MANAGEMENT OF FEMALE INFERTILITY DUE TO TUBAL BLOCKAGE BY AYURVEDIC TREATMENT PROTOCOL: A CASE REPORT

Motherhood is one of those transforming experience which can’t quite put into words. Infertility represents a major crisis for most couples, with both partners experiencing loss in ways that affect them as individu-als, as family members and as members of society as a whole. Tubal factor is second major cause of fe-male infertility. In Tubal factor, modern management are dependent on Tubal Surgery or IVF or Embryo Transfer. All these methods are the solution only for the anatomical aspect of the tube and no success in establishing the tubal function. The present case report revealed effect of Virechana and Uttarbasti karma in a known case of secondary infertility due to Fallopian Tube Blockage. Virechana is indicated in Vandhyatva and Yonivyapada chikitsa. Uttarabasti is a very important and unique Ayurvedic procedure, which is mentioned for the genito–urinary problems. Successful conception occurs after this treatment.

Clinical study of ectopic pregnancy

Background: Ectopic pregnancy is not an uncommon condition and is potentially a life- threatening emergency. There is a rising trend in incidence which necessitates the gynecologists to have comprehensive knowledge about the disease. Aim of the study: To determine the incidence, risk factors, clinical features and management. Materials and method: This study is conducted in Department of Obstetrics and Gynecology of PIMS, Karimnagar. It is a retrospective descriptive study on patients who presented to our department with clinical features of ectopic pregnancy and later confirmed with intraoperative findings or ultrasound, in the 3-year period from January 2017 to January 2020. Result: A Total of 34 patients were diagnosed to have ectopic pregnancy with an incidence of 1in 114 deliveries. The cause of ectopic pregnancy was dilatation and curettage in 11.8% and PID, infertility, prior tubal surgery, previous abortions and OCP usage each contributes by 5.9%. Surgical treatment with salpingectomy was done in majority of the cases and medical management in 3 patients. Blood transfusions were given in 38.2% of cases. Postoperative period is uneventful in all the cases. Conclusion: Gynecologists should have comprehensive knowledge about the clinical presentation and risk factors of EP. If suspected clinically, encouraging women to undergo early ultrasonography allows early detection of EP and can be managed medically or fertility sparing surgical procedures

Laparoscopic Tubal Re-anastomosis or In Vitro Fertilisation in Previously Ligated Patients: A Comparison of Fertility Outcomes and Survey of Patient Attitudes

Introduction: We aim to compare live birth rates, cost analysis and a survey of patient attitudes between laparosopic tubal re-anastomosis and IVF. Materials and Methods: Retrospective study: A retrospective study was done in a single reproductive medicine and IVF unit in Singapore, from January 2011 to December 2016. Previously ligated patients underwent either laparoscopic tubal re-anastomosis or IVF. The primary outcome was first live birth after treatment. Interval to first pregnancy, miscarriage and ectopic pregnancies were also reported. Survey: Patients attending the subfertility clinic completed a questionnaire on IVF and tubal re-anastomosis, on preferred choice of treatment, before and after reading an information sheet. Results: Retrospective study: 12 patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment. Pregnancy (75.0% vs 35.5%) and live birth (58.3% vs 25.8%) were significantly higher in the tubal surgery group (P<0.05%) after transferring all available embryos in one stimulated IVF cycle. Cost per live birth was lower in the tubal surgery group (SGD27,109 vs SGD52,438). Survey: One hundred patients participated in the survey. A majority of patients preferred tubal surgery to IVF (68.2% vs 31.8%) before given information on the procedures, but indicated a preference for IVF (54.6%) to surgery (45.4%) after receiving information on the procedures. Conclusion: For women less than 40 years of age, desiring fertility after tubal ligation, laparoscopic tubal re-anastomosis offers better live birth rates and cost-effectiveness. Patients in Singapore are equivocal as to their preference after education regarding the choices. Thus laparoscopic tubal re-anastomosis remains a viable alternative to IVF treatment. Key words: Artificial reproductive technology, Laparoscopic tubal reversal, Previous tubal ligation

Heterotopic Pregnancy: A Challenge in Early Diagnosis

Heterotopic pregnancy is the simultaneous existence of intrauterine and extrauterine gestation. It is usually seen in women at risk for ectopic pregnancy or those undergoing fertility treatments. The incidence has dramatically risen to 1 in 3900 of pregnancies via assisted reproductive techniques or ovulation induction, compared to 1 in 30000 of spontaneous conception. Besides this, history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery and prior tubal surgery can increase its risk. Here we present a case of heterotopic pregnancy which was diagnosedafter ectopic gestation ruptured along with compromised intrauterine gestation and maternal condition. Earlier diagnosis before this life-threatening event could have saved the intrauterine fetus.Keywords: Extrauterine pregnancy; heterotopic pregnancy; ruptured ectopic.

Endometriosis and Beta-hCG > 775 IU/l Increase the Risk of Non-tube-preserving Surgery for Tubal Pregnancy

Introduction Tubal pregnancy is the most clinically relevant form of ectopic pregnancy. Surgery consisting of laparoscopic salpingotomy is the therapeutic gold standard. This study looked at risk factors for non-tube-preserving surgery. The aim was to determine a cut-off value for beta-hCG levels, which could be used to predict the extent of tubal surgery. Materials and Method 97 patients with tubal pregnancy who underwent primary salpingotomy in the Department of Gynecology and Obstetrics of Jena University Hospital between 2010 and 2016 were retrospectively analyzed. A prior medical history of risk factors such as adnexitis, ectopic pregnancy, tubal surgery, treatment for infertility and intrauterine pessary was included in the analysis. The study population was divided into two subgroups: (1) a group which underwent laparoscopic linear salpingotomy, and (2) a group which had laparoscopic partial tubal resection or salpingectomy. Risk factors for salpingectomy were determined using binary logistic regression analysis. Statistical analysis was done using SPSS, version 24.0, to identify risk factors for non-tube-preserving surgery. Results 68 patients (70.1%) underwent laparoscopic salpingotomy and 29 patients (29.9%) had laparoscopic salpingectomy. The two groups differed with regard to age (p = 0.01) but not with regard to the parameters ‘gestational age’, ‘viability and rupture status of the ectopic pregnancy’ or ‘symptoms at presentation’. Patients who were known to have endometriosis prior to surgery or who were diagnosed with endometriosis intraoperatively were more likely to undergo salpingectomy (OR: 3.28; 95% CI: 0.9 – 10.8; p = 0.05). Calculated mean beta-hCG levels were higher in the salpingectomy group compared to the group who had tube-preserving salpingotomy (3277.8 IU/l vs. 9338.3 IU/l, p = 0.01). A cut-off beta-hCG value of 775 IU/l prior to surgery was predictive for salpingectomy with a true positive rate of 86.2% and increased the probability that salpingectomy would be necessary (OR: 5.23; 95% CI: 0.229 – 0.471; p = 0.005). Conclusion Endometriosis and a beta-hCG value of more than 775 IU/l significantly increased the risk for non-tube-preserving surgery in women with tubal pregnancy.