Background: Polycystic ovary syndrome (PCOS) is the largest single cause of anovulatory infertility. PCOS is associated with oxidative stress. Coenzyme q10 (Coq10) is an antioxidant that protects the mitochondria from damage caused by either insulin resistance or oxidative free radicals. The objective of the study was to compare the effect of combined Coq10 and letrozole than of letrozole alone for ovulation induction in women with PCOS.Methods: This open label parallel design randomized controlled trial study was conducted on 80 infertile women with PCOS selected for ovulation induction. Eligible women were randomized either to combined Coq10 and letrozole (40 patients, 83 cycles) or letrozole alone (38 patients, 91 cycles). The outcome measures were mature follicles, adequate endometrial thickness, ovulation and pregnancy.Results: Mature follicles (≥18-25 mm) were significantly higher in women given Coq10 at 2nd (74.2% vs 31.3%) and 3rd cycles (83.3% vs 28.6%). Adequate endometrial thickness was significantly higher in women given Coq10 in second (90.3% vs 56.3%) and third cycle (94.4% vs 47.6%). When Coq10 was added to letrozole, ovulation rates were significantly higher (87.1% vs 53.1% in second cycle), (83.3% vs 38.1%, in third cycle). Cumulative pregnancy was 2.37 times (95% CI 1.03-5.48) higher in women having Coq10 in addition to letrozole for ovulation induction. Conclusions: Coq10, as an adjuvant to ovulation induction with letrozole improves ovarian response, ovulation and pregnancy in PCOS women. Combination of Coq10 and letrozole can be tried successfully before a more complicated and expensive treatment such as gonadotrophins and laparoscopic ovarian drilling.

Introduction: Long Acting Reversible Contraceptive (LARC) is one of the most popular method of family planning. The Aim of the study was to explore the effects of long-term use of Depomedroxyprogesterone acetate (DMPA) which is the most commonly used LARC, on serum lipid profile. Methods: This cross-sectional analytical study was carried out in the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period December 2015 to September 2016. A total 70 married women at the age range of 20-35 years attending, the family planning clinic of BSMMU were included in this study. Out of them 35 subjects who had been using DMPA for ³ two years uninterruptedly were considered as cases and another 35 subjects who did not use any hormonal contraceptives were labeled as control. In both the groups, age and BMI were matched. All the study subjects in both groups were apparently healthy. Fasting blood samples were collected from each subject for the estimation of Total Cholesterol (TC), Triglyceride (TG), High-density Lipoprotein Cholesterol (HDLC) and Low-density Lipoprotein Cholesterol (LDLC). The data were collected in a pre-designed data sheet and analyzed with student T-test for the statistical significance. Results: Serum TC and LDLC level in group-I (cases) were significantly higher compared to group-II (control) and the difference was statistically significant (p<0.05). Serum High-density Lipoprotein Cholesterol (HDLC) level in group-I was lower than group-II which was also statistically significant (p=0.001). Serum Triglyceride level in group-I was higher than group- II, however the difference was not statistically significant (p=0.177). Conclusion: DMPA use for ³ two years increases serum TC and LDLC and decrease serum HDLC, which may increase the risk of atherosclerosis. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(2): 106-111

Objective:The study is aimed to describe the grave maternal outcomes encountered inpatients having morbidly adherent placenta along with history of previous caesarean section. Materials and Methods: This was a cross-sectional study from September 2014 to August2015. All the patients attended in the in-patient department of obstetrics & gynaecology inDMCH during the study period having morbid adhesion of placenta (diagnosed antenatallyby USG or diagnosed preoperatively) along with history of previous caesarean section. Result: Total 10,805 obstetric patients delivered during the study period, of which 6,337patients had caesarean sections. Out of them 37 pregnant patients were found to havemorbid adhesion of placenta along with history of previous C/S. The incidence is 1 in 292deliveries. All of the 37 patients needed hysterectomy for intractable per operativehaemorrhage. All the patients needed transfusion of more than 04 units of blood. Nineteenpatients needed ICU supports Ten (27%) patients died. Other grave complications werehypovolemic shock (19 patients), bladder injury (16patients), renal failure (07 patients),multiorgan failure (07 patients) and DIC (06 patients). Conclusion: All the patients of morbidity adherant placenta with previous Caesarean Sectionneeded caesarian hysterectomy and ten patients died. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 96-100

Background: Oligospermia or low concentration of sperm is a common finding in male infertility. Alterations in the expression of angiotensin converting enzyme (ACE) may be one of the mechanisms underlying male infertility and ACE inhibitors may improve the sperm count. The objective was to compare the effects of lisinopril and zinc-folic acid with zinc-folic acid alone on idiopathic oligospermia in infertile males.Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology & Infertility of a medical university from March 2021 to February 2022. A total 78 diagnosed cases of infertile males with idiopathic oligospermia were selected for this study. Eligible men who gave their informed consent were randomly allocated to receive either a combination of low dose lisinopril (2.5 mg) and zinc-folic acid or zinc-folic acid alone for 12 weeks. Pretreatment and post treatment semen parameters, including sperm concentration, sperm motility and total motile sperm count were assessed.Results: There was significant rise in sperm concentration and total motile sperm count in both groups but the mean difference in sperm concentration (2.36±2.04 vs 1.53±1.8 million/ml) and total motile sperm count (11.64±8.28 vs 9.95±6.11 million) were higher in those receiving Lisinopril in addition to zinc folic acid. The percentage increase of sperm count was higher (22.65 vs 16.70 million) in this group. Normalization of sperm count (sperm count ≥15 million/ml) was also higher in this group (18.4% vs 8.3%) with relative risk 2.21, 95% CI (0.648-4.56 %).Conclusions: Lisinopril given orally at the dosage of 2.5 mg/day with zinc-folic acid for 12 weeks appears to be well tolerated among men with oligospermia and improves sperm count by a small margin when compared to zinc folic acid only.

Background: Letrozole is a third-generation aromatase inhibitor. As there is aberrant aromatase production by endometriotic stromal cells and the growth and regression of endometriosis is estrogen-dependent, the use of letrozole to reduce the size and symptoms of endometrioma especially in recurrent cases is a promising medical intervention. Dienogest is a fourth-generation progestin which is being used for the treatment of endometriosis due to its antiproliferative and antiangiogenic properties on endometrial tissue. The present study was conducted to compare the effects of letrozole and dienogest on endometrioma recurrent after surgery.Methods: This randomized controlled study was conducted on 38 women having recurrence of endometrioma after surgery. They were randomly assigned to receive either letrozole (2.5 mg daily) or dienogest (2 mg once daily) for 6 months. Size of the endometrioma was measured by transvaginal ultrasound and the pain (dysmenorrhoea) was measured on a visual analog scale (VAS) of 0-10, prior to treatment and after 3 and 6 months of treatment.Results: The mean size of endometrioma was reduced from a baseline of 6.06±2.40 cm to 5.23±1.37 cm and to 4.59±1.25 cm after 3 and 6 months of treatment with letrozole. While with dienogest the reduction was from a baseline of 6.67±1.31 cm to 4.83±1.50 cm and to 3.80±1.34 cm after 3 and 6 months of treatment. The difference between the two groups was not statistically significant but dienogest yielded better result in terms of effect size. Decrease in pain (dysmenorrhoea) was highly significant with both the drugs.Conclusions: In terms of reduction of the size of endometrioma, dienogest yields better results than letrozole. Both the drugs are highly effective in alleviating pain (dysmenorrhoea).