Objective: The main aim of present study was to explore the treatment seeking behavior and pathways of care followed by couples attending infertility clinic at a tertiary care center Research design: The study adopted an exploratory research design. Using total enumeration technique a total of 40 infertile couples were interviewed using semistructured interview schedule. Results: Out of total, 82% couples visited 1–4 healthcare agencies before coming to a tertiary care center. Among all treatment settings and options, majority (62%) visited private health sector as first health agency. Based on first health agency visited a total of three care pathways were revealed with longest pathway comprised total of nine health agencies out of which four were private practitioners. Conclusion: The infertile couples try varied forms of treatments before reaching a tertiary center shuttling from one agency to another. This drains them of all hope and energy for successful treatment.

Primary aim: To study the outcome of intracytoplasmic sperm injection (ICSI) using long protocol. Analysis of the average number of days of stimulation, the incidence of ovarian hyperstimulation syndrome (OHSS), and the number and quality of oocyte retrieved. Secondary aim: Correlation of the outcome against the stimulation phase length Method: Retrospective study of 50 patients who underwent in vitro fertilisation (IVF) using the long protocol in our ART unit during December 2014 to December 2015. All clinical observations including the patient details, number of days of stimulation, the number of oocytes retrieved, the occurrence of OHSS were collected and tabulated. All clinical data were statistically analyzed. Result: The clinical outcome of ICSI using long protocol was satisfactory. In the study group, we achieved 72% grade 1 embryo (36) and 2 weeks after embryo transfer the biochemical testing for pregnancy showed positive pregnancy in 52% (26). The average stimulation phase length was 13.5 days, (SD 5.5). The incidence of severe OHSS needing hospitalization and treatment was 2% (1/50). 8 patients observed to have evidence of mild OHSS. OHSS was observed in patients with a shorter period of stimulation phase, mean SPL among OHSS patient was 11.38 ( SD -1.6). However, it was not statistically significant ( p–0.507). The stimulation phase length did not correlate with the quality of oocyte nor the pregnancy rate as hypothesized theoretically. Conclusion: The present study shows satisfactory clinical outcome using long protocol,the stimulation phase length did not show significant ill effects in the clinical outcome (72% grade 1 embryo, 52% pregnancy), nor increase complications like severe OHSS.

Introduction: Abnormal uterine bleeding (AUB) in perimenopausal women requires careful evaluation due to the risk of endometrial malignancy. Symptomatic women with thick endometrium by transvaginal ultrasound (TVS) warrant endometrial sampling. D&C has been the mainstay over decades whereas pipelle has gained popularity due to good tissue yield and easy technique with no admission or anesthesia. This study aims to determine the use of office endometrial biopsy in perimenopausal women with AUB and the endometrial pathology detected by TVS. Materials and methods: In this observational study over five years, 159 women with AUB who underwent endometrial sampling were included. The patients were randomly assigned D&C or pipelle depending on symptoms and endometrial thickness after clinical examination and laboratory investigations. 79.2% of women underwent office endometrial sampling, and 20.8% underwent D&C. samples were sent for histopathology. Statistical analysis was done with respect to the type of sampling and endometrial thickness by TVS. Results: Mean age of the study group was 44 years. About 60.3% of these women had ET of 10–20 mm. It was noted that women with thinner endometrium had more benign lesions and no atypia or malignancy. Sampling was 100% adequate in D&C cases compared to 97.8% of office biopsy group, though statistically not significant. Office endometrial biopsy and D&C yielded adequate sample and a reliable histopathological report and were comparable with respect to sampling, reports and endometrial thickness. Endometrial malignancy was diagnosed in 1.3% of the study group. 56.6% of women had simple hyperplasia without atypia, and 27% had a normal endometrium. Conclusion: Office endometrial biopsy is a sensitive method to detect abnormal endometrium in women with AUB. Diagnostic Office endometrial sampling is comparable to D&C with lesser complications. TVS prior to endometrial sampling improves the sensitivity to diagnose endometrial pathology.

