Procidentia is uncommon condition altering quality of life of young and nulliparous women. Its management poses significant dilemma and challenges as its associated body image, fertility and sexuality issues. Uterine preservation surgery described by Archibald Donald in 1888 known as Manchester -Fothergill procedure seems best option as alternative to vaginal hysterectomy. Despite its increasing popularity among surgeons and patients, robust clinical evidence is needed. We report a case of recurrent procidentia in a young nulliparous woman who had Manchester repair following vaginal sacrospinous hysteropexy. We concluded that Manchester repair is a useful and safe alternative for uterine-preserving technique.
Elevated glucocorticoid levels during stressed conditions have been demonstrated to impair reproductive function in rats. In our previous study investigating the dose-related effects of corticosterone (CORT) on the fertilising capacity of epididymal sperm in surgically-manipulated rats, we found that 25 mg/kg/day of CORT given subcutaneously for seven consecutive days significantly decreased the number of implantation sites and increased intrauterine embryonic loss compared to controls. Based on these findings, the current study aims to elucidate the possible mechanisms of action of CORT-induced stress on impaired sperm fertility in rats. Results of the present study showed that compared to controls, 25 mg/kg/day of CORT given subcutaneously for 7 consecutive days significantly increased the level of plasma malondialdehyde (MDA) with corresponding attenuated levels of superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) activities. Plasma adrenocorticotropin (ACTH) and testosterone levels were also found to be decreased in CORTtreated rats. These findings suggest that CORT-induced oxidative stress and exert an inhibitory effect at the hypothalamic-pituitary-gonadal (HPG) axis, as evidenced by increased lipid peroxidation, reduced enzymatic antioxidant activities, and decreased testosterone production. These subsequently result in decreased fertilising capacity of epididymal sperm leading to poor pregnancy outcomes.
This study was undertaken to evaluate the reproductive and oncologic outcomes of patients diagnosed with Ovarian Germ Cell Malignancy (OGCM) who underwent fertility preserving surgery and adjuvant chemotherapy treated in Gynaecology Oncology Unit, Sultanah Bahiyah Hospital, Kedah, Malaysia.
PIP: Responses to questions relating to breastfeeding in the World Fertility Surveys of South Korea, Indonesia, Nepal, Sri Lanka, Malaysia, and Bangladesh are analyzed. Of these countries, the percentage of ever-married women who had breastfed in the last closed interval was between 94-99%, except for Malaysia (81%) and average number of months breastfeeding took place was from 16.5-19.2, except for Malaysia (7.3). The infant mortality rate in these countries was 33/1000 live births for South Korea, 45/1000 for Malaysia, 51/1000 for Sri Lanka, 137/1000 for Indonesia, 150/1000 for Bangladesh, and 152/1000 for Nepal. Responses, however, might vary according to different interview situations. Assuming that the reporting errors are of similar magnitude and direction, the relationship between duration of breastfeeding and the birth interval can be studied. But it is possible that breastfeeding was prolonged due to other reasons for which conception was delayed; thus the regression of breastfeeding duration on the birth interval is not as logical as the regression of the birth interval on the breastfeeding is, especially when habitual breastfeeding can be avoided. The negative relationship between breastfeeding and infant mortality does exist, assuming that a woman breastfeeds all her children for similar durations. Some breastfeeding differentials are place of residence (less for rural areas), education (reduces duration), and religion (Christians have shorter duration than Muslims, Hindus, or Buddhists). In South Korea the mean length of breastfeeding of women aged 25-34 and 35-44 are 17.5 and 20.5, and women using contraceptives are 26% for 25-34 and 20% for 35-44. South Korea also has the highest level of breastfeeding, highest incidence of ever use of contraceptives, and a very low level of fertility. Nepal and Bangladesh have a high level of breastfeeding but since their contraceptive incidence is low, their fertility level remains high. Some areas of further research include influence of breastfeeding on infant and child mortality.
