The aim of this randomized controlled trial was to compare the efficacy of extended letrozole regimen with clomiphene citrate in women with unexplained infertility undergoing superovulation and intrauterine insemination (IUI). Two hundred and fourteen patients with unexplained infertility were randomized into two equal groups using computer generated list and were treated by either letrozole 2.5 mg/day from cycle day 1 to 9 (extended letrozole group, 211 cycles) or clomiphene citrate 100 mg/day from cycle day 3 to 7 (clomiphene citrate group,210 cycles). Intrauterine insemination was performed 36 to 40 hours after HCG administration. Both groups were comparable with regard to number of mature follicles (2.24 +/- 0.80 Vs 2.13 +/- 0.76) and the day of HCG administration. Serum estradiol was significantly greater in clomiphene citrate group (356 +/- 151 Vs 822 +/- 302 pg/ml, P = < 0.001) and the endometrial thickness was significantly greater in extended letrozole group (9.10 +/- 1.84 Vs 8.18 +/- 1.93 mm, P = < 0.001).The pregnancy rate per cycle and cumulative pregnancy rate were significantly greater in extended letrozole group (18.96% Vs 11.43% and 37.73% Vs 22.86%, respectively). The extended letrozole regimen had a superior efficacy as compared with clomiphene citrate in patients of unexplained infertility undergoing superovulation and IUI. ClinicalTrials.gov, NCT01232075

/pdf/extended-letrozole-regimen-versus-clomiphene-citrate-for-3l5vp1sby8.pdf

Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: A randomized controlled trial

BACKGROUND Group B Streptococcus (GBS), also known as Streptococcus agalactiae, is a Gram-positive bacterium known for its ability to colonise the vaginal and rectal areas of the mother and is a leading cause of neonatal mortality and morbidity. This study aimed at determining the prevalence, associated risk factors and antimicrobial susceptibility of GBS colonisation among pregnant women attending antenatal care (ANC) at Dschang District Hospital. METHODS This hospital-based cross-sectional study used a multistage sampling method to recruit a total of 621 consented pregnant women who attended ANC in Dchang District Hospital. The 621 Participants at 23.5 ± 6.4 weeks gestation each completed a questionnaire and vaginal swabs were collected for GBS analysis. RESULTS Among the 621 pregnant women that were included in this study, the colonisation rate of GBS was found to be 8.69%. Induced abortion (odds ratio [CI] = 3.09, 95% [1.56-6.21]), Spontaneous abortions (OR = 2.82, 95% CI 1.14-7.29), Stillbirth (OR [CI] = 7.75, 95% [2.61-21.71]), Fever (OR [CI] = 0.37, 95% [0.19-0.71]) and anaemia (OR [CI] = 0.22, 95% [0.12-0.43]) were found to be factors associated with GBS colonisation. CONCLUSION Our findings suggest that we found that, induce abortion, spontaneous abortions and stillbirths were highly associated rates of GBS colonisation, while fever and anaemia were associated with lower rates of GBS colonisation. Further longitudinal research is needed to establish the causal relationship and its biological mechanisms.

Group B Streptococcus colonisation, prevalence, associated risk factors and antimicrobial susceptibility pattern among pregnant women attending antenatal care at Dschang District Hospital, West Region of Cameroon: A hospital-based cross-sectional study.

