Evaluation of hyperprolactinemia risk factors in infertile women referred to Yazd Infertility Center: A cross-sectional study

Background: Hyperprolactinemia is one of the most common causes of infertility in women. The prevalence of pituitary tumors is 25-30% among infertile participants with hyperprolactinemia. Objective: The aim of this study was to describe the causes of hyperprolactinemia in infertile women referred to Yazd Infertility Center. Materials and Methods: This cross-sectional study was conducted with 182 infertile women with hyperprolactinemia who were referred to Yazd Infertility Center from February 2018 to October 2019. Serum prolactin was assessed by the human prolactin ELISA kit according to the Padtan Gostar Isar protocol. The age, duration of infertility, causes of hyperprolactinemia, and type of infertility treatment were noted. The MRI findings were added. Results: The mean age of participants was 28.9 ± 0.36 yr and the prolactin level was 76 ± 8.97 ng/ml. The etiology of hyperprolactinemia among the study participants was 35 participants (19.2%) with pituitary adenoma, 47 participants (25.8%) with polycystic ovary syndrome, 14 participants (7.7%) with pituitary adenoma and polycystic ovary syndrome, and 86 participants (47.3%) with idiopathic hyperprolactinemia. The results of this study showed that there was no statistically significant difference between the mean prolactin levels in participants with different causes of hyperprolactinemia (p = 0.31). Conclusion: Idiopathic hyperprolactinemia and polycystic ovary syndrome are the most common reasons for hyperprolactinemia. Key words: Hyperprolactinemia, Infertility, PCOS.

Clomiphene citrate plus letrozole versus clomiphene citrate alone for ovulation induction in infertile women with chronic anovulation: A randomized controlled trial

Objective To compare the efficacy of combination clomiphene citrate (CC) plus letrozole with that of CC alone for ovulation induction in infertile women with chronic anovulation. Material and methods This randomized controlled trial was conducted at the Infertility and Reproductive Biology Unit of the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during the August 2020-September 2021 study period. Anovulatory women aged 18-40 years were equally allocated into either the CC 50 mg plus letrozole 2.5 mg once daily group or the CC 50 mg once daily group. The study drugs were administered on days 3-7 of each study patient’s menstrual cycle. The primary outcome was the ovulation rate defined by serum progesterone >3 ng/mL at mid-luteal phase. The secondary outcomes were menstrual cycle characteristics, endometrial thickness, conception rate, and adverse events. Results One hundred women (50 per group) were enrolled. The mean age and prevalence of polycystic ovary syndrome were non-significantly different between groups. The ovulation rate according to intention-to-treat analysis was 78% and 70% in the combination and CC alone groups, respectively (p>0.05). There was no significant difference between groups for either mean endometrial thickness or number of dominant follicles. No serious adverse events were observed in either group. Conclusion There was no significant difference between combination CC plus letrozole and CC alone relative to their ability to induce ovulation in infertile women with chronic anovulation. The small number of live births (1 per group) was too low to be statistically analyzed.

Social Struggles and Treatment Seeking Behaviors of Infertile Women among Different Classes in the Urban Areas of Bangladesh

Background: Infertility is considered a taboo in the society of Bangladesh and is negated in reproductive health programs as well as in the research setting. Yet it is crucial and endemic for social and public health sectors. In Bangladesh, infertile women have to bear the drudgery of dishonor and shame because of their childlessness. The childless women have to shoulder most of the burden of ill-treatment for impotence regardless of who is at fault. Like other social stigmas, this also intersects across class, gender and setting barriers. Objective: The aim of the study is to understand the social struggles, stigmatization and treatment seeking behavior of infertile women of different classes in the urban context of Bangladesh. Methodology: A descriptive qualitative research methodology with in-depth interviews was used to collect data from 20 childless urban women aged between 18 to 45 years. They were urban residents for at least ten years and were aware of their infertile condition for at least one year. Results: The research results showed that childless women, irrespective of their class identities, always live with stigma, accusations and fear of abandonment in their personal lives. It also initiates an arena of violence. Many infertile women face physical and mental abuse due to their childlessness. The treatment seeking behaviors also vary based on financial conditions and the formality of the services among infertile women of different social classes. Conclusion: Infertility is a critical component of reproductive health. When a woman’s worth is measured by her reproductive functions, the childless woman faces humiliation and even abandonment. Attitude towards them is changed due to the societal norms and patriarchal social structures. This affects their treatment seeking behaviors as well. A proper understanding of the social condition of infertile women will facilitate the improved quality of women’s reproductive health care services. J Shaheed Suhrawardy Med Coll 2020; 12(2): 82-86

