Comparison of efficacy of intravenous labetalol and intravenous hydralazine for management of pre-eclampsia in pregnant women.

Objectives: To compare the efficacy of intravenous Labetalol and intravenous Hydralazine in reduction of blood pressure in patients with severe pre-eclampsia. Methodology: This comparative study was conducted at the Department of Obstetrics and Gynecology at Ziauddin University Hospital, Karachi from1st June 2019 to 30th June 2020. Total 208 pregnant women having severe pre-eclampsia (systolic pressure ≥160 mmHg and diastolic pressure ≥110mmHg) were included in study. Group A received I/V Labetalol. Group B received I/V Hydralazine. Efficacy of drugs was observed by reduction in blood pressure and the number of doses administered. Data was analysed using SPSS version 26. Results: Systolic blood pressure reduction in Labetalol group was significantly lower than in hydralazine group (105.5 ±11.3 vs. 115.8 ±17.1, p≤ 0.001). Diastolic blood pressure reduction was also lower in labetalol group than in hydralazine group (p= 0.03). Number of dosage of drugs in Group A (Labetalol) was 3.2 ±1.2 vs. Group B (Hydralazine) was 4.4±1.4, p =0.006). Conclusion: The results of this study show that Labetalol is more effective as compared to Hydralazine in terms of reducing the systolic and diastolic blood pressure and number of doses (Drugs) for in patients with severe preeclampsia.

Effect of Administrating Coenzyme Q10 with Clomiphene Citrate on Ovulation Induction in Polycystic Ovary Syndrome Cases with Resistance to Clomiphene Citrate: A Randomized Controlled Trial.

Background: The purpose of this study was to assess the effect of combining low dose of Coenzyme Q10 with clomiphene citrate on ovulation induction in polycystic ovary syndrome (PCOS) women with clomiphene resistance. Methods: A total of 149 women with clomiphene resistant PCOS who needed ovulation induction were randomly allocated to oral clomiphene citrate and Coenzyme Q10 group and oral clomiphene citrate only group using a computer generated allocation sequence. The study was conducted at Aziz Medical Center, Karachi, Pakistan from 1st July 2020 to 1st October 2020. Polycystic ovary syndrome was diagnosed according to Rotterdam criteria. The primary outcome was ovulation and conception rate per cycle. Chi square test and Fischer's exact test were used to compare these variables at p<0.05 level of significance. Results: Of the 133 women assessed, the proportion of women who ovulated with combination (70% vs., 19%, p=0.001) was greater and the combination group had greater conception rate per cycle than those who received only clomiphene (48.6% vs. 6.3%, p<0.001). When stratified according to obesity, 85.3% of non-obese women who received combination ovulated whereas only 55.6% of obese women ovulated (p=0.002). Moreover, 48.6% of non-obese women conceived in the combination group as compared to 6.3% of obese women (p=0.007). Women who received combination were six times more likely to conceive than women who only received clomiphene citrate (AOR=6.344, 95% CI: 1.452-27.71, p=0.014). Conclusion: Coenzyme Q10 is a valuable adjunct in women with PCOS undergoing ovulation induction. It improves ovulation and conception in women with clomiphene resistance.

Triaging Women with Pregnancy of Unknown Location: Evaluation of Protocols Based on Single Serum Progesterone, Serum hCG Ratios, and Model M4.

Background: The purpose of the current study was to evaluate the ability of three protocols to triage women presenting with pregnancy of unknown location (PUL). Methods: Women with pregnancy of unknown location were recruited from Aziz Medical Centre from 1st August, 2018 to 31st July, 2020. The criterion of progesterone, human chorionic gonadotrophin (hCG) ratio, and M4 algorithm were used to predict risk of adverse pregnancy outcomes and classify women. Finally, 3 groups were established including ectopic pregnancy, failed pregnancy of unknown location, and intrauterine pregnancy (IUP). The primary outcome was to assign women to ectopic pregnancy group using these protocols. The secondary outcome was to compare the sensitivity and specificity of the three protocols relative to the final outcome. Results: Of the 288 women, 66 (22.9%) had ectopic pregnancy, 144 (50.0%) had intrauterine pregnancy, and 78 (27.1%) had failed pregnancy of unknown location. The criterion of progesterone had a sensitivity of 81.8%, specificity of 27%, negative predictive value (NPV) of 83.3%, and positive predictive value (PPV) of 25% for high risk result (ectopic pregnancy). The hCG ratio had sensitivity of 72%, specificity of 73%, NPV of 90%, and PPV of 44% for high risk result (ectopic pregnancy). However, model M4 had sensitivity of 86.4%, specificity of 91.9%, NPV of 95.8%, and PPV of 76% for high risk result. Conclusion: Based on the findings of the study, it was revealed that prediction model of M4 had the highest sensitivity, specificity, negative predictive value and positive predictive value for high risk result (ectopic pregnancy).

