Evaluation of efficacy of sonosalphingogram for assessing tubal patency in infertile patients with hysterosalphingogram

Introduction: Infertility is a leading psychosocial problem in couples. Diagnostic evaluation of uterine tube is important in the management of infertility. Causes or factors of female infertility can basically be classified regarding whether they are acquired or genetic, age, smoking, sexually transmitted infections (STIs), adhesions in the peritoneal cavity, previous abdomen surgeries, diabetes mellitus, smoking, alcohol, celiac disease, liver and kidney disease and being overweight or underweight can all affect fertility. Proper evaluation of the infertility is needed for better management of the cases of infertility. Aim of the study: To assess the efficacy of Sonosalpingography (SSG) and Hysterosalpingography (HSG) in the diagnosis and management of infertility. Materials and methods: A total 75 cases attending the department with complaint of infertility. Cases between ages 21 years and 44 years were recruited for this study. Duration of this study was two years, from June 2016 to May 2018. All the cases were undergone with baseline transabdominal sonogram, real time transvaginal sonography and saline infusion sonography to examine pelvic region of the cases. All the participants had to undergo SSG on 8th day and HSG on 10th day of the menstrualcycle. Data was collected and sensitivity and specificity of SSG over HSG was assessed. Statistical analysis was done by using SPSS software version 14.0. Results: Diagnosis by SSG showed bilateral tubal patency in 83.93% cases and by HSG showed bilateral tubal patency in 75% cases. SSG and HSG both correlated well (95.3%) and both procedures had similar diagnostic accuracy. In this study, positive predictive value was 95.2% and negative predictive value was 94.6%. Sensitivity was 98.3%, specificity 85.6% and accuracy rate of this study was 95.8%. The outcome of this study indicates that there is no statistically significant difference (p=0.338) between the values of SSG and HSG. Conclusion: SSG is cost effective and radiation free procedure. The outcome of SSG is almost similar to the values of HSG.

Association of sexually transmitted infection with semen quality in men from couples with primary and secondary infertility / 亚洲男科学杂志(英文版)

This study aims to compare the prevalence of sexually transmitted infections (STIs) with semen quality in men from couples with primary and secondary infertility. Semen samples were collected from 133 men who requested fertility evaluation. Seminal tract infection with Ureaplasma spp. (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and herpes simplex virus-2 (HSV-2) was assessed by PCR-based diagnostic assays. Among all patients, the prevalence of STIs was higher in men from couples with primary infertility than that in men from couples with secondary infertility (39.7% vs 21.7%, P = 0.03). The prevalence of UU was 28.8% and 13.3% in men from couples with primary and secondary infertility, respectively. Men from couples with primary infertility were more likely to be positive for UU than men from couples with secondary infertility (P = 0.04). Regarding the UU subtype, the prevalence of Ureaplasma urealyticum (Uuu) and Ureaplasma parvum (Uup; including Uup1, Uup3, Uup6, and Uup14) did not differ between the two groups. No associations between the prevalence rates of MH, MG, and CT were found in men from either infertility group. A lower sperm concentration was associated with STI pathogen positivity in men with primary infertility according to the crude model (P = 0.04). The crude and adjusted models showed that semen volume (both P = 0.03) and semen leukocyte count (both P = 0.02) were independently associated with secondary infertility. These findings suggest the importance of classifying the type of infertility during routine diagnosis of seminal tract infections.

Ayurvedic Management Of Unexplained Infertility- A Case Study

Infertility is a condition in which successful pregnancy has not occurred, despite normal intercourse over 12 months. The cause of female infertility is multifactorial. Ayurveda assures normal pregnancy by proper maintenance of Garbha Samgraha samagris and normalcy of mind. All the causes of female infertility come under the imbalance of Garbha Samgraha Samagri and mind factors. In this case report patient suffered from primary infertility since six years, after allopathic consultation came for ayurvedic treatment. From detailed history involvement of vitiated Vatha, Agnimandhya and stressful mind was noticed. She was treated with Chiruvilwadi kashayam, Dhanwantharam gulika, Jeerakarishtam, Kumaryasavam and Manasamithravatakam for one month. Took follicular study on next cycle and revealed post ovulatory status on 16th day of cycle. Advised Phalasarpis, Dhanwantharam Gulika and Manasamithravatakam for two weeks. Patient came with positive urine pregnancy test after one week of missed period. The line of treatment followed in this case was to maintain Agni, normalize Vatha and assure proper health to mind. During the second half of the cycle Garbhasthapana medicines were administered. Patient took Dhanwantharam gulika and phalasarpis throughout the first trimester along with regular ante natal check up. Continued Dhanwantharam gulika up to 36 weeks and started Sukhaprasavagritham upto delivery from 36 weeks onwards. She delivered a female baby on 06.05.2018.