Purpose: Our center is known as a pioneer center initiating oncofertility service since 2010 in Japan. We demonstrate our transition of this service in regional university hospitals ingenuously. Methods: We compared two phases of service: initial phase (2011 and 2012) and current phase (2019). The comparison included the number of women attending the oncofertility unit, diversity of breast cancer cases, the acceptability of preservation service, and the type of fertility preservation (FP) option offered in between these phases. Results: A total of 58 women were seen during the initial phase as compared with 41 women in the later phase. The mean age at diagnosis was not significantly different between the two periods. The majority of them were married and diagnosed with stage II luminar type. The current phase had a tendency to have a higher anti-Müllerian hormone level although not reaching significance. At least 50% of them declined FP and 84.5% never received ovarian control stimulation in the initial phase. Otherwise, 61% used aromatase inhibitor in the current phase. Only 15.5% in the initial phase received control ovarian stimulation whereas 63.4% in the current phase received it. The ovarian tissue cryopreservation was highly chosen during the initial phase (25.9%), whereas embryo cryopreservation (39%) was highly opted for during the current phase. All of our parameters are comparable between these two phases (p > 0.05). Conclusion: The significant changes of oncofertility practice were observed mainly due to the understanding of the oncofertility concept among reproductive physicians and the acceptance environment, including standard guidelines, supportive society, as well as advancements in cryobiology technique.
Introduction: To investigate the questions that Muslim patients, embryologists, paramedics, clinical counsellor and doctors may have pertaining to the compliance of Assisted Reproductive Technique (ART) to Shari’aa.
Methods: As a preliminary study, an open-ended survey was administered to participants. Participants for the survey comprised of 21 patients, 2 embryologists, 2 doctors, 4 paramedics and 1 counsellor.
Results: Data analysis showed that most of the participants posed questions that fall into six classifications which are: Munakahat (Family Law), social Hukm, Fiqh Ibadah, Fiqh Qadha (Islamic Hukm), General Fiqh and Usul Fiqh.
Conclusion: It is clear that even though the participants were rather familiar with some of the existing Fatwas pertaining to ART and IVF in Malaysia, there are still remaining doubts which need to be clarified. This indicates that there are challenges faced in seeking and providing ART treatment to Muslim patients. This needs to be addressed perhaps in the form of Shari’aa-compliant guidelines to provide a clear explanation of each process and procedure in fertility treatment.
Introduction: To analyze the ART outcome and factors associated with successful ART treatment for infertile couples in a newly set up medical university IVF centre. Methods: A six-month cohort study of patients undergoing their first assisted reproductive technique cycle was conducted at IIUM fertility centre, Kuantan (from 15th June until 31st Dec 2009). Outcome measures include clinical pregnancy rate, ongoing pregnancy rate, take home baby rate and complications rate. Results: Fifty-five first cycles of IVF/ICSI were studied. Mean embryo per transfer was 2.1±0.8. Four patients were pregnant (23.5%) from a single embryo transfer (SET). Clinical pregnancy rate was 30.9% (17/55). Ongoing pregnancy rate was 23.6% (13/55) and take home baby rate was 21.8% (12/55). There was only one twin pregnancy. Nine patients (16.4%) had OHSS whereby 77.8% were mild and 22.2% were moderate. Conclusion: Take home baby rate at the IIUM fertility centre is comparable to most established ART centres in Malaysia considering that this is only the first year of operation.
Introduction: This study aims to build a standardization method for preparation of effective powder from
FSA and to quantify diosgenin in FSA. Methodology: One kg of FS were used in this study. Setting: BMS, KOM
and KOP, IIUM Kuantan campus. FS were washed with distilled water to exclude any foreign matter, and
were then air dried. FS-powder were put in distilled water in a ratio of 1 g of powder in 20 ml of distilled
water and were shaken at room temperature for 24 hours. Ten mg of hydrolyzed extract sample was diluted
in 10 ml volumetric flask with methanol for 15 minutes. Chromatographic estimation was performed using
an equilibrated reverse phase Eclipse XDB-C18 column (particle size 5 µg, 4.6 mm x 150 mm). Results: One
gram of FSA extract was hydrolyzed to produce sapogenins and 46.6% was recovered. A calibration curve
that was constructed based on five dilutions of diosgenin standard at concentrations of 2, 5, 10, 20, 30 and
50 ppm produced a linear graft (r = 0.999). The concentration of diosgenin in FSA extract as calculated using
the regression analysis was found to be 29.66 µg/ml, 13.81 % w/w on dried weight basis. Conclusion:
Preparation and standardization of effective powder from FSA are the corner stone of many scientific
researches in IIUM and Malaysia. Diosgenin is available in the FSA in adequate concentration. The adequate
amount of diosgenin in the FSA will guide us to do further study in the way of preparation of a natural
product that can be used in the field of reversible anti-fertility therapy.