Pregnant during the COVID-19 pandemic: Knowledge, concerns, attitudes and practices of Pakistani women.

INTRODUCTION: Data regarding pregnancy and related outcomes with COVID-19 are inconsistent, which leads to difficulties in counselling pregnant women. This brings uncertainty to pregnant women regarding mode of birth, transmission and issues that may occur in case they contract the disease. We conducted this study to assess the knowledge about COVID-19 risk during pregnancy and childbirth and to assess the concerns, attitudes, and practices of pregnant women during the pandemic. METHODS: A cross-sectional survey was carried out among 376 consenting pregnant women attending antenatal clinics in Karachi, Pakistan, between 1 July and 16 July 2020, using pretested questionnaires. RESULTS: A total of 376 pregnant women participated in the survey. Participants had inadequate knowledge about COVID-19 risk during pregnancy, including potential vertical transmission (58.5%), preferred route of delivery (52%), safety of breastfeeding (50%), birth defects (44.7%), rooming in and skin-to-skin contact (58.5%). The majority (85.1%) had a high concern score, and negative attitude (62.8%). Only 43.6% said that they would not hide their symptoms, while 37.2% stated that they will deliver at hospital if they tested positive. Only 30.9% of respondents had good practices. During visits, 39.4% maintained social distancing and sanitized hands while only 37.2% said that they did not bring more than one person with them. CONCLUSIONS: The study population had inadequate knowledge, negative attitude, and poor practices regarding pregnancy during the COVID-19 pandemic. More than half of the respondents thought that concealing symptoms and delivering at home would be better. Awareness programs are urgently needed.

Reasons for presenting to antenatal care clinics in a sample of Pakistani women and their knowledge of WHO antenatal care package.

INTRODUCTION: The purpose of antenatal care is to ensure that a woman has a safe pregnancy and that does not mean absence of any disease during this period. Antenatal care allows screening of preeclampsia, fetal abnormalities and other prevention strategies to be incorporated. The purpose of this study was to assess the reason for attending antenatal care clinics and knowledge of antenatal care content package in women. METHODS: A cross-sectional study was conducted on 395 pregnant women attending antenatal care clinic at the Ruth K. M. Pfau Civil hospital, Karachi, Pakistan from 1 July 2019 to 31 December 2019. Each eligible woman was asked about the reason for attendance and her knowledge about WHO standardized antenatal care package. RESULTS: The commonest reason for utilizing antenatal care in booked attendees was place of birth concern (25.9%) and in not booked was referral from private centers (33.6%) which was statistically significant (p=0.006). Both booked and not booked women (67.9% vs 59.1%, p=0.409) stated avoidance of complication during pregnancy and labor as the commonest reason for attendance. Women with higher parity were more likely to identify weight measurement (p=0.001), iron and folic acid supplementation (p=0.001), and urine detailed report (p=0.002), as content of the standard package. CONCLUSIONS: Our study shows that women did not utilize antenatal care clinics for improving their health or the health of their fetus. The knowledge of the antenatal care package was limited to weight measurement and supplements. Moreover, attendance and visits at an antenatal care facility do not equate to good service provision.

Antral follicle count and anti-Müllerian hormone level as predictors of ovarian hyperstimulation syndrome in women with polycystic ovarian syndrome undergoing controlled ovarian stimulation.

