The study was undertaken to compare the efficiency and outcome of laparoscopically assisted vaginal hysterectomy (LAVH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complications rate and patients recovery. A total of 750 patients were prospectively collected in the study period from January 2005 through January 2009 in a tertiary care hospital. The mean estimated blood loss in LAVH and VH group were significantly lower compared with the TAH group. As to postoperative pain, significantly less diclofenac was required in the LAVH and VH group vs the TAH group. LAVH, VH is clinically and economically comparable with TAH, with patients' benefits of less estimated blood loss; less analgesia use; less intra- and postoperative complication rates; less postoperative pain; rapid patient recovery and shorter hospital stay. The study concludes that thus, LAVH, VH is clinically and economically comparable with TAH.

Objective:The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery.Materials and Methods:A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon.Results:There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.5±39.8 ml and 100±32.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.38±13.45 mg and 75.18±16.45 mg), respectively.Conclusions:LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.

Objective: To assess the prevalence and severity of pain in patients with endometriosis and to evaluate the relationship between the severity of pelvic pain with different stages of endometriosis.Methods: A prospective observational study conducted among 65 patients diagnosed with endometriosis during surgery in Infertility Management Center Dhaka, a specialized center for treatment of infertility and assisted reproductive technologies from January 2008 to January 2009.Result: Majority of the patients were between 26-30 years. Pelvic pain was the predominant symptom in 78.5% patients and the rest were asymptomatic. Among the symptomatic patients, most common symptom was dysmenorrhoea (n=47, 92.1%).When severity of pain was graded; it was observed that most (37%) presented with moderate pain. Infertility was present in 85% patients, mostly (n- 47 =74%) in primary sub fertility group. The commonest site of endometriosis was uterosacral ligament (n-58=89%) and ovarian endometriosis is noted in (63%) cases. Most of the lesions (35%) were black, haemosiderin deposits. When r-ASRM staging system was applied, majority (58.4%) of the patients was in stage IV disease and most of the patients (31%) with endometrioma were in stage IV disease. The study revealed a strong positive correlation between severe pain and stage IV disease (Correlation co efficient 0.711). Moderate forms of pain and severity of disease did not show any positive correlation in this study (Correlation co efficient 0.390). There was negative correlation between milder forms of pain with severity of disease.Conclusion: There was no relationship between frequency and severity of pain symptoms and disease stage of endometriosis.J Bangladesh Coll Phys Surg 2016; 34(3): 135-139

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

Background & objective: Infertility is a problem of public health importance because of its high prevalence and serious social implications on affected couples and families. Although once believed that the problem is solely due to female factor, it is now generally accepted that male factor infertility is equally as important as the female factor. However, it is not known how far the problem is attributed to male factor. The present study is intended to find the prevalence of male infertility among the infertile couples and its determinants in the context of Bangladeshi population. Patients & Methods: The present study was a descriptive cross-sectional study conducted on male partners of infertile couples (over a period of three months) visiting the Infertility Clinic of Bangladesh Institute of Research and Development in Endocrine & Metabolism (BIRDEM) General Hospital, Dhaka. Male infertility was defined as the inability of a man to make his partner conceive (because of quantitative and/or quantitative deficiency of his sperm) after 12 months of regular unprotected sexual intercourse. On the basis of semen analysis, male partners were divided into two groups – Infertile Group and Fertile Group and the suspected factors were compared between groups using crosstab analysis to determine the factors responsible for male infertility. Result: The present study demonstrated that respondents were generally middle aged (between 30-50 years) with mean age being 35.5 years. Majority (88.5%) was Muslim and belonged to middle class (74.3%). Nearly half (47%) was service-holder and one-third (35.8%) was businessman. About 62% of the male partners were revealed to be infertile on semen analysis [combined prevalence of azoospermia (19%), asthezoospermia (29.2%) oligospermia (12.8%), and teratzoospermia (7.1%)]. Of them nearly one-third (azoospermic ones) was solely responsible for infertility and the rest played contributing role to the overall infertility. The reproductive tract infection (STDs) was reported to be alarmingly high among infertile males (21.4%) than that among their fertile peers (p = 0.002). Smoking, varicocele, overweight or obesity and diabetes also demonstrated their significant presence among infertile males compared to the fertile male group. History of occupational exposure to high temperature, pesticide, trauma to testes, abdominal and urogenital surgery were not associated with male partner fertility. Conclusion: From the findings of the present study, it can be concluded that a substantial proportion of infertility can be attributed due to male partner infertility and its significant predictors are reproductive tract infections or sexually transmitted diseases. The second leading causes are varicocel, diabetes and obesity. Ibrahim Card Med J 2016; 6 (1&2): 25-32

