Case Report on Primary Infertility with Hypothyroidism and Diabetes Mellitus

Introduction: Infertility is the inability, by natural means, of an animal to reproduce. Typically, adult species are not in their normal state of health. A woman who is unable to conceive well will define infertility as unable to bear a full-term pregnancy. Because of any ejaculating disease, and any declining sperm count, men are directly liable for 30-40% infertility. The WHO estimates the overall prevalence of primary infertility in India at 3.9% and 16.8%. Fertility estimates differ widely between India and 3.7% in Utter Pradesh and Maharashtra. Case Presentation: On 9/12/2020, a 38-year-old female came for In Vitro Fertilization with a known case of primary infertility in AVBR Hospital, Wardha. Her complaint was inability to conceive for 4 years, irregular menses, headache, sleep disturbance, loss of appetite. She was admitted for in-vitro fertilization therapy for the 2nd cycle. She had a history of hypothyroidism for 8 years for which she has been taking Thyrox 50mg OD tablet and has Diabetes Mellitus for one year since she is taking Metformin 500mg BD tablet. Instead, she has no concerns about asthma, tuberculosis, epilepsy, etc. On 9/12/2020, she underwent an embryo transfer. Diagnostic Evaluation: The diagnostic hysteroscopy was conducted at the private hospital in Amravati 2 years ago. She has been diagnosed with nullipara for 4 years as a primary infertility. She has already undergone 2 cycles of Intra Uterine Insemination (IUI) and 1 cycle of in vitro fertilization. Hysterosalpingography: Both fallopian tubes are normal & patent uterus is normal. Conclusion: There is multifactorial infertility. In both men and women, anatomy, physiology, the environment, hormones and genetics all play a role in causing infertility. Therefore, in the coming years, it is a very important problem and research in this zone is very essential.

IMPORTANCE OF HAIR GROWTH IN HISUTISM: DIAGNOSIS AND TREATMENT

The objective of the review is to explain the pathogenesis, causes and various treatment involved in hirsutism. This article discusses the disease’s pathogenesis, causes and diagnosis. This review looks at the main significant type of hairs and clinical studies on the role of several lifestyle therapies in hirsutism development. This review examines the numerous methods that causes hirsutism in order to discover new medicaments. In addition, it covers the various type of hirsutism therapy. Hirsutism, is reported to have the strongest impact on patients’ health-related quality of life, following in descending order by body mass index, irregular menses, and infertility. To assess the types of hairs and pathogenesis, sign and symptoms, as well as causes of hirsutism. Moreover, we studied the management of hirsutism and how to treat this. At least six to nine months of therapy are required to produce improvement in hirsutism. We suggest testing for elevated androgen levels in women with moderate or severe hirsutism or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or macroclitoris. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an Antiandrogens after 6 mo if the response is suboptimal. We recommend against androgen antagonist monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photo epilation.

Perimenopause and the Use of Fertility Tracking: 3 Case Studies

Perimenopause is a time in a woman's life where fertility may vary depending upon her age and her reproductive stage and has been defined as the transition period prior to menopause that is characterized by irregular menses, hormonal changes, vasomotor symptoms, and declining fertility (Casper, 2020). Fertility tracking during this time in a woman's reproductive stage has not been widely studied. Employing the use of Luteinizing Hormone Urine Assay sticks, an electronic hormonal monitor device or mucus, we propose a set of guidelines to determine the potentially fertile times of a woman's cycle based on staging according to the Stages of Reproductive Aging Workshop (STRAW) criteria and illustrate their application with three case reports.