Comparison of pregnancy rates following fresh and frozen embryo transfer in women undergoing assisted reproductive techniques

Freezing embryos is the best way to increase fertility for women with ovarian hyper-stimulation syndrome and women at risk for ovarian dysfunction. Due to the importance of freezing and pregnancy embryos, the present study was conducted to compare the fertility rate and the affecting factors following fresh embryos and frozen embryos in women treated with assisted reproductive techniques. In this study, 250 infertile women and IVF/ICSI candidates were studied. Embryos were used in fresh or frozen groups for transfer to the uterus. The expression of the caspase-3 gene was also examined for further evaluation. Data analysis was performed using SPSS 16 software, Chi-square, independent t-test, and Kruskal-Wallis tests. Out of 250 infertile women, 96 (38.4%) became pregnant, of which 54 were in the fresh embryo group and 42 were in the frozen embryo group, which was not statistically significant (P=0.32). Infertility causes, number of embryonic cells and grading of transferred embryos, delivery complications, embryo implantation methods, number of produced embryos after delivery, and endometrial thickness were not significantly different between the two groups (P=0.53). The difference between the mean number of transferred embryos in the two groups was significant (P<0.05), which was no longer significant after excluding non-pregnant women, and in comparing with only pregnant women (P=0.36). The result of caspase-3 gene expression showed that there was significant differences between fresh embryos, healthy thawed frozen embryos, and destroyed thawed frozen embryos. But these results were totally different from the results of the Pregnancy rate section. Therefore, it is inferred that although caspase-3 genes are expressed in frozen embryos after thawing and are ready to destroy the embryo, there are probably a number of involved factors that prevent the activity of caspase-3 and do not allow the apoptotic process to occur. What these factors are and how they prevent this process needs further study.

The value of endoscopic examination methods in infertile marriage

To optimize the management of infertile women the estimation of efficacy of endoscopic methods of treatment (laparoscopy and hysteroscopy) in this category of patients was undertaken. With the method of retrospective analysis clinico- laboratory and endoscopic examination of2785 sterile pairs was carried out. The results of the study showed that endoscopic methods are not only the most important stage of diagnostics but also the first pathogenetically substantiated stage in treating female infertility. It became clear that half of the patients demonstrated from 2 till 5 factors in pathogenesis of reproductive function abnormalities that brings on the necessity of elaboratingthe algorithm of treatingparticular patients considering the disturbances revealed.So, to increase the effectiveness of treating the patients in question, distinct standards of medical care should be put into practice.

Comparative efficacy of various methods of infertility treatment in patients with external genital endometriosis

With the aim of comparative examination of efficacy of different drugs and methods of endoscopic surgery in treatment of infertile women with genital endometriosis 548 patients were examined. Distinct advantages of combined treatment were revealed: surgical destruction of endometrial foci at the first stage and administration of antigonadotrophic preparations at the second stage. Maximum frequency of impregnation after such therapy was observed during first 6-8 months. By 11-12 months the index decreased to its minimum. So, it is reasonable to give up passive supervision after 12 months

Combined use of laparoscopy and hysteroscopy in the treatment of female infertility

The experience of combined application of hysteroscopy and laparoscopy in treatment of infertile women is analyzed. An alternative technique of treating occlusion of the uterine tubes with the method of their transcervical recanalization using ureteral catheter is represented. The statement is made about the perspectives of applying combined hysteroscopy and laparoscopy in treatment of patients with infertility.