OBJECTIVE:The objective of this study was to test the hypothesis that AMH and antral follicle count (AFC) are good predictors of ovarian response to controlled ovarian stimulation and to compare them.MATERIALS AND METHODS:This observational cross-sectional study included 56 subjects aged between 25 and 42 years who were enrolled between 1st January and 31st December 2010 for their first intracytoplasmic sperm injection (ICSI) program. Baseline hormone profiles including serum levels of Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), and Anti-mullerian Hormone (AMH) were determined on day 3 of the previous cycle. The antral follicle count measurements were performed on days 3-5 of the same menstrual cycle. Antral follicles within the bilateral ovaries between 2-6 mm were recorded. The subjects were treated with long protocol for ovarian stimulation. Ovulation was induced with 10,000 IU of human chorionic gonadotropin (hCG) when at least 3 follicles attained the size of more than 17 mm. Transvaginal oocyte retrieval was performed under ultrasound guidance 36 hours after hCG administration. An oocyte count less than 4 and absence of follicular growth with controlled ovarian hyper stimulation was considered as poor ovarian response. Oocyte count of 4 or more was considered as normal ovarian response.RESULTS:Statistical analysis was performed using SPSS software trail version 16.0. Subjects were divided into 2 groups, depending on the ovarian response. The mean oocyte counts were 12.27 ± 6.06 and 2.22 ± 1.24 in normal and poor responders, respectively, (P = 001). Multiple regression analysis revealed AMH and antral follicle count as predictors of ovarian response (β coefficient ± SE for AMH was 1.618 ± 0.602 (P = 0.01) and for AFC, it was, 0.528 ± 0.175 (P = 0.004). AFC was found to be a better predictor of ovarian response compared to AMH in controlled ovarian hyper stimulation.CONCLUSION:The observations made in this study revealed that both AMH and AFC are good predictors of ovarian response; AFC being a better predictor compared to AMH.

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The primary aim of this study was to assess the feasibility of fetal cardiac evaluation at 11-13?6 weeks by assessing the four chamber and three vessel views. The secondary aim was to assess detection rates of cardiac anomalies at this gestational age. This was a prospective study done over 1 year. It included 355 patients who presented to a routine antenatal service and opted for prenatal genetic screening and anomaly scan at 11-13?6 weeks corresponding to a CRL of 45-84 mm. Four chamber view and three vessel view were examined in both gray scale and color Doppler using transabdominal scanning and transvaginal scanning. A follow-up was done at 18-22 weeks and at delivery. Major cardiac anomalies were seen in 5 (1.4 %) fetuses screened at 11-13?6 weeks. Two fetuses with cardiac anomalies (0.5 %) could not be detected at this gestation and were picked up at the 18-22 week scan. Extracardiac anomalies detected in the first trimester scan were 14 (3.9 %). Nuchal translucency (NT) of more than 3 mm was found in 19 (5.3 %) patients. Nuchal translucency of more than 3 mm was present in 3 (60 %) fetuses with cardiac defects seen at 11-13?6 weeks. Increased NT of more than 3 mm was found in 6 (43 %) patients having noncardiac anomalies. Four (1.1 %) patients had both cardiac and noncardiac anomalies detected at first trimester scan. When CRL was 76-85 mm, the cardiac anomaly detection rate was maximum (3.8 %) compared to detection at CRL 66-75 mm (1.2 %), 56-65 mm (0), 45-55 mm (2.2 %). Noncardiac defects had a detection rate of 2 (4.4 %) at CRL 45-55 mm, 4 (3.6 %) at CRL 56-65 mm, 7 (4.5 %) at CRL 66-75 mm, 1 (1.9 %) at CRL 76-85 mm. Overall detection of major fetal cardiac anomalies at 11-13?6 weeks was 1.4 % and noncardiac anomalies was 3.9 %. This supports the opinion that first trimester can be used for detection of major congenital heart diseases and noncardiac anomalies along with fetal aneuploidy screening. Detection of anomalies in the first trimester helps patient in early decision making and counseling for further management. Keywords 11-14 week scan Á Echocardiography Á Congenital heart defects Á Nuchal translucency Á Four chamber view Á Three vessel view

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Background: Endometriosis still remains an enigmatic disease. There are important reasons to stage endometriosis and to prognosticate the chances of pregnancy after a surgical management. The currently used revised AFS system has poor correlation with pregnancy rate. A scoring system-Endometriosis fertility index (EFI) to prognosticate the outcome was proposed few years back. The objective was to assess the usefulness of the EFI system in predicting pregnancy in patients with surgically documented endometriosis who attempt Non-IVF conception.Methods: Retrospective data was collected from 77 subjects with endometriosis who underwent laparoscopy and had documented least function (LF) score and EFI score. All were followed up until 12 months for the occurrence of a non IVF pregnancy.Results: Our study showed that the pregnancy rate was clearly higher in those with high EFI scores than those with low scores. A score of less than 4 was associated with significantly lower pregnancy rates than those with score above 5 (n=26, pregnancy rate- 11.54%) vs. (n=51, pregnancy rate 50.1%); p = 0.001)). Similarly, the pregnancy rate was significantly lower in those with LF score 1-3 (21.2%) as opposed to those with higher LF scores (p =0.029). Also, sensitivity analysis showed that higher EFI score was significantly associated with higher LF score (P <0.001).Conclusions: EFI is a useful clinical tool that predicts pregnancy with reasonable accuracy after endometriosis surgery. Its use clearly provides reassurance to those patients with good prognosis.