PATTERN OF CLINICAL PRESENTATION OF HYPERPLOLACTINEMIA AMONG INFERTILE PATIENTS

INTRODUCTION– The prevalence of hyperprolactinemia ranges from 0.4% in unselected normal adult females to as high as 9%–17% in females with reproductive health disorders.The etiology of hyperprolactinemia maybe pathological, physiological or pharmacological Drugs that stimulate the hypothalamic dopamine system and/or pituitary or dopamine receptors can cause elevated prolactin.Clinical features of hyperprolactinemia include menstrual disturbances (Oligo-amenorrhea, amenorrhea and irregular menses), anovulation, infertility galactorrhea or a combination of the above symptoms. MATERIAL AND METHOD- This is a retrospective of 88 Infertile females with documented Hyperprolectinimea.The clinical data and infertility workup (Hormonal profile, Imaging report and other tests)were obtained from gynaecological OPD. RESULTS- In this study the maximum number 54 (61.36%) of patientswere in the 21-25 years of age group,65 (73.86%) of patients were of normal weight and 20 (22.72%) of patients were overweight only 3 (3.40%) were obese In this study,the maximum number 60(68.18%)of patients were in primary infertility and 85 (96.59%) of patients had in mild rise in the prolactin level group. In this study, most of the patients 27 (30.68%) of patients were presented with complaints of oligomenorrheaand followed by Amenorrhea 21 (23.86%).Galactorrhea was found in 25(28.40%) patients after clinical examinations,both amenorrhea and galactorrhea were seen in20(22.72%)of the patients. Hypothyroidism was present in 13 (14.77%) of patients. CONCLUSION– Anovulatory cycle, Luteal face defect and sex hormonal imbalance caused by hyperprolactinemia results in infertility.Prolactin may stop ovulation and cause amenorrhea, in less severe cases Intermittent ovulation or ovulation that takes a long time to occur causes infrequent or irregular periods.that's why estimation of serum prolactin should be done at an early stage of an infertility workup. In our study, the prevalence of hyperprolactinemia and hypothyroidism was found very high which emphasize the importance of estimating TSH and Prolactin in infertility.In our study Oligomonorrhea,amenorrhea and galactorrhea are the commonest presentations in hyperprolactinemia.Proper Diagnosis and treatment results in an improvement in symptoms and an increase in conception rates in infertile patients.

Case Report on Hypothyroidism in Infertile Woman with IVF Conception

Introduction: Hypothyroidism affects 2–4% of women in their reproductive years. Anovulatory cycles, luteal phase defects, hyperprolactinemia, and sex hormone imbalances are all symptoms of sex hormone imbalances are all consequences of hypothyroidism on fertility. Main Symptoms/or Important Clinical Findings: A 33 years old female admitted in AVBRH on date 19/1/2021 with chief complaint of infertility with hypothyroidism since 8 year, pain in abdomen, irregular menses. Obstetric History: Patient had obstetric history of menarche start age of 15 year and flow of bleeding in slow/light. After irregular menses, she received IVF cycle and she was conceived the pregnancy in 1st IVF cycle. The Main Diagnoses, Therapeutic Intervention, and Outcome: After physical examination and investigation, doctor was detected a case of primary infertility with hypothyroidism. Patient was treated with tab.thyronom50 mg drug to reduce the symptoms of hypothyroidism. Nursing perspective: Administered flued replacement i.e. DNS, RL, monitored fetal heart rate and vital sign per 4 hourly. Conclusion: Pregnancy conceived with in vitro fertilization increasing the more risk of gestational hypothyroidism as well as fetal complication. Treatment and management improves the outcome of pregnancy.

Management of Arthavakshaya - A Case report

Artavakshaya can be compared to Oligomenorrhoea or Hypomenorrhoea. It is a case study of an unmarried female patient aged 20 years, who presented with complains of irregular menses since 5 to 6 years, amenorrhea of 2 months, painful menstruation, associated with constipation. She took allopathic treatment but could not find the result, so approached Parul Ayurved Hospital, Vadodara for management. Looking into the severity, Samshodhana that is Matra basti and oral medications was planned for the patient. After treatment, patient got menses on 4th day of treatment and also her next menses came on regular time.

Predictors of insulin resistance among women with acne vulgaris and polycystic ovarian syndrome presenting to a tertiary care hospital in North India