Primary amenorrhea is defined as the absence of menses in females by the age of 14 years in the absence of secondary sex characteristics or the absence of periods by the age of 16 years regardless of appearance of secondary sex characters. A total of 108 cases of primary amenorrhea were referred to gynecological outpatient department of BIRDEM Hospital, Bangladesh between July 1995 to July 2008. These patients were studied with the aim to find out the cause of amenorrhea. After taking the detailed history, physical examinations and necessary investigations, patients were subjected to laparoscopic evaluation. The study highlights the role of transabdominal sonography in the work up of these cases and compare those with laparoscopic findings. About 69.4% of primary amenorrhoea were due to mullerian dysgenesis; 19.4% due to gonadal dysgenesis; 2.7% due to male pseudohermaphroditism with virilization; 2.7% due to genital tuberculosis and only one case was due to testicular feminization syndrome. Sonographic findings differ from laparoscopic findings in many cases. It can be observed that for optimal evaluation of primary amenorrhea, laparoscopy is the key tool for diagnosis.

Background: Laparoscopic surgery is the method of choice for treating women with benign adnexal masses. The aim of the current study is to assess the feasibility and surgical outcome of laparoscopic surgery among women with large benign ovarian cysts with a minimum risk of converting the operation to a laparotomy. Materials and methods: Symptomatic women (abdominal pain or mass) with a clinical or ultrasound diagnosis of an adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy=oophorectomy. The following patient information was abstracted: age, menopausal status, body-mass index, preoperative imaging studies, cyst dimensions, preoperative CA-125, date of surgery, surgical procedures, estimated amount of blood loss (EBL), conversion to laparotomy and its causes, operative time, operative and postoperative complications, length of hospital stay, and long-term follow-up. Results: All patients had transvaginal and transabdominal ultrasounds and 18 patients had computed tomography of the abdomen and pelvis. The mean and range of maximum diameter of the ovarian cysts were 16 (10-22 cm). Twenty-seven (27) cysts (51.5%) were unilocular and 16 (27.3%) had one to five septa. Fourteen (14) cysts (21.2%) had an echogenic area thought to be consistent with dermoids. None of the patients had ascites, omental cake, or lymphadenopathy in preoperative imaging studies. Fifty-two (84.8%) patients had preoperative CA-125 values within the normal range (<35 IU=mL). Five (5; 15.5%) patients had elevated 43, 53, 57, and 67 IU=mL, respectively). None of the patients had operative or postoperative complications or had to be converted to laparotomy. The mean (range) operative time, EBL, and hospital stay were 32 (20-45 minutes), 27 (5-55 mL), 8 (4-12 hours), respectively. The pathologic findings included endometriosis (n ¼ 14), dermoid (n ¼ 13), para-ovarian cyst (n ¼ 9), serous cyst adenoma (n ¼ 9), benign epithelial-lined cyst (simple cyst) (n ¼ 5), mucinous cystadenoma (n ¼ 4), borderline ovarian tumors (n ¼ 2), and peritoneal pseudocyst (n ¼ 1) Conclusions: Laparoscopic surgery among women with large benign ovarian cyst is feasible with a minimum risk of converting the operation to a laparotomy. ( J GYNECOL SURG 27:83)

Polycystic ovary syndrome (PCOS) is one of the common disorders in women at child bearing age. The purpose of the present study was to investigate the lipid profile in patients with polycystic ovary syndrome.A total of 103 women with PCOS of 15-36 years of age were included in the present study. Of the 103 PCOS women, 50% were overweight or obese, 29.1% had impaired glucose tolerance (IGT) and 4.9% had type2 diabetes mellitus (T2DM). The mean BMI was generally higher (25.8±5.5 kg/m 2 ). The mean serum cholesterol levels ranged from182 mg/dl to 236 mg/dl in all groups of women. The results of our study showed that women with PCOS had altered lipid profile and glycemic status. Therefore, evaluation of metabolic status is necessary for better management of women with PCOS.Ibrahim Med. Coll. J. 2014; 8(2): 47-49