Objective(s): To identify the common psychosocial effects of infertility among the childless couples of Bangladesh.Materials and Methods: This cross sectional quantitative survey was conducted at a tertiary level fertility center in Dhaka, Bangladesh from November 14, 2012 to November 30, 2012. Respondents were chosen by judgment sampling. Only the couples without any child were chosen for interview. Sixty-six couples were interviewed and three couples refused who came for treatment at the center. Primary data was collected from the respondents with preformed questionnaire. Informed written consent was taken before the interview, from both partners or only one partner where the other was absentResults: The mean ages of the men were 36 years and women were 28 years. The mean age for age at marriage of men and women were 29 and 22 respectively. Among the psychological effects, stress and anxiety were common in both men and women. Family problems were found less among the respondents. Only significant one that was found in both men and women was the pressure from family members, which was found in about one third of the respondents. Social effects were not found among half of the respondents. The other half avoided family gatherings (16%), meeting friends (13%), social gatherings (10%) and 15% respondents said that they do not like to go out at all.Conclusion: The psychosocial effects of infertile couples can lead to depression, frustration and sometimes aggression making them dysfunctional social beings. It also decreases work productivity and quality of life. Necessary preventive measures should be taken through appropriate public health interventions like patient counseling, awareness campaign etc. to avoid the psychosocial consequences.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 28-33

Objective The aim of this study was to evaluate the efficacy and safety of transvaginal ultrasound guided aspiration of ovarian endometrioma and ethanol sclerotherapy before controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) or assisted reproductive technology (ART) in patients with recurrent ovarian endometrioma. Design Prospective study. Setting Infertility Care and Research Center (ICRC Pvt Ltd.), Dhaka, Bangladesh. Materials and methods Fifty-three patients with infertility and recurrent ovarian endometrioma were the target population of this study. Sclerotherapy was performed under sedation (Pethidine) or G/A (propofol) and transvaginal ultrasound guidance. An 16-guage, double-lumen needle was inserted into the endometrioma and the cyst contents were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear. Ninety-five percent ethyle alcohol (ethanol) was then instilled into the cyst and kept in situ. Ultrasound was performed 6 weeks, 3, 6 and 12 months later to assess the efficacy of treatment. Controlled ovarian hyperstimulation and IUI or ART was performed according to patients’ profile and desire. Main outcome measures Resolution and recurrence of endometrioma and pregnancy rate. Results Thirty-nine patients had unilateral, 14 had bilateral, 36 had single and 17 had more than one cysts. Size of the cysts were 3.5 to 10 cm, average 6.75 ± 1.64 cm. Complete resolution of cyst took place in 42 (79.25%) cases. Eleven patients had persistence and refilling of cyst. Four of them needed reaspiration. No complications developed in any case. Thirty patients (52 cycles) underwent COH and IUI and 5 (16.57%) of them got pregnant. Forty-one patients underwent ART (63 cycles) and 13 (31.71%) got pregnant. Six (11.32) patients developed small cyst <3 cm within 1 year during the course of treatment. Conclusion Sclerotherapy with 95% ethanol is a simple, effective and safe alternative to surgical intervention for treatment of recurrent ovarian endometriomas before COH and IUI or ART. How to cite this article Begum M R, Ehsan M, Ehsan N, Santa MSB, Khan F, Sharmin F. Sclerotherapy with Ethanol: An Effective and Safe Alternative to Potentially Complex Surgical Treatment of Recurrent Ovarian Endometrioma. J South Asian Feder Obst Gynae 2015;7(2):97-101.

Objective (s): Aim of the study was to evaluate the safety and feasibility of myomectomy during cesarean section.Materials and methods: This prospective observational study was carried out in a private setting at Dhaka city from January 2006 to June 2015. Forty five (45) women with fibroid uterus with pregnancy who needed caesarean section were the target population for this study. Myomectomy was done during caesarean section. Main outcome measures were: difficulty of myomectomy and caesarean section, time needed for operation, per-operative complications, need for blood transfusion, postoperative complications and duration of hospital stay.Results: During the study period total 45 women were found who had pregnancy with myoma and needed caesarean section for various indications. Twenty nine (64.4%) women were of age 26-35 years, 30 (66.7%) were para 0 and in 37 (82%) cases were term pregnancy. In forty one (91.1%) cases myomas were diagnosed preoperatively. Twenty five (55.6%) women had multiple myomas. Commonest site of myoma was body of the uterus (82.2%) and commonest type was intramural (75.6%). Thirty (66.7%) women had myoma of less than 5cm in size. In forty two (93.3%) cases myomectomy was done after delivery of the baby. Myomectomy was successful in all 45 (100%) cases. In thirty (80%) cases caesarean myomectomy was completed within 1 hour. Thirty seven (82.2%) women did not need blood transfusion and thirty eight (84.4%) women had no postoperative complication. Other had minor complications. Forty one (90.1%) women were discharged from hospital within 72 hours of operations.Conclusion: Myomectomy during cesarean section is a safe procedure and it is feasible in almost all cases. Though large scale RCT is needed before giving final conclusion it is not far away when myomectomy during cesarean section will be norm discarding the traditional view of not touching the myoma in pregnancyBangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 10-14