<p class="abstract"><strong>Background:</strong> Acne vulgaris is now being increasingly associated with hyperandrogenism or metabolic syndrome. The aim of the study was to know the burden and determinants of insulin resistance among females suffering from acne and polycystic ovarian syndrome (PCOS).</p><p class="abstract"><strong>Methods:</strong> This prospective observational study included non-pregnant females with acne and PCOS aged 14 to 36 years. PCOS was diagnosed using Rotterdam criteria. Insulin resistance (IR) was confirmed using HOMA-IR values. Important history was ascertained, and hormonal essays were done. SPSS version 22 was used for the analyses.</p><p class="abstract"><strong>Results:</strong> The average age of the 81 subjects was 22 (IQR: 19-23) years and median duration of acne was 8 (7-9) months. Their median (IQR) insulin level was 10.5 (8.4 - 18.5), fasting blood glucose was 82 (73.2 - 90) and HOMA-IR value was 2 (1.7 - 3.9). A total of 27 (33.3%) were diagnosed with IR. Subjects having IR had significantly lower FSH (median=3.1, IQR: 2.3-6.3), LH (3.0, 1.2-3.3) and insulin level (median=26.0, 18.5-28.5) versus those without IR (p=0.04, p=0.04 and p&lt;0.001 respectively). Subjects with IR were more likely to be having irregular menses, weight gain, and acanthosis nigricans versus those without IR. </p><p class="abstract"><strong>Conclusions:</strong> One-third of the patients with acne and PCOS also had IR according to the HOMA-IR values. All women with acne and PCOS should be considered for underlying IR and examined for other sign of impaired glucose tolerance.</p>

Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

Purpose: The number of international acromegaly-related registries is increasing; however, heterogeneity of acromegaly symptoms and signs across countries is not well described. We compared clinical disease manifestations at diagnosis between two large University referral centers from two continents. Methods: Retrospective, comparative epidemiological study of acromegaly patients at two centers; 1) C. I. Parhon National Institute of Endocrinology, “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania (Parhon), and 2) Pituitary Center, Oregon Health & Science University, Portland, Oregon, United States (OHSU) from approved registries was undertaken. Data were extracted from medical charts and questionnaires. Binary logistic regression analysis was undertaken for the most frequently noted symptoms and clinical signs. Results: Study included 216 patients (87 Parhon, 129 OHSU). Age, sex and median delay in diagnosis were similar between centers. IGF-1 index was higher in patients at Parhon (3.3 vs 2.1, p < 0.001). The top five symptoms at both centers were; enlarged hands/feet, headache, arthralgia, fatigue, and irregular menses in women. A significant difference was noted for multiple signs and symptoms frequency, often >20 percentage points between centers. Center was a predictor of many signs and symptoms, independent of acromegaly biochemical severity or disease duration. Conclusion: We show in the first comparative study that differences in medical practice, documentation, and likely cultural differences can influence patients’ symptom(s) reporting and screening patterns in geographically different populations. Pooling data into large multicenter international registries databases may lead to loss of regional characteristics and thus a mixed overall picture of combined cohorts.

SELF CARE TO FEEL BEST DURING MENSTRUATION (RAJASWALA PARICHARYA): THE IMPACT OF LIFESTYLE MODIFICATION THAT ENHANCE FERTILITY

Out of various Paricharya mentioned in Ayurveda, Rajaswala Paricharya holds an important one. The Charya or code of conduct mentioned for a Rajaswala stree is termed as Rajaswala Parichara. Due to changing lifestyle, physical and mental stress, Mithya Aahar, Woman in reproductive age groups suffer from various conditions related to menstrual cycle like dysmenorrhoea, menorrhagia, irregular menses, PCOS, endometriosis, adenomyosis which increase incidence of infertility also Rajaswala charya is the most neglected part in the society. Acharyas mentioned Aaharas and Charyas which are indicated and contracted for maintaining the health. By the concept of Shuddha Shukra & Shuddha Aartava in the formation of Garbha its very clear that concept of Supraja Jananam i.e., healthy progency begins at the very level of preconceptional care or even before to that in the form of Rajaswala Paricharya. If it followed during menstruation it will get relief from conditions of menstrual abnormalities, infertility and to gain better healthy life of woman.

Approach to: Amenorrhea

This article provides an approach to amenorrhea and is intended for pre-clinical and clerkship medical students. Primary amenorrhea refers to the absence of menarche by 15 years or 3 years post thelarche while secondary amenorrhea is the cessation of menses for 3 months in women with a previously regular cycle or for 6 months in women with previously irregular menses. While amenorrhea can be physiological it can also reflect an anatomical or more complex hormonal problem that students must learn to identify and investigate.