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BACKGROUND Hypothyroidism is the most common endocrinological problem affecting women who present with ovulatory dysfunction resulting in infertility. Its milder form, subclinical hypothyroidism (SCH) characterised by mildly elevated thyroid stimulating hormone (TSH) levels and normal free thyroxin (FT4) levels, may also contribute to disturbed reproductive function. The prevalence of SCH has been reported to be 0.7 % - 2.3 % in large series of unselected infertile women. Undiagnosed and untreated thyroid diseases can be a cause for infertility as well as sub fertility. Prevalence of hypothyroidism in the reproductive age group ranges from 2 - 4 %. We wanted to study the prevalence of hypothyroidism as one of the causes of infertility in infertile women who attended a tertiary care centre, to study the prevalence of clinical / subclinical hypothyroidism in infertile women and to assess the thyroid status in infertile women. METHODS This is a prospective observational study done in the Gynaecology and Obstetrics outpatient department at R.G. Kar Medical College and Hospital, Kolkata, India from 1st January 2017 to 1st July 2018. 314 infertile women in the reproductive age of 20 - 40 years attending the outpatient department were included in this study RESULTS In our study out of the total of 314 cases, 270 patients (86 %) were suffering from primary infertility and 44 patients (14 %) had secondary infertility. Prevalence of hypothyroidism (both clinical and subclinical) was 21.9 % (69 cases) among the infertile patients attending outpatient department of a tertiary care centre. Clinical hypothyroidism was detected in 7.3 % (23 cases) and subclinical hypothyroidism was seen in 46 cases (14.6 %). Among the hypothyroid infertile patients, 75.4 % (52 cases) was of primary infertility. CONCLUSIONS Hypothyroidism is an emerging cause of infertility (both primary and secondary). Subclinical hypothyroidism is more prevalent than clinical hypothyroidism in infertile women. KEYWORDS Hypothyroidism, Subclinical Hypothyroidism, Infertility, Tertiary Care Centre

Background: Shoulder tip pain and discomfort due to peritoneal stretching is the major limiting factor of spinal anaesthesia in laparoscopic surgeries. Aim of the study was to evaluate the effect of intravenous dexmedetomidine along with small dose fentanyl in abolishing the shoulder tip pain during gynaecological laparoscopic surgery and to assess its respiratory and hemodynamic effects. Methods: 50 ASA grade I and II, with age 18-50 yrs and weight 45-70 kgs, who were undergoing elective gynecological laparoscopic surgeries with estimated pneumoperitoneum time of one hour or less, were included in the study. Injection dexmedetomidine 1 mcg/kg was infused over a period of ten minutes before spinal anaesthesia with 3.5 ml of injection ropivacaine (0.75%) in lateral position. Injection fentanyl 0.5mcg/kg was given intravenously before intraperitoneal insufflation. Shoulder tip pain, peri-operative heart rate, noninvasive blood pressure, end tidal carbon dioxide, respiratory rate and sedation level using Ramsay sedation score were assessed at frequent intervals. Results: 35 patients were comfortable with no complaints, 11 patients had mild and two patients had moderate shoulder tip pain which was relieved by reducing abdominal pressure or/and an additional dose of fentanyl (25 mcg). One patient had severe pain and had to be converted to general anaesthesia. Ready sedation score was 2 or 3 for all the patients except one who was deeply sedated and had to be intubated. The drug combination used reduced the shoulder tip pain in gynaecological laparoscopic surgeries performed under spinal anaesthesia while maintaining the stable intra-operative hemodynamics. Conclusions: This study has provided the preliminary evidence of feasibility of use of dexmedetomidine along with low dose fentanyl to reduce the discomfort and shoulder tip pain during gyanaecological laparoscopic procedures of short duration under spinal anaesthesia in selected patients.

To identify and analyse the risk factors associated with postpartum haemorrhage (PPH) and assess their impact on the maternal morbidity, a prospective observational study was carried out over a period of one year in a tertiary level referral institute in Kolkata, West Bengal, India. All the cases of PPH were identified and studied. Data analyses were done using Chi-square test. Out of 210 cases of maternal morbidity, 79 (37.6%) were found to have PPH as the causative factor. Uterine atonicity was found to be the main cause leading to 45 cases (56.9%) of PPH. With respect to the mode of delivery severe PPH was found in 34.3% of vaginally and 60% of operatively delivered patients which had statistical significance. More number of severe PPH cases, 17/31 (54.8%), had delivered outside the medical college. Here comes the role of 24-hour quality emergency obstetric care (EMOC), active management of 3rd stage of labour and early referral to the higher centre. The case fatality rate of PPH during the study period was 7.5%. This finding is quite close to the observation made in a North Indian tertiary hospital based study. In order to reduce maternal morbidity and thereby indirectly maternal mortality and to improve the overall maternal health, prevention and control of PPH can play a significant role. An integrated approach at all levels of healthcare delivery system, active management of labour and efficient emergency obstetric care will help in controlling the PPH.

The objective of this prospective, randomised study was to compare the efficacy, safety and tolerability of vaginal micronised progesterone with oral dydrogesterone as luteal phase support after in-vitro fertilisation (IVF). A total of 430 women underwent IVF/intracytoplasmic sperm injection (ICSI) treatment. Long protocol gonadotropin releasing hormone analogue down-regulation was followed by gonadotropin stimulation. Human chorionic gonadotropin was given when two or more follicles reached > or = 17 mm. After 36 h, oocytes were retrieved and IVF was performed. Embryo transfer was done at the 4-8 cell embryo stage. Luteal support was initiated from the day of embryo transfer and continued for up to 14 days. Patients were randomised to luteal supplementation with either intravaginal micronised progesterone 200 mg three times daily (n=351) or oral dydrogesterone 10 mg twice daily (n=79). In cases of a positive pregnancy test, luteal support was continued for 12 weeks. Both dydrogesterone and micronised progesterone were associated with similar rates of successful pregnancies. Vaginal discharge or irritation were reported by 10.5% of patients given micronised progesterone. Significantly (p

Genital tuberculosis is reported to be a major pelvic factor causing infertility in Indian women and often exists without any apparent signs and symptoms. The role of latent tuberculosis in repeated IVF failure in unexplained infertility is examined. 81 women with unexplained infertility having repeated IVF failure tested for Mycobacterium tuberculosis using PCR, ZN staining and BACTEC-460 culture were selected. Fresh IVF-ET or frozen embryo transfer (FET) was attempted on patients successfully treated with anti-tubercular drugs (ATD). ATD-treated fresh cycles (group A1) and frozen cycles (group B1) were compared to previously failed fresh cycles (group A2) and FET attempts (group B2), respectively. Main outcome measures were gonadotropin required, terminal E2, number of oocytes retrieved, fertilization rate, embryo quality, endometrial thickness and sub-endometrial blood flow (Vmax). Gonadotropin required in group A1 was significantly less as compared to group A2. Number of oocytes retrieved and grade I embryos, endometrial thickness and Vmax were significantly higher in group A1. Endometrial thickness and Vmax were significantly increased in group B1 as compared to B2. The study indicates that latent tuberculosis should be considered in young Indian patients presenting with unexplained infertility with apparently normal pelvic and non-endometrial tubal factors and repeated IVF failure.