The prospective study of laparoscopic finding in infertility cases

Background: Infertility is a global reproductive health issue that affects many individuals and family. The aim of the present study was to evaluate the laparoscopic finding in infertility cases.Methods: Present study is a prospective study on laparoscopic evaluation of female infertility at Panna Dhai Mahila Chikitsalaya, Udaipur, Rajasthan, India. This study was done for the duration of one year from January 2017 to December 2017. Present study included total 100 cases randomly selected attending OBG OPD with both primary and secondary infertility.Results: Out of 100 cases infertile women 62 cases (62%) were of primary infertility and 38 cases (38%) were of secondary infertility. The mean duration of infertility was 3.7 years. Laparoscopic finding were as follow 42% had polycystic ovaries, 33% women had tubal pathology diagnosed on laparoscopy in which 22 women had tubal blocks diagnosed on chromopertubation and among them 19 had cornual block and 3 had ampullary block ,11% uterine finding and 7 women had adhesions in the pouch of douglas and one women had obliterated. About 20 women (20%) conceived during the period of study. Seven women had post laparoscopic complication two women complained of shoulder pain and another four of abdominal pain post operatively.Conclusions: Laparoscopy is the gold standard for diagnosing tubal factors, peritoneal factors, endometriosis and adhesions, because no other imaging technique provides the same degree of sensitivity and specificity and it should be considered in infertility workup for early treatment decision.

Hysterosalpingogram in evaluation of primary and secondary infertility: a two year study at a tertiary care hospital of South India

Background: Infertility globally is a raising threat and problem associated with significant social and psychological problem. Infertility currently affects about 10 to 14 percent of the Indian population, with higher rates in urban areas where one out of six couples is impacted. Patency of the tubes, structure of uterus and cervix can be visualized by hysterosalpingogram which is a simple safer inexpensive investigation of choice in cases of infertility. Objective of this study was to study the role of hysterosalpingography (HSG) in cases of primary and secondary infertility and to observe the structural abnormalities of cervix, uterus and fallopian tubes.Methods: A two year prospective study was conducted on cases of primary and secondary infertility attending the OPD of infertility clinic. HSG was performed on the subjects included in study and findings were noted. Analysis was done by Microsoft excel spread sheet.Results: A total of 286 cases with 11.19% of primary infertility and 88.81% of secondary infertility evaluated by HSG. Mean age of the study group was 35.16±2.8 years. 74.83% had abnormal findings, with 20.28% having normal uterine cavity with uterine filling defect being the common abnormality. Two congenital anomalies of uterus were noted. Tubal occlusion was seen in 8.39% right and 9.09% left cases. Hydrosalpinx was observed in 7.69% of right and 9.79% of left cases.Conclusions: To conclude, women presenting with infertility should be evaluated for tubal pathology. The tubal pathologies like occlusion or hydrosalpinx may be due to infections or post surgical sequelae. HSG remains one of the diagnostic backbone in infertility even availability of new modalities.