Objective : To assess the effects of semen characteristics on the success of in- trauterine insemination (IUI). Design : A retrospective study. Settings : The Department of Obstetrics and Gynecology, Tokushima University Hospital, Japan. Patients : Between 2004 and 2008, 1,177 IUI cycles in 283 couples were studied. Intervention : IUI cycles were preceded with ovarian stimulation. Main Outcome Measure : Clinical pregnancy. Result : A total of 82 clinical pregnancies were obtained (7.0% pregnancy rate per cycle, 28.9% er case). Their subsequent outcomes of pregnancies were 18 miscarriages (21.9% 2 ectopic pregnancies (2.4%) and 60 live births (73.2% Of the 82 clinical pregnancies, 2 were twin pregnancies (2.4% There was no triple or higher order multiple pregnancies. At the end of the sixth cycle, 73 clinical pregnancies had been achieved (89.0% After diagnostic laparoscopy, the pregnancy rate per cycle for patients 35 years age was 18% which is significantly higher than that of patients 35 years of age. Pregnancies occurred up to the fifth cycle after laparoscopy. The pregnancy rate (PR) per cycle was significantly higher in cases of sperm movement rates more than 30% PR 9.3% and total motile sperm counts more than 10 10 6 /ml (PR 8.2% A study comparing the washed and unwashed cases did not reveal any differences. Conclusion : In male sub-fertility cases of sperm parame- ters as motility rates 30% and motile sperm concentration 10 10

/pdf/effect-of-semen-characteristics-on-pregnancy-rate-following-vg5uxggntd.pdf

Effect of semen characteristics on pregnancy rate following intrauterine insemination.

Aerobic vaginitis (AV) is an endogenous opportunistic infection brought about by the disruption of the normal vaginal microbiota. Its early diagnosis and treatment during pregnancy may reduce the risk of negative pregnancy outcomes. The aim of this review was to report on the aerobic bacteria most prevalent in AV and to provide evidence of the threat of untreated AV on pregnancy outcomes. More than 300 papers on preterm delivery were extracted from several research domains and filtered to include only AV-associated bacteria such as Staphylococcus aureus , Enterococcus faecalis , Escherichia coli and Group B streptococci and their association with adverse pregnancy outcomes. Due to the diverse sample groups, study techniques and outcomes, a meta-analysis was not conducted. The review revealed that the association of AV with adverse pregnancy outcomes has not been as widely researched as bacterial vaginosis (BV) and needs further investigation. Furthermore, the frequent misdiagnosis of AV coupled with the emerging antimicrobial resistance associated with bacteria implicated in AV and neonatal nosocomial infections pose a problem for prophylaxis and treatment to reduce the risk of maternal and neonatal morbidity and mortality. Keywords: Aerobic vaginitis; pregnancy risks; antimicrobial resistance

https://www.ajrh.info/index.php/ajrh/article/download/812/pdf

The Threat of Aerobic Vaginitis to Pregnancy and Neonatal Morbidity.

Streptococcus agalactiae (Group B Streptococcus or GBS) is a frequent cause of serious disease in newborns and adults. Epidemiological evidence indicates a strong association between GBS strains belonging to the hypervirulent CC17 clonal complex and the occurrence of meningitis in neonates. We investigate here the role of PbsP, a cell wall plasminogen binding protein, in colonization of the central nervous system by CC17 GBS. Deletion of pbsP selectively impaired the ability of the CC17 strain BM110 to colonize the mouse brain after intravenous challenge, despite its unchanged capacity to persist at high levels in the blood and to invade the kidneys. Moreover, immunization with a recombinant form of PbsP considerably reduced brain infection and lethality. In vitro, pbsP deletion markedly decreased plasmin-dependent transmigration of BM110 through brain microvascular endothelial cells. Although PbsP was modestly expressed in bacteria grown under standard laboratory conditions, pbsP expression was markedly upregulated during in vivo infection or upon contact with cultured brain endothelial cells. Collectively, our studies indicate that PbsP is a highly conserved Plg binding adhesin, which is functionally important for invasion of the central nervous system by the hypervirulent CC17 GBS. Moreover, this antigen is a promising candidate for inclusion in a universal GBS vaccine.

/pdf/the-plasminogen-binding-protein-pbsp-is-required-for-brain-5blovju93p.pdf

The plasminogen binding protein PbsP is required for brain invasion by hypervirulent CC17 Group B streptococci.

