In December 2019, a cluster of four cases of pneumonia of unknown etiology in Wuhan, China, were reported to the World Health Organization (WHO). Since then, the world has seen unprecedented effects of this virus on our health and life in general and every country of the world has been affected. Pregnant women are considered the most vulnerable population and clinical trials and research are going on to ensure the safety of mother and the fetus during this pandemic. The data regarding management of pregnancy during COVID-19 era is evolving every day. In this review, we evaluate the recent evidence of the effects of SARS-CoV-2 infection throughout pregnancy and provide a balanced and informed evidence-based management of pregnancy during the COVID- 19 era. Birdem Med J 2020; 10, COVID Supplement: 93-102

Background: Infertility in polycystic ovary syndrome (PCOS) is one of the leading causes of anovulatory infertility. Ovulation induction is indicated for the management of anovulatory infertility in PCOS and for augmentation of ovulation in ovulatory infertility, in unexplained infertility. The aim of this retrospective study was to compare and determine the efficacy of letrozole administration in infertile women with PCOS to that of infertile women without PCOS by transvaginal sonography. Methods: This retrospective study was done at Centre for Assisted Reproduction (CARE), BIRDEM General Hospital 2 from January to December 2011. Fifty six infertile women including 16 diagnosed as having PCOS and 40 infertile women with regular menstrual cycle (non-PCOS) were included in this study. Patients were treated with letrozole 7.5 mg/day from day 2-6 of the menstrual cycle. Subjects were monitored once during the days 11 to 14 of the cycle by transvaginal ultrasound. Main outcome measures were number of ovulatory follicles, dominant follicle diameter and endometrial thickness. Results: Letrozole as an ovulation inducing drug was found equally effective in terms of follicular recruitment, follicular maturation and endometrial development both in PCOS and non-PCOS women, as there was no significant difference regarding mature follicular development and endometrial response between the two study groups. Association of endometrial response particularly with follicular diameter 18 mm or more among the study groups revealed no statistically significant difference. Conclusion: In conclusion, our results indicate that the effect of letrozole on endometrial thickness and follicular development in patients of anovulatory PCOS did not significantly differ compared to non-PCOS infertile women. Birdem Med J 2019; 9(3): 234-239

Cervical agenesis or dysgenesis (fragmentation, fibrous cord and obstruction) is an extremely rare congenital anomaly. Conservative surgical approach to these patients involves uterovaginal anastomosis, cervical canalization and cervical reconstruction. In failed conservative surgery, total hysterectomy is the treatment of choice. We report what we believe to be the first successful end-to-end uterovaginal anastomosis of an unusual case of congenital cervical agenesis. A 25-yearold female presented complaining of primary amenorrhea and primary subfertility for the same duration. At laparoscopy, complete separation between the cervix and the body of the uterus was found and hanging from surrounding supports. Both ovaries and fallopian tubes were anatomically positioned. There was another muscular tissue of 2 cm in diameter at the pouch of Douglas which was attached with lateral pelvic wall by transverse cervical ligament. Upon readmission, laparotomy was performed under general anesthesia in a semilithotomy position allowing both abdominal and vaginal approaches. Uterovaginal anastomosis was done by the restoration of the genital tract by direct suturing of the isthmus uteri to the vagina. Insertion of a 16F Foley catheter transvaginally through the vaginal opening into the endometrial cavity and was inflated with 5 ml of fluid into the catheter balloon. There were no postoperative complications. Foley catheter was kept in situ for 21 days. Patient had her first menstruation on 11th day of surgery and that was continued for 5 days with regular flow. Consecutive 3-cycles follow-up has been done and the patient is having her normal menstruation. In the presence of cervical anomaly with functional uterus and intact vagina, uterovaginal anastomosis is feasible and effective and should be applied as a first-line treatment option. How to cite this article Mahmud N, Mahtab NT, Chowdhury TA, Deb AK. Successful Uterovaginal Anastomosis in an Unusual Presentation of Congenital Absence of Cervix. J South Asian Feder Menopause Soc 2014;2(2):105-110.

Background: Routine use of diagnostic laparoscopy for the evaluation of all cases of female infertility is under debate. Until now, laparoscopy has been widely used as a diagnostic and therapeutic means of treating infertility. This study investigates the fertility outcome for women 2 to 3 years after laparoscopic management. It assessed the benefit and effectiveness of both diagnostic and laparoscopic ovarian drilling regarding reproductive outcome and menstrual regularity. Methods: From May 2013 to November 2014, a total of 303 infertile women undergoing laparoscopy at BIRDEM Hospital, were asked to participate in the study. Sixty subjects were lost to follow up making the study sample size 243. Results: Mean age at the time of laparoscopy was 29.86 ± 4.6 (range 21 - 43) years, 61.7% of women (150 cases) were nulliparous, 38.3% (93 cases) had one child, abortion or ectopic pregnancy. From the time of index surgery to follow-up, 40.3% (98) of women who had tried to conceive had home pregnancy test positive and 25.5% (62) had a live birth following their surgery. Among these 62 subjects, 33 underwent Laparoscopic Ovarian Drilling (LOD) and other 29 had diagnostic laparoscopy along with or without other laparoscopic manipulations. A Chi-square test has revealed that there was significant increase in regularization of menstrual cycle among irregularly menstruating women after laparoscopy indicating regular ovulatory cycles. Conclusion: Laparoscopic procedures can lead to positive results while treating infertility as well as menstrual disturbances, thus establishing a defined position in current fertility practice. Birdem Med J 2020; 10(2): 125-129

Twin-to-twin transfusion syndrome (TTTS) is an obstetric condition with high perinatal mortality, which develops when blood flows disproportionately from one fetus to another in a monochorionic twin pregnancy. Approximately 1 in 7 monochorionic pregnancies are affected with TTTS. The donor twin develops oligohydramnios and poor fetal growth, while the recipient twin develops polyhydramnios, heart failure and hydrops. Here we report two cases of severe TTTS in BIRDEM General Hospital 2 within a period of two years. It has been observed in different studies that, the mortality rate of both twins can be as high as 80% in TTTS depending on the stage of diagnosis and progression of the condition if untreated. In both our cases, the outcome was poor due to delayed diagnosis and lack of intrauterine therapies. So, there is an urgent need for timely diagnosis and appropriate management of this rare but complex condition which prompted us to report these two cases. Birdem Med J 2020; 10(3): 207-211