalStudy design : A retrospective descriptive studySetting : Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen UniversitySubjects : 10 cases with LAVH between February 1996 and July 1996Main outcome measures : Operating times, techniques for LAVH, 8 cases were myoma uteri, 2 cases were recurrent DUB. The average operating time was 2 hours 27 minutes DUB. The average operating time was 2 hours 27 minutes per case. One case had torn dome of urinary bladder during surgery, repaired by laparoscopic suturing.Conclustion : LAVH is a new technique for gynecologic surgery. It needs gynecologists with more training and requires further study to determine the effectiveness of the procedureKey words : LAVH
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Background: Severe pre-eclampsia is not an uncommon obstetric complication. The incidence or risk factors for this complication in Srinagarind Hospital has not previously been studied.Objectives : 1. To analysel the ratio of severe pre-eclampsia to total number of deliveries in Sringarind hosptialj ; 2. The risk factors for severe pre-eclampsia; and 3. The modes of delivery and the condition of the infant born to mothers with severe pre-eclampsia.Design: A descriptive case-controlled study.Setting: Department of Obstetrics and Gynecology, Srinagarind hosptial. Faculty of Medicine, Khon Kaen University, Thailand.Subjects: 10, 580 women who has delivered at Srinagarind Hospital between January 1, 1992 and December 31, 1993.Main outcome measures: Ratio of cases of Sever pre-eclampsia to total number of deliveries, and risk factors analysed by multiple logistic regression.Results: The incidence of severe pre-eclampsia was 0.96 per 100 deliveries. Thei risk factors were primigravida status (adjusted OR:2.4,95%CI: 1.3-4.3); base history of pre-eclampsia (adjusted OR:0,95%CI: 2.7-18.8); gestational diabetes (adjusted OR:4.6,95%CI: 1.3-16.6); and body mass index of more than 20 kg/m2 prior to the pregancy (adjusted OR:3.3,05%CI: 1.3-8.2). The most common mode of delivery was cesarean section, while normal vaginal birth was the most common mode of delivery in the case and control groups were 2599.7 grams (SD. = 699.4) and 3095.7 grams (SD. = 420.7), respectively. The percentrage of infacnts with a low birth weight (less than 2500 grams) in the pre-eclampsia group was 40.6% compared with 5.9% in the control group. Severe birth asphyxia occurred in 9.9 % of the pre-eclampsia group compared with 1.8% in the control group.Conclusion: Severe pre-eclampsia is not uncommon in Srinagarind Hospital. It was found in 0.96 per 100 deliveries. The risk factors are primigravida status, past history of pre-eclampsia, grestational diabetes, and body mass index of more than 30 kg.m2 prior to the pregnancy. Themost common mode of delivery was the most common in the controls group. The gestational age, birth weight and apgar score of infants in the pre-eclampsia than the control group.
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Objectives: 1. To compare severity of pain from endometrial curettage by Karman cannula and metal curette. 2. To compare duration of bleeding after endometrial curettage by Katman cannula and metal curette. 3. To compare adequacy of pathological specimen obtained by Karman cannula and metal curette.Design: Randomized controlled trail studySetting: Srinagarind Hospital, Khon Kaen UniversitySubjects: Women who attended gynecological outpatient clinic with abnormal uterine bleeding which required endometrial curettage from 16 June 1997 to 20 January 1998 were randomly allocated to either Karman cannula or metal curette group.Intervention: Endometrial curettage by Karman cannula or metal curetteMain outcome measurement: 1. Level of pain by visual analogue scale and descriptive pain evaluation. 2. Duration of bleeding after endometrial curettage in day(s) by postcard questionnaire. 3. Adequacy of pathological specimen.Results: The number of patients in the metal curette group who suffered from severed from severe pain was more than in the Karman cannula group, with relative risk of 5 (95% confidence interval 2.25-11.13) and 7.25 (95% confidence interval 2.71-19.36) in pain assessment by visual analogue scale and by descriptive pain evaluation, respectively. Duration of bleeding after curettage by Karman cannula was 2.93±2.58 days and by metal curette was 2.50±2.06 days and there was no significant difference in duration of bleeding between the procedures. Adequacy of pathological specimen was 86.67% in metal curette group and 83.33% in Karman cannula group which was not significantly different.Conclusion: Endometrial curettage by Karman cannula is less painful than curettage by metal curette and there is no significant difference in both duration of bleeding after the procedure and adequacy of pathological specimen.Key words: Karman cannula, metal curette, endometrial curettage, pain, bleeding
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Objective: To compare severity of pain and determine side effects from digital examination between using Aloe vera gel and K-Y gel as a lubricant.Material and Method: This study included 400 patients who required per vaginal examination from February 1,1999 to June 30, 1999. Aloe vera gel was used as a lubricant in 200 patients and K-Y gel was used in other 200 patients. Visual analogue scale was used to assess the level of pain during digital examination. Mailing questionnaire was used to evaluate side effects during the first week after examination.Results: There were no significant differences in the level of pain and side effects between using Aloe vera gel and K-Y gel.Conclusion: The level of pain and side effects were not significantly different between using Aloe vera gel and K-Y gel. Therefore, Aloe vera gel should be promoted to be an alternative lubricant for digital examination due to its lower cost.Key words: K-Y gel, Aloe vera gel, lubricant, per vaginal examination
