Mental health status and the quality of life of infertile women receiving fertility treatment in Bangladesh: A cross-sectional study.

Infertility poses significant physical and psychological challenges for women of reproductive age. In low- and middle-income countries, the prevalence of depression among infertile women is alarmingly high, reaching 44.32%. Additionally, over 50% of infertile women worldwide experience varying degrees of decline in their quality of life. Therefore, this study aimed to assess the effects of infertility on the mental health status and quality of life of infertile women in Bangladesh. Between December 2022 and March 2023, 375 infertile women in Dhaka, Bangladesh were selected using simple random sampling for this cross-sectional study. The participants' mental health status was assessed using the Depression Anxiety and Stress Scale (DASS-21), while their quality of life was evaluated by the Short Form-12 (SF-12) scale. The prevalence of depression, anxiety, and stress were 59.7%, 55.0%, and 48.7%, respectively. Multiple logistic regression showed that infertile homemakers had 2.98 (95% CI: 1.30 to 6.80) times the odds of depression than government service holders. Aborted infertile women had 1.8 (95% CI: 1.10 to 3.26) times the odds of depression. Infertile women who married between 20 and 24 years old were 49% (95% CI: 0.27 to 0.98) less anxious than those who married earlier. Low-income infertile women (<30,000 BDT) were 2.29 (95% CI: 1.02 to 5.14) times more likely to be stressed than those with higher incomes (>60,000 BDT). Multiple linear regression analysis suggests that education and infertility diagnosis status significantly affect the Mental Component Summary (MCS-12) scores of the Short Form-12 (SF-12). In contrast, age, occupation, and Body Mass Index (BMI) were the significant predictors for the Physical Component Summary (PCS-12). Policymakers may use lessons learned from this study to incorporate appropriate counseling techniques, social awareness campaigns, and media involvement to control the added burden of infertility on women's psychological health and quality of life.

Pretreatment and co-administration of oral anti-diabetic agent with clomiphene citrate or rFSH for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome.

AIM: The objective of this study was to explore the result of pretreatment and concomitant use of metformin with clomiphene citrate (CC) and rFSH for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: This randomized controlled trial was done in the Dhaka Medical College and Hospital and the Infertility Care and Research Centre, Dhaka, Bangladesh. A total of 165 infertile patients with CC-resistant PCOS who attended for treatment were the target population for this study. Patients were divided into three groups: groups A and B were given metformin and group C was the control. Along with metformin, group A received CC and group B received rFSH. Group C was treated with only rFSH. Metformin was given 1500 mg daily for 4 weeks. Afterwards CC or rFSH were added for induction of ovulation along with metformin. Six ovulatory cycles were assessed. Treatment was terminated when there was no response with maximum dose of CC and rFSH or after six ovulatory cycles without pregnancy or after achieving pregnancy. A P-value of <0.5 was considered as significant. RESULTS: Ovulation (89.09%) and pregnancy (54.55%) rates were higher in group B. Ovulation (74.55%) and pregnancy (29.09%) rates were also satisfactory in group C but a dose of rFSH requirement was significantly higher (P = 0.000). In group A, both ovulation and pregnancy rate were much lower than the other two groups (27.27% and 12.73%, respectively). CONCLUSIONS: Use of metformin increases the response of ovulation-inducing agents and can be used safely in PCOS.

Prevention of gestational diabetes mellitus by continuing metformin therapy throughout pregnancy in women with polycystic ovary syndrome.

AIM: The aim of the present study was to assess whether continuation of metformin therapy throughout pregnancy can reduce the development of gestational diabetes in women with polycystic ovarian syndrome (PCOS). METHODS: This experimental study was conducted in a private tertiary level infertility care center between June 2002 and December 2006. Fifty-nine non-diabetic PCOS patients who conceived while taking metformin and different ovulation-inducing agents comprised the sample group. Twenty-nine of them continued metformin throughout pregnancy and 30 did not The main outcome measure was development of gestational diabetes in women with PCOS and their fetal outcome. RESULTS: Basic parameters such as age, body mass index, levels of follicle-stimulating hormone and luteinizing hormone, free testosterone, dihydroepiandrosterone sulfate, fasting sugar and fasting insulin did not differ between the two groups. Among 29 women who received metformin, gestational diabetes developed during one of 29 pregnancies (3.44%) versus nine of 30 pregnancies (30%) without metformin. The odds ratio for gestational diabetes in women without metformin versus with metformin was 12 (95% confidence interval: 6.20-18.08). All babies born in the metformin group had average birthweight and those in the control group 4 (13.33%) were large for date. CONCLUSION: In PCOS use of metformin throughout pregnancy is associated with and might be responsible for a ninefold reduction (30-3.44%) of gestational diabetes.

Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome.

