In the modern era, contemporary management of male infertility has undergone groundbreaking changes with the introduction of new concepts, advanced testing, and therapeutic interventions. As practicing gynecologists are often the first physicians who encounter an infertile couple, it is essential that these clinicians are continuously updated about the new pearls and pitfalls of male infertility management. Semen analysis is commonly ordered by gynecologists. In 2010, the WHO released new cutoff reference values for the semen parameters adopting novel methodology, which has incited much debate. Reference values have been lowered in comparison with previous standards, with a direct clinical implication in decision-making strategies. Specialized sperm-function tests, such as sperm oxidative stress and sperm chromatin integrity assessments, became clinically available, thus offering an opportunity to better understand sperm dysfunctions concealed during routine semen analysis. Furthermore, the initial counseling of azoospermic men by an andrologically well educated gynecologist may alleviate the misconception and distress surrounding the false belief of sterility, and will clarify the available options of percutaneous and microsurgical spermretrieval techniques and assisted conception outcome. Regarding varicocele, which is commonly seen in infertile males, it is now clear that the best treatment option for infertile men with clinical varicocele is the microsurgical vein ligation. Natural conception is significantly improved after varicocelectomy, and recent data suggest that such treatment optimizes reproductive outcome of couples undergoing ICSI or micro-TESE sperm retrieval. Lastly, new therapeutic interventions, including oral antioxidant therapy and lifestyle modifications, have gained increasing attention, as they aid in alleviating male infertility.
Pregnancy is affected by maternal age from conception till delivery. Various studies have been conducted globally to study this effect; few in developing countries. Maternal age is increasing in developing countries as well, so we have conducted this study.
Method: This was a prospective observational study consisting of 1,263 women booked at Jehangir hospital during a period of 2 years, fulfilling inclusion criteria and consenting for the study. They were divided into two groups; women aged 35 years and above and women less than 35 years of age. Pregnancy outcomes were studied in terms of antepartum, intrapartum and postpartum complications. Neonatal outcomes were studied in terms of birth weight and NICU admissions. Data was analyzed statistically using statistical package for social sciences version 17, by applying Chi square test and Fisher exact test. A p value below 0.05 was considered significant.
Results: Women aged 35 years and above constituted 9.63 % of the total study population. Most were multigravidae. Rate of assisted conception was significantly higher among women aged 35 years and above; early pregnancy loss was also high in this group. Pre-eclampsia and abruption were significantly higher among them. Neonatal outcomes were comparable.
Conclusion: Women with advanced maternal age are at higher risk of complications from conception till delivery and should be provided close supervision for better pregnancy outcome.
Purpose: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and transvaginal sonography (TVS).
Method: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I–IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I–IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I–IV).
Results: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and interdelivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS.
Conclusions: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.
Background/Purpose: Maternal to child transmission (MTCT) is responsible for over 90 % of all childhood HIV infections. Lack of awareness regarding HIV and preventive practices against MTCT maybe one of the reasons behind high HIV transmission rates. In our study, we assessed the knowledge of HIV/AIDS in antenatal women, attending a tertiary care hospital in India as well as their attitude toward voluntary counseling and testing (VCT) for HIV.
Materials and Methods: This was a cross-sectional descriptive study carried out from May–July 2012 using a pretested interview-based questionnaire given to 386 antenatalwomen after obtaining consent. Data were abstracted for knowledge of HIV,MTCT, and attitude toward VCT. Results were expressed as percentages using SPSS v.16 software.
Results: Amongst the respondents, 92.5 % had heard of HIV and in 41 % of them, the source of information was through mass media. 81 % were aware of sexual intercourse as a mode of transmission of HIV while 55 % knew that sharing sharp objects and infected blood products can spread HIV. 37.6 % of respondents were aware of MTCT and 44 % heard of antiretroviral therapy as a method of prevention of MTCT. While 68 % were willing to get tested for HIV, 18.9 % knew about the steps involved and 44 % knew where to get VCT.
Conclusion: There exists a lack of adequate knowledge regarding HIV and preventive practices against MTCT. Health education and awareness campaigns on MTCT prevention and VCT promotion should target women in their antenatal period in order to increase acceptability and
accessibility of these services.
Objectives: To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first and second trimester induced abortions.
Methods: In first trimester, women received oral mifepristone followed by misoprostol either by buccal or vaginal route. In second trimester, women received oral mifepristone followed by repeated doses of misoprostol either by buccal or vaginal route. A comparative analysis using SPSS was done.
Results: In first trimester, success rate of medical abortion was 96 % in buccal group and 88 % in vaginal group. Nausea was the most common adverse effect which was similar in both groups. In second trimester, success rate was 96 % in buccal group and 80 % in vaginal group. A statistically higher incidence of nausea was noticed in buccal group. Patient satisfaction level was almost similar in both the groups in both trimesters.
Conclusions: Buccal and vaginal routes of misoprostol administration have similar efficacy and patient satisfaction level for first and second trimester induced abortions. Hence, buccal route may serve as an alternative to vaginal misoprostol.
Background: The discrimination between benign and malignant adnexal masses is central to decisions regarding clinical management and surgical planning in such patients.
Purpose of Study: To determine if the RMI (RMI 2) can distinguish between benign and malignant adnexal masses.
Method: A prospective cohort study was conducted of 58 women with an adnexal mass referred to a teaching hospital for diagnosis and management.
Results: RMI[200 had a sensitivity of 70.5 % (95 % CI 46.87–86.72), a specificity of 87.8 % (95 % CI 74.46–94.68), a positive predictive value of 70.5%, and negative predictive value of 87.8 %. ROC showed that cut off value of 25 achieved a sensitivity and specificity of 82.35 and 43.9 %, respectively, and a cut off value of 1,000 gave a sensitivity and specificity of 58.81 and 97.56 %, respectively. The association between RMI and disease status was not statistically significant for mucinous tumors.
Conclusion: RMI is a reliable tool in differentiating benign from malignant adnexal masses. It is simple, easy to use and cost effective. However it’s predictive accuracy was less for mucinous as compared to serous epithelial ovarian cancers. The study is limited by its small sample size.