Sirenomelia, the Mermaid Syndrome is a rare and lethal congenital anomaly with an incidence of one in 60,000 to 70,000 pregnancies. Sirenomelia is characterized by complete fusion of the lower limbs, commonly associated with renal agenesis, absent external genitalia and other gastrointestinal defects. Another pathognomonic finding is the presence of single umbilical, persistent vitelline artery which is the chief distinguishing anatomic finding from Caudal Regression Syndrome. We report a case of termination of pregnancy done on the basis of ultrasound diagnosis of bilateral renal agenesis with no liquor volume. The foetus was identified to have characteristic features of Sirenomelia at the time of termination.

/pdf/sirenomelia-the-mermaid-syndrome-case-report-and-a-brief-1f9rm0v4zc.pdf

Sirenomelia, the Mermaid syndrome: case report and a brief review of literature.

OBJECTIVES To determine the prevalence of Group B Streptococcus genital tract infection in pregnant women and to determine the risk factors for its colonisation. METHODS The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi and Sobhraj Hospital, Karachi, from May to August 2007. Pregnant women at 35-37 weeks gestation attending antenatal clinic at these hospitals constituted the study population. Based on stratified sampling, 405 patients were recruited. High vaginal swabs of these patients were taken in order to calculate the prevalence of infection at each hospital. Logistic regression was used to evaluate the risk factor association. SPSS 11.5 was used for statistical analysis. RESULTS The overall prevalence of colonisation was 17% (n = 69) (95% CI: 13.4-20.7). Of the 155 (38.27%) women at the Aga Khan Hospital, 35 (22.6%) were positive, while among the 250 (61.72%) women at Sobhraj Hospital, the prevalence was 13.6% (n = 34). The colonisation was found to be significantly associated inversely with the body mass index of the patient (OR 0.91; 95% CI: 0.08-1.0). CONCLUSION Group B Streptococcus screening should be an integral part of antenatal care and should be offered to all pregnant women.

/pdf/maternal-genital-tract-colonisation-by-group-b-streptococcus-4ynj9wqvmv.pdf

Maternal genital tract colonisation by Group-B Streptococcus: A hospital based study

The objective was to determine the success rate of intrauterine insemination (IUI) following controlled ovarian hyperstimulation (COH) and to identify the prognostic factors associated with successful outcome in couples undergoing this form of assisted reproduction. Design: Case series. Place and Duration of Study: Concept Fertility Centre Karachi Pakistan from January - December 2004. A total of 290 IUI procedures carried out for the treatment of unexplained and male factor subfertility were included. The age of women ranged from 20 - 44 years and the duration of subfertility were variable. All women had tubal patency confirmed before undergoing COH with one of the three regimens. IUI was performed at follicular maturity of = 16mm and endometrial thickness of = 7mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI miscarriage rate and ongoing pregnancy rate. Other variables observed were the various prognostic factors associated with successful outcome in IUI such as maternal age effect of different regimen of COH motile sperm count and numbers of pre-ovulatory mature follicles > 16mm. Data was collected and entered in SPSS version 10. Chisquare test of significance was applied and p-value determined. The cycle pregnancy rate (CPR) miscarriage rate and ongoing pregnancy rate was 10% 13.8% and 8.6% respectively. CPR was 12% in women 35 years (p-value 0.03). Significant difference was not observed in the CPR with three different COH regimes. CPR increased dramatically with motile sperm count of > 10 millions/ml compared with 16 mm (6.2% 12.9% and 30% with one two and three follicles p-value 0.0019). There was no case of OHSS and only one case of twin gestation. The overall CPR in patients undergoing IUI following COH at our clinic is comparable to the pregnancy rates as shown in different studies. Younger age motile sperm count of > 10 millions/ml and two or three mature follicles = 16 mm are good prognostic factors for successful outcome. However no significant difference was observed in CPR with different COH regimes. (authors)

Intrauterine insemination with controlled ovarian hyperstimulation in the treatment of subfertility.

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Sirenomelia, the Mermaid syndrome: case report and a brief review of literature.

Maternal genital tract colonisation by Group-B Streptococcus: A hospital based study

Intrauterine insemination with controlled ovarian hyperstimulation in the treatment of subfertility.