INTRODUCTIONPolycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in infertile women. Infertility affects 40% of women with PCOS.1 Polycystic ovary syndrome (PCOS), a relatively common reproductive endocrine disorder often associated with high endogenous LH secretion, menstrual cycle disorders, infertility and high rates of spontaneous abortion, was considered the paradigm condition that proved the potential untoward actions of LH.Raised tonic levels of luteinizing hormone (LH) is one of the main endocrinological disturbances in PCOS patients.2 This inappropriate secretion of LH seems to affect both fertility and pregnancy outcomes of PCOS women. Increased production of androgens associated with high LH concentrations, coupled with their inefficient aromatization to estrogens related to the low FSH levels in PCOS patients, results in local androgen excess and oestrogen deficit within the ovary.3 This would constitute a potent androgenic environment for the follicle leading to cessation of follicular growth. This ABSTRACT Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in infertile women. Raised tonic levels of luteinizing hormone (LH) is one of the main endocrinological disturbances in PCOS patients. Objective of present study was to evaluate the effect of baseline serum luteinizing hormone levels on follicular development, ovulation and conception and pregnancy outcome in infertile patients with PCOS. Methods: This is a prospective study conducted on 50 consecutive infertile patients with PCOS. Baseline Day 2 serum luteinizing hormone concentration was done in selected patients. Ovulation induction was done with clomiphene citrate 100 mg from Day 3 to Day 7 of the cycle. Then patients were monitored for follicular development, ovulation, conception and early pregnancy loss. Results: The mean age of the patients is 25±3.6 yrs. The average duration of infertility is 5.4 yrs (2-10). The mean basal serum LH concentration in patients who ovulated was significantly low (5.6 IU) in comparison with patients who did not ovulate (10.1 IU). The mean basal serum LH concentration in patients who conceived was 3.9 IU in comparison with patients who did not conceive (5.9 IU) which was statistically significant (p=0.04). Out of 15 patients who conceived, 3 patients (20%) had early pregnancy loss. Conclusions: Tonic hyper secretion of LH results in premature oocyte maturation, causing the problems with fertilization and miscarriage. Inappropriately raised LH appears to have deleterious effects on the pregnancy outcome.

Background: The incidence of tubal disease in infertility in India is as high as 40%. The aim of our study is to evaluate the diagnostic accuracy of Saline Infusion Sonosalpingogram (SSG) in the assessment of tubal patency in infertile patients with laparoscopy as the gold standard.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology on 50 consecutive infertile patients. Patients with acute pelvic inflammatory disease were excluded from the study. After complete examination and basic infertility work up, the tubal patency testing by Saline Infusion Sonosalpingogram was performed on day 8 of the cycle, followed by diagnostic laparoscopy with chromopertubation to confirm the tubal patency.Results: Out of 50 enrolled patients, 3 were excluded during the course of study. Thus, the study population comprised of 47 infertile women. During our study, 42 patients had tubes patent on SSG, out of which 41 patients had patent tubes on laparoscopy. 2 patients with blocked tubes on SSG had patent tubes on laparoscopy. 3 patients had blocked tubes on both SSG and laparoscopy. On statistical analysis, the sensitivity of SSG in diagnosing tubal patency is 95.34%, specificity 75%, positive predictive value 97.65% and negative predictive value 60%.Conclusions: Saline Infusion Sonosalpingogram is a simple, safe, convenient procedure for assessment of tubal patency in infertile women. It can be included in basic infertility work up. Hence, laparoscopy can be reserved for patients with tubal block, suspected pelvic pathology and unexplained infertility.

No abstract

No abstract

A rare condition called Peripartum Cardiomyopathy (PPCM) causes a pregnant woman’s heart to weaken and expand. It occurs in the last month of pregnancy or within five months of delivery. The presented paper was a series of three cases with unusual presentations of PPCM. Cases 1 and 2 demonstrated unique PPCM presentations that included abrupt cardiogenic shock and failure symptoms and signs. The postpartum period’s typical PPCM appearance is illustrated by case 3. The index patients (cases 1 and 2) had low systemic blood pressures, acute respiratory distress, and reduced cardiac output that was indicative of cardiogenic shock. An early echocardiogram was ordered as a result, and the results were suggestive of heart failure. Their varying clinical manifestations posed a significant diagnostic problem due to the heterogeneity. Even though they are uncommon, such catastrophic presentations including acute respiratory distress and low-output cardiac failure can happen. In these unusual cases, rapid pharmacological and mechanical support is required. In order to provide patients with the finest and most efficient care possible, it is crucial to understand the aetiology, clinical signs and symptoms, management, and prognosis of PPCM. Thus, physicians need to be familiar with different presentations of PPCM and always consider it with a high index of suspicion to expedite treatment for a potentially lethal condition to get a better outcome.