OBJECTIVE: To compare the effectiveness of letrozole and clomiphene citrate (CC) in induction of ovulation in polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized, not blinded, controlled trial. SETTING: A tertiary level infertility care center. PATIENT(S): Sixty-four anovulatory patients with PCOS, who failed to ovulate when taking 100 mg/day CC in previous cycles. INTERVENTION(S): Patients were randomly divided into two groups by lottery and treated with either 7.5 mg/day letrozole (an aromatase inhibitor) or 150 mg/day CC for 5 days starting from day 3 of the menstrual cycle. MAIN OUTCOME MEASURE(S): Occurrence of ovulation, endometrial thickness, and pregnancy rate (PR). RESULT(S): Twenty (62.5%) patients from the letrozole group and 12 (37.50%) patients from the CC group ovulated during the observation period. Mean serum E2 level was 817.75 pg/mL and 448.03 pg/mL in the CC and letrozole groups, respectively, on the day of hCG administration. The mean endometrial thickness on the day of hCG administration was 9.03 mm and 10.37 mm in the CC and letrozole groups, respectively. The mean D21 serum P was 13.09 ng/mL and 19.09 ng/mL in the CC and letrozole groups, respectively. Thirteen patients from the letrozole group (40.63%) and six patients from the CC group (18.75%) became pregnant. CONCLUSION(S): Letrozole has better ovulation and PR in comparison to CC in patients with PCOS.

Eclampsia: still a problem in Bangladesh.

This descriptive study, conducted at Dhaka Medical College and Hospital, Bangladesh, includes 2956 consecutive eclamptic patients who were admitted between 1998 and 2000 and evaluates their outcomes after treatment with magnesium sulfate. Although magnesium sulfate controls convulsion efficiently, death from eclampsia remains high in our country. Thus, a second purpose of this study was to identify additional factors responsible for death from eclampsia. Among 32,999 obstetric patients admitted to the hospital during the years 1998 to 2000, 2956 were eclamptic, yielding an incidence of 9%. The antepartum/intrapartum and postpartum incidences of eclampsia were 80% and 20%, respectively. Among the patients with eclampsia, 79% had good prognosis without any added complication except convulsion, and 21% had other complications. For the period 1998 to 2000, the rate of maternal death from eclampsia was 8.6%, which was lower than that of the immediate past year (1997) for which the mortality was 16%. Changing the protocol from diazepam to magnesium sulfate for control of convulsion significantly reduced the incidence of death. But reduction of the risk of death was difficult when patients had developed complications. Most of the patients in the group who had complications died (98%); these complications developed as a result of a delayed decision for treatment. Therefore, efforts should be directed at developing awareness to receive treatment at an appropriate time to prevent the development of eclampsia and to reduce the mortality from eclampsia and its complications.

Use of a condom to control massive postpartum hemorrhage.

OBJECTIVES: To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive postpartum hemorrhage (PPH). DESIGN AND SETTING: This prospective study was done in the Obstetrics and Gynecology Department of Dhaka Medical College and Hospital, Bangladesh, between July 2001 and December 2002. PATIENTS: During the study period, 152 cases of PPH were identified; 109 were managed medically; 20 were managed using the B-Lynch procedure, and 23 were managed using the condom catheter. Patients were selected for intervention with the condom catheter when PPH that occurred as a result of atonicity or morbid adhesion (accreta) could not be controlled by uterotonics or a surgical procedure. In patients who were in shock due to massive hemorrhage, a condom catheter was introduced immediately without prior medical management. INTERVENTION: With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 mL normal saline, according to need. The condom catheter was kept for 24-48 hours, depending upon the initial intensity of blood loss, and gradually deflated when bleeding ceased. MAIN OUTCOME MEASURES: (1) Ability of condom catheter to stop bleeding; (2) time required to stop bleeding after the tamponade was applied; (3) subsequent morbidity in terms of severe infection, despite use of prophylactic antibiotics. RESULTS: In all 23 cases in which the condom catheter was used, bleeding stopped within 15 minutes. No patient needed further intervention. No patient went into irreversible shock. There was no intrauterine infection as documented by clinical signs and symptoms and culture and sensitivity of high vaginal swab. CONCLUSION: The hydrostatic condom catheter can control PPH quickly and effectively. It is simple to use, inexpensive, and safe. In developing countries where PPH remains a primary cause of maternal mortality, any healthcare provider involved in delivery may use this procedure for controlling massive PPH to save the lives of patients.

Management of hypertensive emergencies of pregnancy by hydralazine bolus injection vs continuous drip--a comparative study.

This prospective study was conducted at Dhaka Medical College and Hospital, Bangladesh. The objective was to identify the time required to control high blood pressure levels in obstetric patients by injection of hydralazine in a bolus intravenous dose vs continuous drip. Seventy-seven patients with eclampsia and hypertensive emergencies comprised the target population. Patients were managed either by hydralazine drip in normal saline (existing official protocol, n = 33) or hydralazine bolus injection (as experiment, n = 44) until diastolic blood pressure fell to 90-95 mmHg. Results were compared. Student's t-test was done for statistical significance, and a P value of <.05 was considered as significant. The groups were similar with respect to maternal age and their mean systolic and diastolic blood pressure at the time of enrollment. Patients who received bolus injection required less time to achieve the therapeutic goal (65.23 +/- 23.38 minutes) than continuous drip (186.36 +/- 79.77 minutes; P <.001). The experimental group also required significantly lower doses (6.68 +/- 1.66 mg) in comparison to that required by control group (20.07 +/- 11.38 mg; P <.001). There was no overshoot hypotension in either group. The data suggest that hydralazine bolus dose is equally safe and more effective than continuous drip in the management of hypertensive emergencies in pregnancy.