Aim: To compare the rate of ovarian hyperstimulation syndrome in women with and without polycystic ovarian syndrome, and to determine the cut-off for the antral follicle count and the anti-Müllerian hormone level predictive of ovarian hyperstimulation syndrome in both groups. Methods: This was a prospective cohort study conducted in women aged 20-35 years who were undergoing controlled ovarian stimulation. The women were divided into those with polycystic ovarian syndrome and the controls on the basis of the Rotterdam criteria. The outcome of stimulation was recorded, and the ovarian response markers were compared in both groups. Results: Among 689 women included in the study, 276 (40.1%) had polycystic ovarian syndrome, and 476 (59.9%) were used as the controls. Ovarian hyperstimulation syndrome occurred in 19.6% of the cases, and in 7.7% of the controls (p <0.001). The conception rate was greater in the group of cases (52.5% vs. 16.5%, p = 0.001). Among the cases, the sensitivity and specificity for the prediction of hyper-response were 94.4% and 97.3% for AFC, and 92.6% and 93.7% for the anti-Müllerian hormone, at the cut-off values of ≥18 and ≥6.425 ng/ml, respectively. Among the controls, the sensitivity and specificity for the prediction of hyper-response were 93.8% and 97.1% for the antral follicle count, and 93.6% and 94.5% for the anti-Müllerian hormone, at the cut-off values of ≥10 and ≥3.95 ng/ml, respectively. Conclusion: Group-specific values should be used to identify and counsel women undergoing controlled ovarian stimulation. In light of available evidence, gynaecologists should be trained to perform ultrasound evaluation, determine the antral follicle count of their patients, and offer them appropriate counselling.

Knowledge and practices: Risk perceptions of COVID-19 and satisfaction with preventive measures at workplace among maternity care providers in Pakistan.

INTRODUCTION: While all healthcare services across the globe deferred non-urgent surgeries, labor wards provided maternity care during the COVID-19 pandemic continuously. This study assesses the knowledge and practices of obstetricians and midwives about personal protective equipment (PPE); their risk perception of COVID-19 and satisfaction with the preventive measures adopted at their workplace. METHODS: A questionnaire designed according to the World Health Organization's advice on rational use of personal protective equipment for COVID-19 was administered to 452 Pakistani maternity care providers between 1 July and 30 July 2020. RESULTS: Most (85%) had adequate knowledge and 78.8% had good practices regarding PPE use. The perceived risk of contracting COVID-19 was lower than for influenza and tuberculosis. Perceived risk of contracting COVID-19 was highest for outpatient clinics. Fewer midwives compared to obstetricians (23.3% vs 32.9 %, p=0.001) were satisfied with the job security provided. Only 19.5% were satisfied with the social distancing measures at their setups. Less than one-third (31%) were satisfied with the PPE available to them. CONCLUSIONS: The participants had good knowledge and practices regarding PPE. The perceived risk of contracting COVID-19 was lower than for contracting influenza; however, they were concerned about contracting COVID-19 in outpatient clinics and emergency rooms. They had poor satisfaction with the measures adopted by hospital managements regarding job security and social distancing.

Anti-phospholipid antibodies in women presenting with preterm delivery because of preeclampsia or placental insufficiency

Objective: To assess the proportion of women presenting with preterm delivery because of preeclampsia or placental insufficiency (PREPI) with anti-phospholipid antibodies (APLA). Material and Methods: This was a prospective cohort study conducted at an obstetrics and gynecology department. Women, aged 20-40 years, with preeclampsia who delivered before 34 weeks were cases while those who delivered before 34 weeks but did not have preeclampsia acted as controls. Both groups had APLA measured at diagnosis and 12-weeks postnatally. Anti-phospholipid antibody syndrome (APS) was diagnosed according to Sapporo's criteria. Results: The study included 98 cases and 106 controls. Both cases and controls were similar in terms of age, gestational age and parity. The frequency of APS positivity was 17.3% in cases but only 3.8% in controls (p=0.001). Cases were more likely to be of Baloch ethnicity (34.7% vs. 11.3%, p=0.001), have a history of miscarriage (25.5% vs. 13.2%, p=0.026), use aspirin (p<0.001) or low molecular weight heparin (p<0.001), and be obese (p<0.001) than controls. Cases were more likely to have lupus anticoagulant antibodies (82.4% vs. 75%). Conclusion: Our study confirms a high prevalence of APLA in women who have preterm delivery due to PREPI. An opportunity to screen these women should be made, so that proper counselling can be given and future pregnancies can be managed in an appropriate and timely manner.

Frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance.