Objective: The aim of this study was to explore the efficacy of low dose and high dose antioxidants for the treatment of idiopathic oligiospermia, asthenospermia and oligoasthenospermia. Materials and methods:This prospective quasi experimental study was conducted in Infertility Care and Research Center (ICRC) Ltd, Dhaka, Bangladesh between January 2013 and December 2014. Eighty four patients were the target population for this study. After thorough investigations those patients were diagnosed as idiopathic oligo, astheno and oligoasthenospermia were recruited for this study. Those patients whose female partner had infertility factor except PCOS were excluded from this study. For treatment patients were divided into two groups by lottery. Treatment for group A was Cap Doxycycline 100 mg twice daily for 1 month and tablet Oligocare, low dose antioxidant (Meyer Organic Pvt Ltd, India) 1 tab twice daily for 2 months. Group B was treated by Cap doxycycline 100 mg twice daily for 1 month and combination of micronutrients (High dose antioxidants) for 2 months. Ovulation induction was given to female partner of patient whose semen parameters improved. Results for pregnancy were observed for 6 ovulatory cycles. Data were expressed as mean standard deviation and percentage. Student's t test and χ 2 tests were done for test of significance where appropriate. A p value <0.05 was considered as significant. Results:In both treatment groups both count and motility were increased significantly after 2 months of treatment. Though mean semen parameter improved significantly in both treatment groups, there was significant difference in number of patient improvement between the groups. In high dose group 79% patients improved after two months of treatment whereas 48% patients improved in low dose group. Similarly pregnancy rate was also higher in high dose group 22% in comparison to 12% in low dose group. Conclusion:Antioxidants if can be used at a higher dose instead of low dose can give better result in terms of improvement of sperm count, motility and subsequently pregnancy rates.

Corona virus disease 2019 (COVID-19) is a global pandemic disease caused by novel corona virus called SARS-CoV-2. Over 213 countries as of July 15, 2020, 13.1 million people are affected by this deadly virus. More than 100 million women are pregnant worldwide and potentially all are at risk of exposure to SARS-CoV-2 infection. Coronaviruses cause illness ranging in severity from common cold and severe respiratory illness to death. Frequent manifestations of COVID-19 include fever, cough, myalgia, headache, and diarrhoea. Abnormal test result shows abnormalities on chest radiographic imaging, lymphopenia, leukopenia, and thrombocytopenia. Physiological changes during pregnancy like altered immunity, reduced functional residual volume, pressure on diaphragm by advanced gravid uterus may lead to adverse respiratory outcome in any viral disease. Maternal mortality was very high in other corona viruses like Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). No evidence of in utero transmission was seen in SARS or MERS. Coronavirus disease 2019 might increase the risk of vertical transmission and pregnancy complications. So, meticulous management is necessary for safe maternal and foetal outcome. Early isolation, aggressive infection control procedures, oxygen therapy are the key component of COVID-19 management. In pregnancy multidisciplinary approach should be taken for general and obstetrical management. At present there is no specific treatment for COVID-19. Based on results from observational studies empiric antibacterial and antiviral drugs are used. Very recently a few controlled trials were published that suggest few treatment options. On the basis of published data and recommendations of international health organizations, the aim of this review is to explore effective treatment and care of the pregnant women throughout pregnancy, during childbirth and afterwards in this novel SARS-CoV-2 crisis. J Bangladesh Coll Phys Surg 2020; 38(0): 91-108

Introduction:Recurrent pregnancy loss (RPL) is a common and frustrating obstetric problem affecting 0.5% -5% women in different population 1,2 . Approximately 15-20% of clinically recognized pregnancies are generally subjected to spontaneous abortion, mostly during first trimester 3 . Most of these abortions are early missed abortions. Missed abortion may be either embryonic (preclinical) or fetal miscarriage. Embryonic miscarriage is defined as an embryo with crown rump length of more than or equal to 5cm without cardiac activity, fetal miscarriage is defined as a fetus of 7-20 weeks size with negative cardiac activity 4 .Genetic factors including chromosomal disorders, single gene defects, and multifactorial factors account for 3.5-5% of the causes of recurrent missed abortion 5 . There is a big volume of literature describing that cytogenetic abnormality is detected in 31% of early missed abortion 6,7 . Other studies showed that foetal chromosomal abnormalities account for about 50% of first trimester and near 30% of second trimester pregnancy losses 8,9 . Studies revealed that maternal insertional translocation associated with recurrent missed abortion 10-15 .

Objective (s): The aim of the study was to assess ovarian reserve (OR) of patients with endometrioma and to explore the differences of ovarian reserve in age matched group of infertile patients without endometrioma.Materials and methods: This prospective analytic study was done in Infertility Care and Research Center, between January 2013 and December 2015 to assess the ovarian reserve of patients with endometrioma. During this period 105 patients of endometriosis with endometrioma were selected for study. Selection criteria were: no history of previous surgery, <36 years of age, no history of endocrine problems, no history of recent medical treatment for this condition within 6 months and no history of irregular menstruation. For ovarian reserve testing we assessed serum FSH, E2 and AMH. Patient of same age group who had no emdometrioma, no history of any surgery, no menstrual irregularity, endocrine disorder or any other medical diseases were taken as control to compare the ovarian reserve between these two groups. For control group also we did the same tests. Data was analyzed by SPSS package. One-way ANOVA test was done for test of significance. A p-value of <0.05 was considered as significant.Results: There was no difference in characteristics of patients of both groups regarding age, type of infertility and duration of infertility. Size of the endometriotic cysts were variable and average diameter of cyst was 6.2 ±2.32 cm. Most (58.10%) of the cysts were unilateral. There is a significant difference of FSH and AMH level between the groups. FSH of endometrioma and non-endometrioma group was 7.9 ±1.17 and 7.1 ±1.05 mIU/mL respectively with a p value of 0.029. Similar difference was present in AMH level, which was 2.42 ±.63 and 2.98 ±.88 ng/ mL in endometrioma and non-endometrioma group respectively with a p value of 0.020.Conclusion: This small study shows a reduced ovarian reserve in patients with endometrioma in comparison to patients of same parameters without endometrioma. It suggests that there is an association of presence of ovarian endometrioma and reduced ovarian reserveBangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 98-104