Correlation between Helicobacter pylori infection and primary infertility / 中华消化杂志

Objective To investigate whether Helicobacter pylori (H.pylori) infection correlated with primary infertility,whether H.pylori infection caused the abnormal elevation of pro-inflammatory cytokines in primary infertility women,and whether cytotoxin associated gene A (CagA) protein played a key role in it.Methods From September 2015 to August 2016,213 patients with primary infertility (infertility group) and 97 healthy individuals (control group) were selected.According to the common etiologies,patients with primary infertility were divided into groups with single-factor infertility,multifactorial infertility and unexplained reason groups.Serum H.pylori IgG antibody and CagA antibody were examined by H.pylori antibody type test kits.The levels of interleukin (IL)-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-13,IL-18,IL-1β,granulocyte-macrophage-colony stimulating factor (GM-CSF),interferon-γ (IFN-γ),tumor necrosis factor-a (TNF-a) and IL-12p70 were tested by ProcartaPlex Immunoassays.Chi square test and independent sample t test were performed for statistical analysis and risk was assessed.Results The positive rate of serum H.pylori IgG antibody of patients with primary infertility was higher than that of healthy control group (74.0％,37/50 vs 56.7％,55/97),and the difference was statistically significant (odds ratio (OR) =2.173,95 ％ confidence interval (CI) 1.028 to 4.595,x2=4.216,P =0.040).There was no statistically significant difference in the positive rate of CagA antibody between primary infertility group and healthy control group (71.7 ％,91/127 vs 74.5 ％,41/55,OR=0.863,95％CI0.421 to1.772,P＞0.05).The serum levels ofIL-8,IL-18 andIFN-γ of H.pylori positive primary infertility patients were (35.14 ± 12.16),(11.83 ± 4.01) and (11.05 ±3.17) ng/L,respectively,which were all higher than those of H.pylori positive healthy control group ((21.44±12.35),(9.89±2.23) and (8.90±1.45) ng/L,respectively) and H.pylori negative primary infertility group ((11.45±8.63),(7.90±0.99) and (8.18±1.10) ng/L,respectively),and the differences were statistically significant (t=6.947,3.366 and 4.811;15.596,8.900 and 8.068;all P＜0.05).The levels of IL-8,IL-18 and IFN-γ of H.pylori positive unexplained reason primary infertility group were (39.97 ± 11.52),(13.12±4.61) and (13.06±3.70) ng/L,respectively,which were all significantly higher than those of single-factor infertility group ((31.65 ±11.20),(11.12 ± 3.46) and (10.14 ± 2.41) ng/L,respectively) and multifactorial infertility group ((30.47±8.49),(11.13±3.79) and (10.07±2.50) ng/L,respectively);and the differences were statistically significant (t=4.217,2.942 and 5.738;5.138,2.562 and 5.218;all P＜0.05).In H.pylori positive primary infertility group,the levels of IL-8,IL-18 and IFN-γ of CagA positive patients were (40.42 ± 13.80),(13.04 ± 4.19) and (11.51± 3.41) ng/L,respectively,which were all significantly higher than those of CagA negative patients ((23.49 ± 11.57),(9.08 ± 1.43) and (10.04 ± 2.29) ng/L,respectively) and CagA positive individuals in healthy control group ((21.85 ± 12.14),(10.20 ± 2.29) and (9.31 ± 2.38) ng/L,respectively);and the differences were statistically significant (t =6.507,5.533 and 2.380;7.417,4.069 and 3.738;all P＜0.05).Conclusion CagA positive H.pylori infection can increase the level of serum pro-inflammatory cytokines,which may be a risk factor of primary infertility.To patients with unexplained primary infertility,this may be the cause of infertility.

Efficacy of TVS colour doppler in comparison of primary infertility with endometrial biopsy

Background: Accurate prediction and diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities Transvaginal ultrasonography (TVS) is one among all. Aim: To determine the efficacy of TVS ultrasonography in screening for endometrial disease and studied the concordance of abnormal endometrial thickness, as measured by ultrasonography, with diagnoses based on histopathological examination of endometrial biopsy specimens. Materials and methods: A total 200 Subjects were elected from OPD of ESIC Hospital, Hyderabad. All subjects were undergone to the routine clinical and blood investigation, ultrasound, transvaginal and colour doppler investigations. Results: Study of primary infertility the diagnosis by transvaginal ultrasound and histopathology matched in 82% cases, while in 18% cases there was a disparity among the two modes of investigation. Conclusion: TVS can play an effective role in diagnosis and management of primary infertility, as it has a greater patient compliance with non-invasive technique and without necessitating full bladder. It can replace the EB in the diagnostic work up of female infertility.