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Objective: To assess the success rate and factors influencing the success rate of sterilization reversal in Srinagarind hospitalDesign: A descriptive studySetting: Srinagarind hospital, Khon Kaen UniversitySubject: 206 patients who underwent microsurgical sterilization reversal in Srinagarind hospital between January 1, 1984 to June 30, 1993.Result: Mean age of the patients was 32.0 years, most of them were government officers and farmers. The reasons for reversal were remarriage (68.0 percent) and death of their children (17.5 percent). Most of the patients had postpartum tubal reanastomosis was performed in 83.0 percent of the patients. Ampulla to ampulla was the most common type of reanastomosis. The mean duration of the operation was 135.8 minutes. Success rate of the operation as determined by delivery of the liveborn was 58.7 percent while abortion rate and ectopic pregnancy rate were 8.3 and 6.6 percent, respectively. Most of the pregnancies occurred in the first two years after the operation with the mean interval between the operation and the commencement of pregnancy of 21.6 months. Factors that influence the success rate of sterilization reversal were age of the patients, time interval after sterilization, type of sterilization and part of the uterine tubes being reanastomosed. This study revealed that the patients with age under 35 years, operation performed within 5 years after sterilization, interval type of sterilization, and isthmic-isthmic reanastomosis were the factors that resulted in the better success rate.Conclusion: sterilization reversal in Srinagarind hospital had a good success rate and factors that influenced the success were age of the patients, time interval after sterilization, type of sterilization, and part of the uterine tubes being reanastomosed
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Objective: To determine the prevalence of tubal abnormalities among infertile patients treated at Srinagarind Hospital.Design: A descriptive studySetting: Infertility clinic, Srinagarind hospital, Faculty of Medicine, Khon Kaen University, Thailand.Subject: Total of 523 female patients being treated at infertility clinic, Srinagarind hospital between 1 January 1998 to31 December 2000.Method: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted.Main outcome measure: Prevalence of tubal abnormalities in infertile females being treated in our infertility clinic during the study period.Results: Among the 523 patients being recruited to this study, 387 cases (74.0%) were diagnosed with primary infertility while the rest (136 patients or 26.0%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 5.0 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 417 cases (79.7%), 18 cases (3.4%) and 88 cases (16.8%), respectively. The prevalence of tubal abnormalities demonstrated in this study was 26.8 % (140 from 523 cases). Among the 140 patients with tubal abnormalities, the pathologies detected were cornual occlusion (42.8%), combined tubal abnormalities (32.9%), distal tubal occlusion (9.3%), hydrosalpinx (5.7%), peritubal adhesion (5.7%), and other abnormalities (3.6%). Other pelvic pathologies detected from laparoscopy were endometriosis (55.7%), pelvic adhesion (27.4%), leiomyoma (12.3%), and ovarian cyst (0.9%).Conclusion: Tubal abnormalities was detected in over one-fourth of all infertile females being treated at Srinagarind hospital. Furhter study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.
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Objective: To determine the prevalence of chlamydial infection in the lower genital tract, patient demographics and reproductive health, among infertile women being treated at Srinagarind Hospital, Khon Kaen University, Thailand.Design: Descriptive studySetting: Infertility Clinic, Department of Obstetrics and Gynecology, Srinagarind Hospital, Khon Kaen University, Thailand.Subjects: Infertile women attending the Clinic between June 2000 and June 2001.Methods: Screening for Chlamydial trachomatis was initiated at Srinagarind Hospital's Infertility Clinic in June 2000. Specimens were taken by endocervical swabs at the first visit from 70 consecutive patients for PCR and GENPROBE testing. Demographic and reproductive health data were recorded.Outcome measurement: The prevalence of chlamydial infection in the lower genital tract in infertile women being treated at the Hospital.Results: The overall chlamydial infection rate was 1.43% (0.04-7.70 95% CI). The average of studied women was 29.6 years. The proportion of primary and secondary infertility was 81.4 and 18.6 %, respectively. The average length of infertility was 4.6 years. Only 28.6% of the consecutive women had previously used contraception of which 85% was a combined contraceptive tablets.Conclusion: The prevalence of chlamydial infection in the lower genital tract of infertile women at Srinagarind Hospital was 1.43%. Keywords: Chlamydial infection; Infertile women