To assess the frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance we undertook a cross-sectional study conducted from July to December 2018. Women aged 20-45 years, who were pregnant and planned to deliver at the facility, were included. Women were counseled and offered about Human Immunodeficiency virus (HIV) screening. A total of 718 women were included in the study. The screening was accepted by 32.3% of women. Six women tested positive in the study giving a seroprevalence of 0.8% in the population studied. Acceptance of counseling and screening varied significantly with age range, educational status, socioeconomic status, and employment status. Women aged 30 years and above (p = 0.023) and women with higher education (p < 0.001) were more likely to refuse counselling. Similarly, employed women (p = 0.041) and women of higher socioeconomic class (p = 0.039) refused counselling. However, when logistic regression was conducted, only educational status (p < 0.001) and occupational status (p = 0.039) were significantly associated with acceptance of counseling and screening. The acceptance of counselling and testing for HIV in antenatal care attendees was low. Women of higher educational status and having some employment refused counselling and testing more commonly.

Pessary offer documentation in women undergoing surgery for pelvic organ prolapse at a tertiary care hospital.

BACKGROUND: Women report similar functional outcomes after pessary treatment or surgery for pelvic organ prolapse (POP). AIMS: To assess the documentation of pessary counselling in women who underwent surgery for POP. Methods: This was a retrospective cohort study conducted on women who underwent hysterectomy for prolapse. The primary outcome measure was documentation regarding offer of pessary. 'Pessary offer' was defined as documentation that clearly stated that the care provider offered pessary to the patient. FINDINGS: Over the study period, 81 hysterectomies took place for POP; pessary offer was documented for only 19 (23.5%) case records. Characteristics significantly associated with pessary offer were history of chronic cough (P=0.031), previous pelvic surgery (P<0.001), no secondary indication for surgery (P=0.012), concomitant surgery performed other than hysterectomy (P=0.046), age range (P<0.001) and BMI range (P<0.001). CONCLUSION: Pessary offer was documented in less than quarter of cases. This denotes a need to strengthen documentation of offer, counselling for pessary, or both of these.

Femiject, a once-a-month combined injectable contraceptive: experience from Pakistan.

OBJECTIVES: The aims of the study were to compare the 12 month continuation rate, level of satisfaction and bleeding patterns of a once-a-month combined injectable contraceptive (CIC; Femiject), a 3 monthly progestogen-only injectable contraceptive (depot medroxyprogesterone acetate [DMPA]) and combined oral contraceptives (COCs). METHODS: A prospective observational study was conducted at Aziz Medical Centre, Karachi, Pakistan. The study comprised 171 married women aged 19-35 years and requesting contraception. Participants were offered injectable contraceptives or COCs and evaluated twice: once at the beginning of the study and again after 12 months, or earlier if they discontinued use. RESULTS: Sixty (35.1%) women chose COCs, 53 (31.0%) chose DMPA and 58 (33.9%) chose the CIC. The continuation rate was higher among CIC users (p = .034). CIC users were more satisfied with their method compared with those who chose COCs or DMPA (63.8% vs 25.0% and 28.3%, respectively). Most CIC users said they were likely or very likely to use the method again (63.8%); only 25.9% said they would not recommend it to a friend. CIC users had, however, more spotting compared with COC users (60.3% vs 3.3%; p ˂ .001). CONCLUSION: As the continuation rate, level of satisfaction and bleeding profile of CIC users was promising, increased uptake should be encouraged. Our study shows that CIC is a good option for women requesting contraception.

Cervical stenosis and pregnancy rate after ultrasound guided cervical dilation in women undergoing saline infusion sonography.