UTERINE ARTERIOVENOUS MALFORMATION TRANSVAGINAL DOPPLER ULTRASONOGRAPHY: CASE REPORT

Uterine arteriovenous malformation (AVM) is a rare condition, with fewer than 100 cases reported in the literature. Despite it being rare, it is a potentially life-threatening condition. This case report describes a healthy 29-year-old patient, nulligravida, with an unremarkable medical history, came from gynaecologist for ultrasaound due to complain of irregular heavy PV bleeding. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method. Transvaginal ultrasound (TVS) of the pelvis showed increased vascularity with multidirectional flow of the uterus and a prominent vessel, located on the posterior wall.

Two Cases of Microperforation of the Transverse Vaginal Septum

Primary amenorrhoea with microperforate transverse vaginal septum is a rare entity with varied incidence in different parts of the world. It may be asymptomatic, unlike imperforate hymen. Depending on the size of the microperforation in transverse vaginal septum clinical features may vary similar to those found in imperforate hymen cases. We report two cases of a 25 and 22-year-old women who sought the gynaecologist with complains of primary infertility. They had normal menses with one of them having secondary dysmenorrhea. Physical examination and imaging disclosed microperforation of transverse vaginal septum in the upper part of the vagina at mid point position. Resection of the septum under anesthesia was done. The outcome was favourable and 25 year asymptomatic patient with primary infertility at the present moment have conceived carrying six weeks pregnancy and second patient is in follow up. We conclude that this anomaly may be overlooked, interfering on its incidence determination. The finding of transverse vaginal septum in an asymptomatic infertility patient is highly unusual. Clinicians must be aware of atypical presentations and potential multifactorial etiologies of primary infertility. Ensuring a thorough evaluation is essential in order to mitigate long-term effects of a misdiagnosis.

CURRENT STATE OF LAPAROSCOPIC SURGERY FOR THE WOMEN WITH REPRODUCTIVE PROBLEMS / Шинэ санаа Шинэ нээлт

Today, in technologically updated world medicine, laparoscopy is more preferable than the common, open surgery procedures. There is a lack of scientific studies on laparoscopic surgery in gynecology, especially its present state and further tendencies. Therefore it served us as the background of the study.Retrospective study was conducted on 2016 laparoscopic surgery histories, which were performed in 2010-2014, at Mongolian state and private obstetric-gynecological hospitals and clinics. The study was developed by the program SPSS21.In 2010-2014 totally 2016 laparoscopic surgeries was performed: 713 – in First Maternity Hospital, 653 – in Bayangol hospital, 429 - inASE hospital, 221 – in National Cancer Center of Mongolia. The patients were classified by their age, education state, and citizenship. Mean age of these patients was 33.03 ±7.6(min 12, max 70). By educations: the 72.4% (1460) of them were high educated, 18.2%(367) has the secondary education, 4.7%(95) – college education, 4.5%(91) – 8th grade education, and 0.2%(3) – elementary school education or non-educated. The 81.8 %( 1649) patients were citizens, the 18.15 %( 366) – from rural areas. And only 0.05% (1) was the foreigner. We noted 7 %( 14) cases that shifted from laparoscopic surgery to open procedure. The post surgery average bed day was 2.7 ±1.3 (min 1, max 12), duration of the laparoscopic surgery 58.46 ±31.6 minutes (min 10, max 260). The average amount of blood loses during the surgery was 76.17 ±69.3( min 5, max 700),The relevance of the surgery duration and preoperative bleeding was(r-0.445). Various diagnoses were involved in the study: the 25.9% (524) of them had second infertility, ovarian endometriosis cyst- 10.5% (212), ectopic pregnancy- 9.4% (189), hydrosalpinx- 7.5% (152), endometrioma ≥ 4.5 cm - 6.3% (128), ovarian follicularcyst- 6.3% (128), ovarian cancer- 5.7% (115), primary infertility- 5% (101), ovarian dermoids cyst-4.3% (86), endometrioma ≤ 4.5cm- 3.4% (68), others-15.7%. Surgical procedures are classified by their purposes: 29% (584) of surgery for examine the fallopian tube using contrast for medium and divide adhesion, 17.6% (354) – to remove ovarian cyst, 12.8% (259) – to examine fallopiantube using contrast and remove ovarian cyst, 9.4% (189) – to remove fallopian tube, 7% (142)- to remove endometrioma, 6.3% (128) – to examine uterine tube using contrast dye, 6% (121)-ot do hysterectomy, 11.9%- for other reasons. The 76.7% of all surgeries were done within one hour and there was moderate correlation between duration of surgery and bleeding (r-0.445). The secondary infertility was the most common diagnosis. And the laparoscopic manage of adhesion and hystersalpingography were performed more. According to the study, non-cancerous growth of uterus was 9.7 and the 6% of it surgeries was laparoscopic myomectomy.

