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Introduction: The study aimed to assess the perceived quality of life (QOL) and to estimate the prevalence of depression among infertile couples as well as to study the congruence of the outcome among both partners. The sociodemographic factors influencing these outcomes were also examined. Method: A prospective, cross-sectional study of 130 infertile couples over 1 year at a tertiary level teaching hospital. Couples were requested to complete the WHOQOL-BREF instrument and Beck Depression Inventory (BDI). Data was analyzed using paired t test, 1-way multivariate linear variance analysis, and regression, and correlation models. Results: Mean QOL scores between men and women showed a strong agreement within psychological, social, environmental, and physical domains (r = .70, .67, .69, and .59 likewise). The presence of depressive symptoms was associated with significantly impaired QOL scores through all domains. Depression was present in 30.6% of female partners and 27.2% in male partners. Pearson correlation between female partner BDI scores and male partner scores was highly statistically significant with a correlation coefficient of .745. The presence of depression was not found to be significandy associated with sociodemographic and clinical parameters. Conclusions: QOL and depression scores of 1 partner were reflected in the scores of the other partner. Henceforth, screening and psychoeducation should be couple based considering the couple as 1 unit which is likely to improve the mental wellbeing of the couple. The presence of depression is not influenced by the sociodemographic profile of couples therefore all infertile couples should be screened and offered counseling. Public Significance Statement This study highlights the alarming prevalence of depression among infertile couples which is not influenced by their sociodemographic parameters in a significant way. The impaired Quality of Life score of 1 partner was reflected strongly in the scores of the other partner. These findings suggest the need for routine couple-based screening of infertile couples for psychological morbidity irrespective of their sociodemographic status. Keywords: infertile couples, depression, quality of life, WHOQOL-BREF, Beck Depression Inventory (BDI), Parenthood is one of the most primary and universal desires among all cultures and societies (Riskind & Patterson, 2010) and is considered a vital milestone in adult life. Continuation of [...]

Ovotesticular disorder represents 10% of cases of disorder of sex development characterized by the presence of both ovarian and testicular tissue in the same individual, with karyotype 46 XY being a rare sex chromosomal abnormality. We report the case of a 16-year-old person, who is reared as female, with a complaint of primary amenorrhea along with lack of secondary sexual characteristics, karyotype 46 XY. Prophylactic bilateral gonadectomy was done, and histopathological examination of bilateral gonads revealed ovarian stroma with a few Sertoli cell line tubules suggestive of bilateral ovotestis; hence, we concluded and framed our diagnosis of ovotesticular disorder.

Background: There is ongoing research to find an optimum modality to predict male fertility potential. Aims: To compare the semen parameters, sperm DNA damage and seminal metal levels of Zinc, Lead and Aluminium among the male partners of couples with unexplained infertility and men with proven fertility. Settings and Design: Prospective case-control study at a tertiary level teaching hospital. Materials and Methods: One hundred male partners of couples with unexplained subfertility and 50 men with proven fertility were included in the study. Male partners of unexplained infertility couples and fertile men were compared for their semen parameters, sperm DNA Fragmentation Index (DFI) and seminal metal levels in semen. Statistical Analysis Used: Chi-square test, Student's t-test, sensitivity and specificity analysis, binomial logistic regression analysis. Results: Fertile men had statistically significantly higher mean progressive sperm motility than male partners of unexplained infertility (53.12 ± 9.89% vs. 44.81 ± 19.47%, P = 0.005). Semen volume and sperm concentration were comparable among the cases and control population. The mean sperm DFI was significantly lower among fertile men (10.83 ± 6.28 vs. 21.38 ± 10.28, P < 0.0001). Plotting the receiver-operating characteristic curve the threshold for discrimination was calculated to be 18% DFI. The sensitivity specificity and overall accuracy were 43%, 84% and 56.67%, respectively when the DFI cut-off was set at 18%. Zinc concentration in the semen had a strong positive correlation (Point Biserial correlation coefficient = 0.831) with fertility, whereas lead and aluminium had a moderate negative correlation. Conclusion: Conventional semen analysis had limited differentiating ability for unexplained infertility. The sperm DFI may be employed for explanatory purposes among couples with unexplained subfertility. A lower discriminatory threshold of DFI (18%) has better overall accuracy as opposed to a 30% cutpoint for unexplained subfertility. Among metals, Zinc was strongly correlated with fertility status. [ABSTRACT FROM AUTHOR]