Aim: To assess the effect of ultrasound-guided cervical dilation on clinical pregnancy rates in women with cervical stenosis. Methods: A prospective case control study was conducted in women with unexplained infertility. These women underwent saline infusion sonography and were suspected of having cervical stenosis if a 7 French Foley's catheter could not be introduced into the cervical canal. Women with suspected stenosis who agreed to undergo ultrasound guided dilation were included as cases. Those with suspected stenosis who refused dilation were used as controls. Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heart beat present on transvaginal scan during the follow up period. Results: During the study period, 1097 women who underwent SIS were included. A total of 117 (10.7%) patients had cervical stenosis. No statistically significant difference was there in both groups in terms of mean age (p = 0.617), mean body mass index (p = 0.598), duration of infertility (p = 0.588) and type of infertility (p = 0.167). However, both groups were significantly different in terms of history for risk factors i.e. endometriosis (p <0.001), prior surgery (p <0.001), polyps (p = 0.004) and pelvic inflammatory disease (p = 0.001). Eighty-nine women agreed to have dilation and were used as cases and 28 women refused and were used as controls. Of the cases, 70.45% conceived as compared to 18.5% of controls. The mean time to conception in months was also significantly lower in cases (8.10 ± 3.43 vs. 11.39 ± 1.97, p <0.001). Conclusions: Our study shows that ultrasound-guided cervical dilation in women with cervical stenosis can lead to improved conception rates.Aim: To assess the effect of ultrasound-guided cervical dilation on clinical pregnancy rates in women with cervical stenosis. Methods: A prospective case control study was conducted in women with unexplained infertility. These women underwent saline infusion sonography and were suspected of having cervical stenosis if a 7 French Foley's catheter could not be introduced into the cervical canal. Women with suspected stenosis who agreed to undergo ultrasound guided dilation were included as cases. Those with suspected stenosis who refused dilation were used as controls. Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heart beat present on transvaginal scan during the follow up period. Results: During the study period, 1097 women who underwent SIS were included. A total of 117 (10.7%) patients had cervical stenosis. No statistically significant difference was there in both groups in terms of mean age (p = 0.617), mean body mass index (p = 0.598), duration of infertility (p = 0.588) and type of infertility (p = 0.167). However, both groups were significantly different in terms of history for risk factors i.e. endometriosis (p <0.001), prior surgery (p <0.001), polyps (p = 0.004) and pelvic inflammatory disease (p = 0.001). Eighty-nine women agreed to have dilation and were used as cases and 28 women refused and were used as controls. Of the cases, 70.45% conceived as compared to 18.5% of controls. The mean time to conception in months was also significantly lower in cases (8.10 ± 3.43 vs. 11.39 ± 1.97, p <0.001). Conclusions: Our study shows that ultrasound-guided cervical dilation in women with cervical stenosis can lead to improved conception rates.

A comparison of antenatally and intraoperatively diagnosed cases of placenta accreta spectrum

Objective: To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes. Material and Methods: This was a retrospective cohort study conducted from January 2017 to December 2018. Women with PAS diagnosed antenatally were designated as group A and those where diagnosis was suspected during operation and confirmed on histopathology (PAS diagnosed perioperatively) were designated as group B. Outcome in terms of uterine conservation, maternal death, admission of mother to intensive care unit (ICU), perinatal death and neonatal ICU (NICU) admission were recorded. Results: During the study, PAS was confirmed in 96 cases which were included. Out of these, 34 (35.4%) cases were included in group A while 62 (64.6%) were diagnosed intraoperatively (group B). The median number of units of blood transfused was lower in group A compared to group B (4 vs 6, p<0.001). The uterus was conserved more often in group A compared with group B (67.6% vs 43.5%, p=0.024) while admission to ICU occurred significantly more often in group B (26.5% vs 59.7%, p=0.002). Maternal death (p=0.038) and perinatal death (p=0.008) were also significantly higher in group B. More neonates delivered to mothers in group B were admitted to NICU (85.7% vs 24%, p=0.033). Survival analysis showed a statistically significant increase in uterine conservation rate in group A compared with group B (log rank, p=0.04). Conclusion: PAS diagnosed antenatally has better fetomaternal outcome than intraoperative detection of PAS. Diagnosing PAS antenatally is therefore crucial to improve management and achieve a better outcome.

Women's decision versus couples' decision on using postpartum intra-uterine contraceptives.

BACKGROUND: In conservative societies of low- and middle-income countries, the decision-making process is heavily influenced by male partners. AIMS: To assess the male partner's influence on female partner's ultimate decision regarding uptake of postpartum intrauterine contraceptive device (PPIUCD). METHODS: This was a prospective, analytical study conducted at Abbasi Shaheed Hospital, Karachi, Pakistan, from 1 March 2016 to 30 August 2016. The study included 566 pregnant women who were counselled regarding postpartum contraception (PPC) and asked to choose their preferred method. The choice was noted before and after discussion with their spouse. Discordance was assessed using McNemar's test for paired samples, taking P ≤ 0.05 as statistically significant. RESULTS: Among those counselled, 470 (83.03%) showed willingness to accept PPC. Out of these, 142 (30.2%) chose PPIUCD initially. After discussion with their spouse, only 82 (17.4%) accepted PPIUCD. The discordance between original decision of the woman and final decision to accept PPIUCD was statistically significant (P < 0.001). CONCLUSIONS: The discordance between original decision and final decision shows considerable influence by males on uptake of PPIUCD.