Analysis of clinical characteristics and prognosis of younger patients with endometrial cancer / 中国综合临床

Objective To investigate the clinical characteristics and prognosis of young patients with endometrial cancer.Methods Thirty cases with endometrial cancer were selected as our observed group (age less than 40 years old).Forty cases with endometrial cancer were selected as control group and their age were over 40 years old.The information about clinical characteristics,diagnosis,treatment and prognosis of patients in two groups were collected.Results The rates of primary infertility and less than 3 times of pregnancy in observed group were 30.0％ (9/30),56.7％ (17/30) respectively,higher than that in control group (5.0％(2/40) or 30.0％ (12/40)).The differences were statistically significant (x2 =6.183,5.372 respectively,P ＜ 0.05).The positive rate of estrogen receptor(ER) and progesterone receptor(PR) expression were 93.3％ (28/30) and 86.7％ (26/30) in observed group,higher than that in control(42.5％ (17/40),52.5％ (21/40)respectively).The differences were statistically significant (x2 =5.951,4.721 respectively,P ＜ 0.05).Two groups of patients were statistically significant differences in pathological stage,the pathological type of observed group was mainly stage Ⅰ (76.7％ (23/30)),higher than that of control group (47.5 (19/40),and the difference was statistically significant (x2 =5.464,P ＜ 0.05).There was statistically significant difference between the observed and control group on Cervical infiltration and lymph node metastasis(x2 =5.464,1.018respectively,P ＜ 0.05).Conclusion The infeaility and less than 3 times of pregnancy may be the risk factors of younger endometrial cancer and the pathological type of observed group was mainly stage Ⅰ.However the prognosis is similar between the young and the old patients.

Professor Yu Zengrui Treating Three Cases of Gynaecology Common Diseases / 浙江中医药大学学报

[Objective] Summary of female primary infertility, climacteric metrorrhagia and metrostaxis treated by Professor Yu Zengrui, a lump in the ab-domen of the gynecological diseases:clinical experience.[Methods] Respectively recorded in the Division of primary infertility, climacteric metrorrhagia and metrostaxis, in the treatment of a lump in the abdomen present a typical case, with differentiation theory analysed, thereby summarizing his clinical practice on treatment emphasizes the overal focus on disease differentiation combined with syndrome differentiation;pay attention to western medical drugs used in auxiliary roles such as clinical experience and the detection of characteristics.[Results] Patients achieved vision of treatment effect. By proof in the Division useing kidney warmer, tonifying spleen assisting pregnancy, Yin-nourishing dry, stop bleeding treatment of metrorrhagia and metrostaxis; activating blood circulation first to get rid of a lump in the abdomen, the method to use the balance of yin and Yang, and tapping up properly rule is appropriate.[Con-clusions] In Professor's treatment of women with primary infertility, uterine bleeding during peri-menopause and differentiation, treatment of a lump in the abdomen is productive, and has reference value to clinical treatment.

Kartagener’s syndrome : A rare case.

Primary ciliary dyskinesia (PCD) is a syndrome characterised by productive cough with bronchiectasis and sinusitis early in life and reduced fertility later in life. PCD is a rare syndrome with an estimated incidence of 1: 20,000 to 30,000 . Primary ciliary dyskinesia is a genetic disorder which manifests early in life and that distinguish it from the acquired mucociliary disorders . Here we discuss one such case of Kartagener’s syndrome that presented to us with bronchiectasis , recurrent sinusitis with primary infertility and situs inversus , all of which which fit into the triad of Kartagener’s syndrome.