Background: Infertility has been an issue of concern especially for women for decades, and one of the identified etiological factors is polycystic ovary syndrome (PCOS) that impact on ovulation and conception. Aim: This study aims to study the sociodemographic characteristics and clinical presentationof infertile women with (POS). Materials and methods : In this prospective case-control study, out of 150 infertile patients 75 women served as PCOS group. The demographic details such as age, socioeconomic class, employment status residential area, Body mass index, menstrual patterns, clinical presentation, and infertility related lab values were noted.The collected data were statistically analyzed using the Chi-square test. Results: The prevalence of PCOS was high in the age group 24 to 27 years (37.33%), from middle socioeconomic class (45%), residing in urban areas (62.67%) and housewives (65.33%). Most of the PCOS patients were overweight (32%) and obese (21.33%) and showed statistical significance p = 0.021 and p = 0.021 respectively. Oligomenorrhea (54.67%) and amenorrhea (40%) were the commonly found clinical presentations. Weight gain (p = 0.000) and acne (p = 0.049) were found to be significant. Also, a significant relationship was seen for Luteinizing Hormone (LH) (p = 0.003) and Prolactin (p = 0.001) in both groups. Conclusion: In this study, the prevalence of PCOS was high in patients from a middle socio-economic class, residing in urban areas and obese patients. Oligomenorrhea was found to be the most common clinical presentation in PCOS patients. Furthermore, evidence of high LH and Prolactin levels were found that is known to be associated with hyperandrogenism in PCOS patients.

Hemivertebra is a rare congenital disorder, where only one side of the vertebral body develops and it is even rarer to find it associated with a longitudinal bar. Prenatal ultrasound diagnostic features along with postnatal radiological correlation at 20 weeks gestation are presented in this report. Also, the relevant background, incidence, and associations are discussed for the clinicians especially obstetricians and radiologists to make them familiar with this condition.

Aim: To enlighten about one of the rare complications of ovarian stimulation during in vitro Fertilization (IVF) and how to manage it with early diagnosis and intervention. Background: Torsion of ovary, tube or both are estimated to be responsible for a minimal number of overall gynecological emergencies with an incidence of 2.7–7.4%. It is considered a common diagnostic challenge in any emergency setting. Torsion should be referred and managed at a tertiary health center with all emergency facilities. The trending availability of assisted reproductive technology and its increasing success day by day has resulted in an increase in ovulation induction and its complications including OHSS and ovarian torsion in the present scenario. Case report: At our center, one case of bilateral ovarian torsion as a consequence of controlled ovarian stimulation in a woman with PCOS was reported. This can be considered as a potentially fatal complication of pharmacological stimulation of ovary in assisted reproduction. Life–saving emergency laparoscopic surgery was undertaken. Timely diagnosis and intervention prevented oophorectomy and fertility was preserved. Conclusion: An Early and prompt intervention to preserve ovarian function and conduct a fertility-conserving surgery should be laparoscopic whenever and wherever possible. Detorsion should be the treatment of choice in reproductive age women whose families are incomplete, regardless of the fact of the color of the ovary. Oophoropexy may be considered to prevent recurrence. In older women whose family are complete and in postmenopausal women, oophorectomy is the treatment of choice to remove the risk of retorsion. Clinical significance: If on laparoscopy, a cyst whether nonfunctional or not is found in the ovary or paraovarian structure, cystectomy or interval cystectomy should be performed in younger women. Ovarian mutilating surgery is not considered to be a viable option in the management of torsion in a patient who is undergoing fertility preserving management except in cases with complete tissue necrosis.

Duchenne muscular dystrophy (DMD) is the most common hereditary cause of neuromuscular weakness and the most common of X-linked recessive diseases. It is caused by a mutation in the DMD gene located on chromosome X, 21.2 locus that encodes the dystrophin protein. Nucleic acid analytical techniques have advanced so much that the identification of potential carriers is possible by assessment of the causative mutations. The following case report describes the identification of a denovo dystrophin gene mutation in a carrier female and the subsequent antenatal workup of her present pregnancy