Fertility outcome after saline sonography guided removal of intrauterine polyps in women with unexplained infertility.

Objective: To assess the effect of removal of unsuspected polyps as delineated on saline sonography on the clinical pregnancy rate in women with unexplained infertility. Methodology: A prospective case control study was being conducted from 1st October 2016 to 30th September 2018 at Aziz Medical Centre, Karachi. Women diagnosed with unexplained infertility and unsuspected polyps revealed on saline sonography were included as cases (Group A). They were offered removal of polyps under ultrasound guidance and general anesthesia. Saline sonography was repeated at the time to ensure complete removal (Izhar's Modification). Those with unsuspected polyps on saline sonography, but who refused the intervention, were classified as controls (Group B). Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heartbeat present on transvaginal scan during the follow up period. Results: During the study period, out of 92 cases, 37 (40.2%) conceived and out of 92 controls, 10 (10.9%) conceived, which proved that polypectomy increased the chances of conception four-fold (p <0.001). The mean time to conception was also significantly lower for cases than controls (9.26 ± 3.928 months vs. 11.33 ± 2.07 months, p <0.001). The cumulative pregnancy rate was significantly higher in the polypectomy group (log-rank test, p <0.001). The duration of infertility (p = 0.007), position of polyp (p = 0.049) and polypectomy (p <0.001) influenced pregnancy rate. Conclusions: Our study shows the beneficial effect of removal of polyps. Women are four times more likely to conceive spontaneously after polypectomy.Objective: To assess the effect of removal of unsuspected polyps as delineated on saline sonography on the clinical pregnancy rate in women with unexplained infertility. Methodology: A prospective case control study was being conducted from 1st October 2016 to 30th September 2018 at Aziz Medical Centre, Karachi. Women diagnosed with unexplained infertility and unsuspected polyps revealed on saline sonography were included as cases (Group A). They were offered removal of polyps under ultrasound guidance and general anesthesia. Saline sonography was repeated at the time to ensure complete removal (Izhar's Modification). Those with unsuspected polyps on saline sonography, but who refused the intervention, were classified as controls (Group B). Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heartbeat present on transvaginal scan during the follow up period. Results: During the study period, out of 92 cases, 37 (40.2%) conceived and out of 92 controls, 10 (10.9%) conceived, which proved that polypectomy increased the chances of conception four-fold (p <0.001). The mean time to conception was also significantly lower for cases than controls (9.26 ± 3.928 months vs. 11.33 ± 2.07 months, p <0.001). The cumulative pregnancy rate was significantly higher in the polypectomy group (log-rank test, p <0.001). The duration of infertility (p = 0.007), position of polyp (p = 0.049) and polypectomy (p <0.001) influenced pregnancy rate. Conclusions: Our study shows the beneficial effect of removal of polyps. Women are four times more likely to conceive spontaneously after polypectomy.

The Effect of Suboptimal Semen Parameters on Male Partner's Ability to Conceive. Is He Really Subfertile Because the Test Says So?

CONTEXT: In many developing countries, subfertility treatment is not covered by government-funded institutions. It is observed that healthcare providers incriminate male factor for subfertility even when only a slight deviation from presumed normal criteria is observed. AIM: This study aims to provide scientific evidence that pregnancies are possible at semen parameters that are below the generally accepted lower limits of normal. SETTING AND DESIGN: This was a retrospective cohort study conducted from January 2014 to December 2018. MATERIALS AND METHODS: During the study period, couples who conceived without any treatment of male partner were included. The World Health Organization (WHO) reference values for semen analysis were utilized to assess the reports. The primary outcome measure was conception despite abnormal semen parameters. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS software program, version 15.0 (IBM, Armonk, USA). RESULTS: Of the 332 couples included, 233 (70.1%) couples conceived despite suboptimal semen parameters, The most common criterion not satisfied was rapid linear motility -200 (85.8%), 87 (37.3%) men were oligozoospermic, 94 (40.3%) were asthenozoospermic, and 21 (9%) were teratozoospermic. The abnormalities were more common in men having primary subfertility (71.7% vs. 28.3%, P = 0.002). The abnormalities were most common in the age group 40-44 years (n = 91, 39.1%) and those who were overweight (n = 110, 47%). CONCLUSIONS: A consensus for defining poor semen criteria is the need of the hour so that these males can be counseled satisfactorily. WHO criteria are a standard commonly employed, but they do not necessarily predict the fertility potential.