Background: Pre-term birth (PTB) is the leading cause of mortality and morbidity in newborn and infants. One of the proposed theories is the withdrawal of progesterone, either actual or functional, to be an antecedent to the onset of labor. The aim of the study is to evaluate the role of vaginal progesterone in delaying delivery following an episode of arrested pre-term labor. Methods: This is a pragmatic open-label randomized controlled trial that was conducted in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences, Jodhpur. Hundred patients with singleton pregnancies presenting with pre-term labor between 24 and 34 weeks of gestation and treated successfully with acute tocolysis for 48 hours and steroids covered were randomized to receive either progesterone 400 mg vaginal suppository or no treatment. Results: The primary outcome was the duration of randomization to delivery interval, which was significantly higher in the study than in the control group (28 days versus 10 days). The secondary outcomes such as gestational age at delivery was also higher in the study group compared to the control group (82% versus 60% delivered after 37 weeks in the study group and control group, respectively). The neo-natal outcomes such as birth weight (2802 grams versus 2324 grams), incidence of respiratory distress syndrome (RDS) (13% versus 26%), and newborn intensive care unit (NICU) admission (17% versus 31%) were lower in the study group, which signifies decreased neo-natal morbidities and mortalities in pre-term labor treated with maintenance tocolysis in the form of vaginal progesterone. Conclusion: Administration of vaginal progesterone (400 mg, daily) following an episode of arrested pre-term labor significantly increased the duration to delivery interval; that is, it reduced the rate of PTB before 37, 32, and 28 weeks of gestation among women. It further reduced the neo-natal morbidities such as RDS and NICU admission and increased the birth weight among infants of women assigned to progesterone treatment. [ABSTRACT FROM AUTHOR]

Background: Nonstress Test (NST) involves interpretation of foetal heart rate patterns in the background of clinical scenario. At least 50% of antenatal deaths occur in low risk population. Antenatal NST provides us opportunity to pick up at-risk foetuses, intervene and improve perinatal outcome. Objective: To determine if routine antenatal NST can improve perinatal outcome, and compare the results in both low and high-risk term pregnancies Materials and methods: A prospective cohort study was conducted in Department of Obstetrics and Gynaecology, AIIMS, Jodhpur from May 2017 to April 2018. A total of 449 cases were included; Low risk cases – 268, high risk cases – 181. All included women underwent antenatal NST from 37 weeks onwards at every visit. These NSTs were compared with foetal and maternal outcome. Results: During antenatal period, normal and suspicious NST is highly suggestive of good perinatal outcome. Foetuses with pathological antenatal NST showed increased chance of foetal distress. Also, pathological NST indicated more chances of caesarean delivery, low 1-minute APGAR scores, meconium staining, and need of resuscitation (p< 0.05). There were no perinatal deaths. Conclusion: Antenatal NST is a tool to be used wisely and judiciously after case selection. It can help us in selecting patients needing high index of care, specifically in busy labour room settings with inadequate staffing and low doctor to patient ratio. Patients with pathological antenatal NST in both low risk and high-risk pregnancies deserve equal and efficient further foetal monitoring and early delivery. There is no proven benefit of doing antenatal NSTs in otherwise low risk women except the ones having decreased foetal movements or prior foetal demise. [ABSTRACT FROM AUTHOR]

Objective: Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods., Methods: This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the 'plan-do-study-act' (PDSA) cycle was implemented to improve the OSCE., Results: Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE., Conclusion: The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.