PIP: The influence of socioeconomic status (ethnicity, income and parity) on electrolyte composition (sodium and potassium) in human milk is little known. We have thus quantitatively analyzed approximately 700 samples of milk (1-90 days postpartum) obtained from healthy Malaysian mothers' (Malay, Chinese and Indians) of full term infants. Results show that the mean concentration (mmol/l) of sodium is highest (48.2+or-1.7, Mean+or-SEM) in the Malaysian mothers' colostrum and this value decreased by 30% in their transitional milk and remained constant throughout subsequent days of lactation (mature milk). Ethnically, it is found that the level of sodium in colostrum of Malay and Chinese mothers were similar while the Indian mothers' colostrum showed apparently higher value (52.7+or-3.4 mmol/l) that is statistically insignificant. The transitional milk of all 3 ethnic groups studied exhibited similar levels of sodium. On subsequent days of lactation (mature milk) the Malay mothers exhibited lowest concentration (25.9+or-2.6 mmol/l) of sodium that is significantly (P0.05) different from that of Chinese and Indian mothers. Income and parity do not significantly affect the sodium level in Malaysian mothers' milk during all stages of lactation studied. The level of potassium, however did not change significantly with days of lactation. Like sodium, potassium too was not influenced by income and parity. (Author's).
This study was conducted to determine the effect of edible bird's nest (EBN) supplement on uterine function and embryo-implantation rate. A total of 24 adult female rats, divided equally into four groups, were treated with different doses of EBN for 8 weeks. In the last week of treatment, intact fertile male rats were introduced into each group (three per group) for overnight for mating. On day 7 post-mating (post-implantation), blood samples were collected from the hearts of anaesthetised rats that were later sacrificed. The uteri were removed for assessment of embryo implantation rate, histological and electron microscopic examination, and immunohistochemical analyses. Results showed that as the concentration of EBN supplemented increased, the pregnancy and embryo implantation rates were also increased in the treated groups; significantly at G3 and G4. Although histological evaluation did not show much difference among the groups, scanning electron microscopic examination showed enhanced development of elongated microvilli and pinopods in G4. Results also revealed up-regulated expressions of epidermal growth factor (EGF), EGF receptor (EGFR), vascular endothelial growth factor (VEGF), proliferating cell nulear antigen (PCNA), and progesterone and estrogen receptors (P4R, E2R) in the uteri of treated groups. Moreover, plasma E2, P4, growth hormone (GH) and prolactin (P) levels were higher (p
PIP: The initial results of a study conducted to develop guidelines for the clinical management of family planning acceptors with regard to return of fertility following contraceptive use, are presented. 193 parous women attending an urban family planning clinic were interviewed regarding their last pregnancy conceived after stopping a method of contraception. The average interval to pregnancy was 3.9, 2.8 and 1.8 months for ex-users of oral pills, intrauterine devices and conventional methods of contraception, respectively, with median delays to conception of 1.9, 1 and within the 1st month for the 3 categories. In comparison, 149 women who had not used any method at all took 7.3 months before becoming pregnant. Selected variables including age and parity, duration of use and problems encountered, and outcome of pregnancy are further analysed. Follow-up investigations and treatment are recommended 12 months after stopping oral pills and 6 months after removal of intrauterine device for those who have not yet conceived.
17α-ethynylestradiol (EE2) is a synthetic hormone, which is a derivative of the natural hormone, estradiol (E2). EE2 is an orally bio-active estrogen, and is one of the most commonly used medications for humans as well as livestock and aquaculture activity. EE2 has become a widespread problem in the environment due to its high resistance to the process of degradation and its tendency to (i) absorb organic matter, (ii) accumulate in sediment and (iii) concentrate in biota. Numerous studies have reported the ability of EE2 to alter sex determination, delay sexual maturity, and decrease the secondary sexual characteristics of exposed organisms even at a low concentration (ng/L) by mimicking its natural analogue, 17β-estradiol (E2). Thus, the aim of this review is to provide an overview of the science regarding EE2, the concentration levels in the environment (water, sediment and biota) and summarize the effects of this compound on exposed biota at various concentrations, stage life, sex, and species. The challenges in respect of EE2 include the extension of the limited database on the EE2 pollution profile in the environment, its fate and transport mechanism, as well as the exposure level of EE2 for better prediction and definition revision of EE2 toxicity end points, notably for the purpose of environmental risk assessment.