Loading dose versus standard regime of magnesium sulfate in the management of eclampsia: a randomized trial.

OBJECTIVE: To determine whether only loading dose of magnesium sulfate is effective in controlling convulsion in eclampsia. STUDY METHODS: This prospective study was conducted in Dhaka Medical College and Hospital, Bangladesh between July and November 1999. Eclamptic patients who were eligible for magnesium sulfate (MgSO4) therapy were randomly assigned by lottery to receive either only loading dose (n = 202) or standard regime (n = 199) of MgSO4. Besides the anticonvulsant, patients of both the groups were managed by same protocol for eclampsia management prepared by Eclampsia Working Group, Bangladesh. Efficacy of both the regimes was assessed by measuring the rate of recurrent convulsion. Results were expressed as mean +/- SD and a proportion. Statistical analysis was done using unpaired t-test, Z-test and chi2 test as appropriate. A P-value of < 0.05 was considered significant. RESULTS: At the time of randomization there were no significant differences between the two groups in terms of age (22.40 +/- 4.21 vs 22.49 +/- 4.67 years), parity (72.77% vs 70.35% primi), type of eclampsia (84.65% vs 85.42% antepartum eclampsia), number of convulsions (5.30 +/- 3.26 vs 5.48 +/- 3.32 times), gestational age (35.65 +/- 3.37 vs 35.13 +/- 3.26 weeks), systolic blood pressure (153.19 +/- 20.19 vs 154.17 +/- 22.32 mmHg), diastolic blood pressure (106.23 +/- 13.84 vs 105.60 +/- 12.88 mmHg), proteinuria (70.80% vs 72.36% had > + proteinuria) and Glasgow Coma Scale (GCS) (73.26% vs 75.88% > 8) for the loading and standard regime groups. There were also no differences between the two groups in mean fit and treatment interval (6.88 +/- 5.26 vs 7.12 +/- 4.29h), fit and delivery interval (11.35 +/- 10.22 vs 11 +/- 6.69h) and return of consciousness (10.94 +/- 8.29 vs 11.24 +/- 8.37h). The recurrent convulsion rate was almost the same in both the groups (3.96% in loading vs 3.51% in standard regime, P > 0.05). Case fatality rate was 4.45% and 5.02% in loading and standard regime groups, respectively (P > 0.05). CONCLUSION: Only loading dose of MgSO4 can control convulsion in eclampsia and it is as effective as standard regime.

Conservative management of eclampsia and severe pre-eclampsia--A Bangladesh experience.

OBJECTIVE: To observe whether the pregnancy can be safely continued for a reasonable period to gain fetal maturity in cases of eclampsia and severe pre-eclampsia. METHODS: Fifty-one patients were followed up in a specialized care (eclampsia) unit in Dhaka Medical College and Hospital between January 1998 and October 2000. Twenty-one patients with complaints of headache and blurred vision, and 30 patients with history of convulsion, all at gestational age < 36 weeks, were enrolled for this study. Magnesium sulfate was used to prevent convulsion in severe pre-eclampsia and to control convulsion in eclampsia. After conducting a baseline assessment, pregnancy was continued to gain fetal maturity. Patients were monitored closely. Diastolic blood pressure, 24-hour urinary total protein (UTP), and serum uric acid were chosen as the main parameters to detect the deterioration of a patient's condition. Pregnancy was terminated when deterioration occurred, as determined clinically or by 1 or more of the above parameters. Dexamethasone was used during the waiting period for fetal lung maturity. Patient outcomes were analyzed. RESULTS: At admission, the patients' mean gestational age ( SD) was 30.65 2.38 weeks, and the range was 24-34 weeks. Mean diastolic blood pressure was 109.06 11.61 mm Hg, 24-hour UTP was 2.25 1.73 g/24 h, and serum uric acid level was 5.5 1.12 mg/dL. Pregnancy was continued for a mean of 13.27 8.26 days (range, 3-35 days). Thirty-two babies (62.75%) with birth weight 1.0-2.5 kg (2.02 0.45) were born alive. Six of them (18.75%) weighing between 1.0 and 1.5 kg at birth were referred to the intensive care unit, and 1 (3.13%) weighing 1 kg at birth died within 5 minutes after birth. Among live-born babies, 93.75% were in good condition at the time of discharge from the hospital. Intrauterine death occurred in 19 (37.25%).cases. Twelve of them delivered spontaneously within 7 days of death and 7 required induction. In all cases, maternal condition was satisfactory. CONCLUSION: In carefully selected cases and with close supervision, pregnancy may be continued in women with eclampsia and severe pre-eclampsia to increase fetal maturity without increasing the risk to the mother.