INTRODUCTIONThe accurate prediction of the response to ovarian stimulation is a valuable diagnostic step in the process of assisted reproduction. Increasing female literacy and employment have resulted in a clear rise in the age at which women conceive. As fertility starts to decline with advancing age more and more number of women are facing the problem of infertility and are seeking medical attention to overcome this problem. This decline in fertility is predominantly due to reduced ovarian reserve with increasing age. It has been shown that the rate of ovarian reserve decline varies considerably between individual women making it a challenge to design tests that estimate an individual's reproductive lifespan at a given age.1 A reliable marker for the age at which subfertility will occur would have great potential value as predictor of future reproductive lifespan. The ideal ABSTRACT Background: Increasing female literacy and employment have resulted in a clear rise in the age at which women conceive. As fertility starts to decline with advancing age more and more number of women are facing the problem of infertility and are seeking medical attention to overcome this problem. A number of ovarian reserve tests were developed to overcome this problem. Recent studies indicate that anti mullerian hormone is a promising marker for predicting ovarian reserve and pregnancy outcome. Methods: A retrospective study conducted at SAMAD IVF hospital, Trivandrum, Kerala. The aim of this study was to assess the influence of age on Anti-Mullerian Hormone (AMH) in ART (assisted reproductive technology) program outcomes and determine whether AMH levels and age predict the availability of total oocytes and MII oocytes retrieved and good quality of embryos. Ninety-six subjects in the age group of 25 to 40 years were included and underwent controlled ovarian stimulation (COS) and later intracytoplasmic sperm injection (ICSI) was performed. Results: In present study, it is seen that age and AMH (anti-mullerian hormone) have negative correlation. In accordance to AMH, total number of oocytes retrieved, MII oocytes, total number of embryos and grade A embryos were higher in AMH group (>5ng/ml). Total embryos for cryopreservation were lower in age group of 31-35yrs and 36-40yrs with least AMH value as compared to younger age group, good quality of embryos was higher in age group of 25-30yrs with 1.5-5 and >5 AMH group. Conclusions: Serum AMH is an important ovarian reserve test to predict response in ART cycles. Age is an independent marker in terms of quality of oocytes retrieved. We conclude that age and AMH have negative correlation. Hence, AMH can predict number of oocytes retrieved but age predicts quality of oocytes and embryos.

Background: Incidence of induction of labour has increased in the recent past due to increased screening facilities like ante partum fetal surveillance. Vaginal birth after caesarean section (VBAC) is one of the strategies developed to control the rising rate of caesarean sections. Intracervical Foley’s catheter reduces the risk of uterus hyper tonicity and rupture in women with one caesarean section as it’s placement induces the cervical repining without inducing any uterine contractions.Methods: A prospective study of 35 women with one previous LCSs, term gestation and singleton pregnancy, were selected for trial of labour (TOL) considering inclusion and exclusion criteria.Results: Out of 35 cases studied 21 cases (60%) went for successful induction with Foleys and the remaining 40% underwent caesarean section. The mean time interval for Foley’s expulsion was 6.74 in the success group and 10.04 in the failed group (p value <0.05). In 4 cases there were meconium stained liquor, and they underwent emergency LSCS. One case (2.8%) had scar rupture which also underwent caesarean section.Conclusions: This study shows that the Foley catheter is an effective method of cervical ripening with additional benefit of low cost, reversibility, easy availability and lack of need for special storage. This method confers significant improvement in Bishop Score and vaginal delivery was achieved in majority of patients.