Incidence of intrauterine abnormalities in Pakistani women with unexplained infertility diagnosed via saline infusion sonography.

To determine the frequency of intrauterine abnormalities in women with unexplained infertility using saline infusion sonography. This was a retrospective cohort study conducted at Aziz medical centre, Karachi, Pakistan between January and December 2015. The study population comprised of women with unexplained infertility who underwent saline infusion sonography as a part of their diagnostic workup. The frequency of uterine abnormalities in these women was determined and the relationship between these pathologies and patient age and body mass index was assessed. Of the 769 women included, 202 (26.3%) had uterine abnormalities. Endometrial polyp (118 cases, 15.3%) was the most common abnormality, followed by submucous fibroids (54, 7%), intrauterine adhesions (20, 2.6%), and septae (10, 5%). Intrauterine pathologies were more common in women with primary infertility (71.8% versus 28.2%, p = 0.002). Uterine abnormalities were most common in the age group 30-34 years ( n = 80, 39.6%) and in overweight patients ( n = 95, 47%). The distribution of abnormalities differed significantly in various age groups ( p = 0.009) and among women with different BMI ( p = 0.029). A significant number of women with unexplained infertility present with unsuspected uterine abnormalities; therefore an assessment of the uterine cavity should be performed in all cases.

An Overview of Menopausal Symptoms Using the Menopause Rating Scale in a Tertiary Care Center.

CONTEXT: Due to increased life expectancy worldwide, women are expected to spend a significant portion of their lives in menopause. Proven prevention strategies against serious risks and tested effective treatments for common symptoms may remain unutilized in our population if these women are not asked about these symptoms. AIM: This study aims to assess the prevalence of different menopausal symptoms and their severity according to menopause rating scale (MRS) in women. SETTING AND DESIGN: The present study was a cross-sectional survey, conducted in the outpatient department of gynecology and obstetrics. SUBJECTS AND METHODS: After written and informed consent, 121 women having their last menstrual period at least 1 year ago were included. The menopausal symptoms were assessed using the MRS. The primary outcome measure in this study was the prevalence of menopausal symptoms in these women according to MRS and the severity of these symptoms. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS software program, version 15.0 (IBM, Armonk, New York, USA). RESULTS: The most common symptom was mental and physical exhaustion which was reported by 88 (72%) women, followed by joint and muscular discomfort which was reported by 83 (68.59%). Hot flushes were reported by 54 (44.62%) respondents. Majority of women reported mild-to-moderate symptoms. CONCLUSIONS: The prevalence of menopausal symptoms is high, and a health policy needs to be generated for the region.

Occult Form of Premature Ovarian Insufficiency in Women with Infertility and Oligomenorrhea as Assessed by Poor Ovarian Response Criteria.

BACKGROUND: The purpose of this study was to evaluate the ability of poor ovarian response criteria to classify women presenting with infertility and oligomenorrhea as having "occult" premature ovarian insufficiency. METHODS: This was a cross sectional study conducted at Aziz Medical Center, Karachi, Pakistan from 1st August 2015 to 31st July 2016. Women with infertility and oligomenorrhea were included. All eligible women underwent day 2 FSH level and an early follicular phase transvaginal ultrasound to assess the antral follicular count (AFC). All women then underwent the confirmatory test, of Anti-Mullerian Hormone (AMH) level. The main outcome measure was assignment to occult premature ovarian insufficiency (POI) after screening that used the criteria set out in fertility guideline for predicting the likely ovarian response to gonadotrophin stimulation. Another measure was to compare the sensitivity and specificity of the two index criteria, of FSH and AFC, relative to the emerging reference standard, of the AMH criterion. RESULTS: The three criteria together classified 59 (34.91%) women as occult POI in those with oligomenorrhea. The sensitivity, specificity, negative predictive value and positive predictive value of FSH relative to AMH for these women were 77.8%, 95.7%, 90.2% and 89.4%, respectively whereas the same values of AFC relative to AMH were 92.6%, 99.1 %, 96.6% and 98%, respectively. CONCLUSION: Women with menstrual irregularity and infertility are at a higher risk for satisfying criteria of poor ovarian response irrespective of age. A policy incorporating these surrogate markers can be used to screen these women for occult premature ovarian insufficiency.