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Background: Infertility is defined as the inability of a sexually active couple to conceive within one year of regular unprotected coitus. Worldwide, it is estimated that 15% of couples are infertile; among them, the male factor is responsible for 50% of cases. This may be the sole underlying cause or a contributory factor to infertility. We aimed to assess the effects of a complementary treatment with a strong antioxidant (levo-carnitine) on sperm function and fertility of infertile men.Methods: This was a randomized controlled trial study and was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, Bangladesh. during the period from July 2022 to June 2023. In our study, we included 72 infertile men presenting with asthenozoospermia. There were two groups-group A (Participants who received tab levo-carnitine 330 mg twice daily orally for three months) and group B (Tab placebo twice daily orally for three months)Result: The majority of patients in both groups, 51% in group A and 49% in group B, were aged 30-40 years, with no significant difference in mean age (35.36±5.50 vs 34.50±5.50, p>0.05). Overall, 62.5% of patients reported primary sub-fertility. Levo-carnitine administration leads to significant improvements in sperm motility (15±2.68 vs. 36.58±5.16, p<0.05). In the case of placebo treatment, there were no significant improvements in sperm motility (13.91±5.53 vs. 16.36±1.19, p>0.05). We found that the comparison of TMC of both groups reflected statistically significant differences (p<0.05) before treatment and after treatment with levo-carnitine and placebo (6.40±2.87 vs 22.91±14.88) 5.64±3.96 vs 7.71±4.91). Conclusions: Levo-carnitine treatment can lead to significant improvements in semen parameters, particularly in motility.
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Background: Endometriosis, a chronic inflammatory disease, significantly affects reproductive health and fertility in women. This study compares the efficacy of pentoxifylline plus metformin versus metformin alone in treating symptomatic endometrioma in infertile women.Methods: This randomized controlled trial was conducted at the department of reproductive endocrinology and infertility, BSMMU, Dhaka, from July 2022 to June 2023, involving 51 women. Participants were randomly allocated into two groups: pentoxifylline plus metformin (n=25) and metformin alone (n=26). Baseline and post-treatment evaluations included the size of endometrioma, pain scores using the visual analogue scale (VAS), and serum interleukin-6 (IL-6) levels. Data analysis focused on comparing treatment outcomes between the two groups.Result: At baseline, both groups were comparable in terms of sociodemographic characteristics, BMI, and type and duration of infertility. Post-treatment, the pentoxifylline plus metformin group showed significant reductions in endometrioma size (2.23±0.97 cm), VAS score (2.73±1.21), and IL-6 levels, all with p<0.001s. In contrast, the metformin alone group exhibited a significant reduction in endometrioma size (3.12±1.42 cm, p=0.003s) and VAS score (3.48±1.89, p<0.001s), but not in IL-6 levels (p=0.505ns). Pregnancy rates were 8.0% in the pentoxifylline plus metformin group and 3.85% in the metformin alone group (p=0.610ns). Side effects were minimal and comparable between the two groups.Conclusions: Pentoxifylline plus metformin demonstrated superior efficacy in reducing endometrioma size, pain scores, and IL-6 levels compared to metformin alone. However, no significant differences were observed in pregnancy rates or side effects. These findings indicate that the combination therapy could offer greater benefits in managing endometrioma size and pain, although further research is required to evaluate its impact on fertility outcomes in endometriosis patients.
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The cervical fibroids are rare and large cervical fibroids are rarer. Removing large cervical fibroids when a patient desires future fertility is a surgical challenge because of the risks of significant blood loss, bladder and ureteric injury, and unplanned hysterectomy. For women who desire future fertility, myomectomy can improve the chances of pregnancy by restoring normal anatomy. In this article, we describe a successful pregnancy following the restoration of the normal anatomy of the cervix by a challenging myomectomy in a sub-fertile patient with a large cervical fibroid. A 38-year-old nulliparous lady presented to the reproductive endocrinology and infertility (REI) department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with primary sub-fertility for five and half years, and dysmenorrhea for 2 years. She was a regularly menstruating woman with average flow and duration. Being a resident of Canada, she was diagnosed there as a case of large cervical fibroid (10×9 cm) by TVS extending up to the posterior wall of the uterus, cervix, and upper vagina impacted in the pouch of Douglas during infertility workup. For this reason, she was advised for in vitro fertilization (IVF) keeping the fibroid in situ. However, due to the failure of embryo transfer with this large cervical fibroid, she was advised for embryo transfer following myomectomy. Hysteroscopic myomectomy was tried first (in February 2019 in Canada) but was unable to be removed. Then Laparotomy was tried (in September 2019 in Canada) but failed again. Being a complicated case, she was counselled there for myomectomy by a multidisciplinary approach with the high risk of injury to the urinary bladder, ureter, bowel, and other pelvic structures. But she refused to do a myomectomy there after knowing the dreadful complications with the fear of injury to the pelvic organs. With this problem, she went to different institutions both in the country and abroad but couldn’t get the proper treatment. Finally, she visited the outpatient department (OPD) of the REI department, BSMMU, Dhaka, Bangladesh with the hope of getting the most appropriate treatment for her and she was reassured, counselled, and managed by a challenging myomectomy (in March 2022) through a combined approach of the vagina and abdominal route without any significant intra and post-operative complications. Her whole post-operative period was uneventful, the anatomy of the cervix was restored and detected by TVS, and trial transfer was done before embryo transfer with easy negotiation to the cervix. Finally, she conceived 1 year after myomectomy with easy frozen embryo transfer. Myomectomy in expert hand even for the large cervical fibroid can restore normal anatomy and can achieve successful pregnancy outcomes.
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Background: Oligozoospermia is the cause of male infertility in 33.3% of cases. Omega-3 fatty acid has been utilized in infertility because of its widespread availability, low cost, and high safety profile. We intended to conduct a study to evaluate the efficacy of omega-3 fatty acid in oligozoospermia.Methods: A prospective comparative study was conducted in the outdoor of the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2022 to August 2023. A total of 70 Infertile males with oligozoospermia, were enrolled in the study. The participants were assigned to the omega-3 fatty acid group who was treated with omega-3 fatty acid 1 gm orally twice daily for 12 weeks. The other group was treated with placebo orally twice daily for 12 weeks. Sixty patients completed the 12 weeks of treatment. The changes in sperm count were determined.Results: The mean age of the participants was 35.6±4.59 years. Following treatment with omega-3 fatty acid significant improvement was observed in sperm count from 11.10±2.81 million/ml to 34.2±31.36 million/ml. Significant improvement in total motile sperm count was also observed. At the end of 12 weeks of treatment 76.7% of participants in the omega 3 fatty acid group and 10.0% in the placebo group had normozoospermia.Conclusions: Supplementation with omega-3 fatty acid results in improvement of sperm concentration and total motile sperm count in infertile men with oligozoospermia.