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   Table of Contents - Current issue
January-December 2021
Volume 6 | Issue 1
Page Nos. 1-22

Online since Wednesday, September 7, 2022

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Approach to management of submucous fibroids by gynaecological endoscopy surgeons/trainees in Nigeria p. 1
Lateef Adekunle Akinola, Jude Okohue, Joseph Ikechebelu, Christian Olajuwon Alabi, Ayokunle Moses Olumodeji
Hysteroscopic myomectomy is the treatment of choice for submucous fibroid. Studies have shown positive impacts on recurrent pregnancy loss and infertility. Our survey documents approach to managing submucous fibroids by gynaecologists with special endoscopy skills among members of the Association of Gynaecological Endoscopy Surgeons of Nigeria (AGES). Materials and Methods: A questionnaire-based-cross-sectional survey of members of the Association of Gynaecological Endoscopy Surgeons of Nigeria between December 31, 2019, and January 21, 2020, using the SurveyMonkey platform. Results: One hundred and forty-one of 210 members participated; a response rate of 67.1%. Of the respondents, 130 (92.2%) were consultants, 10 (7.1%) were senior registrars. Hysteroscopy training varied from basic/advanced certificate courses to post-fellowship training in endoscopy. Sixty-nine (53.1%) had been in practice for >10 years. Monthly, 60.7% (82/135) performed <5 hysteroscopic procedures; 25.2% (34/135) 6–10; 9.6% (13/135) 11–20; 3.7% (5/135) performed 21–30 and 0.7% (1/135) >40. Up to 64.2% (86/134) use 2D transvaginal scans to diagnose submucous fibroid, 37.5% (51/136) combine ultrasound and hysterosonography or hysterosalpingography. About 65.1%, (82/126), 35.9% (47/131), 12.2% (16/131), respectively, use FIGO, the International Society for Gynaecologic Endoscopy/ European Society of Human Reproduction and Embryology (ISGE/ESHRE) or use none of these for classifying submucous fibroids. Glycine was preferred for monopolar resection by 52.5% (62/118), while 59.7% (71/119) use saline for bipolar resection. About 93.2% (109/117) will not consider sterile water for bipolar resection. About 70.5% (86/122) regularly monitor fluid deficit, 17.6% (22/125) do not (due to lack of a monitoring device). Also, 14.4% (18/125) do not (because they use <3 L of distention media). For uterine cavity distention, 52% (64/123) use fluid pressure pumps, 28.6% (34/129) use gravity, while 25.4% (31/122) use Hysteromat or other fluid management equipments. About 3.7% (4/109) conveniently resect type-2 submucous fibroids in >2 hysteroscopic procedures, while 20.2% (23/114) and 23.2% (26/112), respectively, in one or two hysteroscopic approaches. Notably, 50.4% (63/125) refer such patients to experienced gynaecologists. None use barrier gels-only anti-adhesion therapy; 78.5% (95/121) combine balloon catheter/intrauterine device with oestrogen/progesterone tablets. About 38% (40/105) offers no 2nd-look follow-up. About 45% (52/115) had experienced complications, including uterine perforation during operative hysteroscopy. Conclusion: Hysteroscopic myomectomy is increasingly being used by AGES-registered gynaecologists to manage submucous fibroids, a very common cause of morbidity and subfertility in women. AGES can significantly and positively impact the trends of gynecologic endoscopic training, skills and practices among Nigerian doctors.
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Is male factor infertility rising? Another side of the equation from an in vitro fertilization clinic in southwestern Nigeria p. 10
Gbolahan Oladele Obajimi, Charles Oluwabukunmi Kolade, Ademola Aladejare
Background: Male factors account for about half of the causes of infertility and a high premium is placed on childbirth and rearing in developing countries. With the introduction of assisted conception, the burden of care for managing male infertility has shifted to the female partner. Male infertility is generally evaluated via seminal fluid analysis which includes parameters such as concentration, motility, and morphology. The etiology of male infertility is multifactorial, and majority of cases are known to be idiopathic. Materials and Methods: A descriptive cross-sectional study of 77 male partners of infertile couples presenting to an in vitro fertilization clinic in Ibadan, Nigeria, between January 1 and June 30, 2019. Participants were selected consecutively at their first consultation visit. A self-administered questionnaire was completed by each participant comprising socio-demographic information, results of laboratory screening, and seminal fluid analysis. Data was analyzed using the Statistical Package for Social Sciences (SPSS, IBM, NY), version 22. Descriptive statistics were generated, and presented with the aid of a bar chart, pie chart, and frequency tables. Results: The average age of the participants was 43.64 ± 3.1 years and 97.4% (75) were in a stable relationship. Duration of infertility ranged between 3 and 17 years with an average of 7.6 ± 1.8 years. Human immunodeficiency virus, syphilis, hepatitis B, and hepatitis C were diagnosed in 3%, 4%, 5%, and 1%, respectively. Over half of the participants had semen volume and liquefaction time of 1-2 mL and 15-30 min, respectively. 34 men (44.1%) had normal semen parameters while the remaining 43 (55.9%) had various forms of abnormalities. Mid-piece defects were the most prevalent morphological defects and were found in 70 men (90.9%) while immature spermatozoa were found in 38 men (49.4%). Only one participant had azoospermia (1.3%). Conclusion: The impact of male factor infertility cannot be over-emphasized. Male contribution to infertility is thought to be rising and this study from male partners of infertile couples revealed semen abnormalities in over 50% of the participants. Addressing preventable causes of male infertility through health awareness and lifestyle modifications are important steps towards engendering optimal reproductive health.
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Serum homocystein and C-reactive protein in predicting outcome of in-vitro fertilization in infertile women with polycystic ovary syndrome p. 14
Kingsley C Onwumere, Bolanle O P Musa, Abimbola O Kolawole, Nkeiruka Ameh, Ibrahim Wada, Christopher Danga, Abdurrahman Ahmad EL-Fulaty, Bamgbopa Kehinde
Background: Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility. Hyperhomocysteinemia (HHcy), is common in PCOS and reportedly causes poor oocyte quality and recurrent pregnancy loss. The aim of this report is to assess serum concentrations of Hcy and its association with C-reactive protein (CRP) levels in patients with PCOS undergoing in-vitro fertilization (IVF) treatment. Materials and Methods: Eighty-five women of reproductive age 25–35 years were included in this study, comprising 30 infertile women with PCOS (group 1), 30 infertile women without PCOS (group 2), and 25 matched apparently healthy women without infertility or PCOS (group 3). The serum Hcy and CRP levels were measured using the TOSOH AIA 360 enzyme immunoassay method and Raytor6000 Semi-Autoanalyzer, respectively. Results: The median CRP values were 15.13 (4.43–21.77 mg/L), 3.42 (2.50–8.04 mg/L), and 1.45 (0.97–3.51 mg/L) for Group 1, Group 2, and Group 3, respectively. The median Hcy values were 19.75 (15.50–39.98 μmol/L), 10.00 (9.38–10.92 μmol/L), and 10.00 (8.93–10.93 μmol/L) for Group 1, Group 2, and Group 3, respectively. The differences between Group 1 and Group 2, and between Group 1 and Group 3 median Hcy values were significant for both CPR and Hcy (P < 0.0001). There was a significant association between embryo qualities and the groups. Similarly, there were more of higher (Grades 4 and 5) embryo qualities in Group 3. Conclusion: Serum Hcy and CRP levels estimation should be included in the evaluation and management of patients with PCOS undergoing in-vitro fertilization.
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SARS-CoV-2 and male infertility p. 20
Rashmi Baid
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AFRH Conference 2021 Abstracts p. 22

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