Impact of intrauterine insemination as first line treatment of subfertility.

OBJECTIVE: To determine the success rate of intrauterine insemination (IUI) in couples presenting with subfertility following controlled ovarian hyperstimulation (COH) by the use of cost effective intrauterine catheter (insertion tube). METHODS: An experimental study was conducted at the Obstetric and Gynaecology Departments of Combined Military Hospital Kharian and PNS SHIFA Karachi in collaboration with the Department of Pathology from June 2002 to March 2005. A total of 89 couples were studied, out of which 28 couples presented with abnormal finding in the seminal fluid of husband whereas in 61 couples no identifiable cause could be detected. The mean age of women was 29 years and the duration of infertility was variable. All women had tubal patency confirmed before undergoing COH. IUI was performed at follicular maturity of 18-22 mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI, miscarriage rate and ongoing pregnancy rate. Prognostic factors associated with successful outcome in IUI, such as maternal age and motile sperm count was also observed. For cost effective measures, we used the sterilized disposable insertion tube of the 'Copper-T 380 A' device for insemination of reated sperms into the uterine cavity. Chi-square test was applied to assess the effectiveness of IUI in relation with these variables. RESULTS: A total of 205 insemination cycles were performed resulting in achievement of pregnancy in 31 patients. Miscarriage occurred in 3 patients. Out of these 31 women who conceived, 21 (67.7%, p=0.003) were aged < 35 years with higher pregnancy rate per cycle (21 / 90 = 23.3%). CONCLUSION: Intrauterine insemination may be regarded as valuable procedure for couples presenting at younger age with lesser duration of infertility and unexplained subfertility.

Effectiveness and safety of raloxifene in post-menopausal females.

OBJECTIVE: To determine effects of raloxifene on lipid profile, breast tissue and endometrial thickness in post-menopausal women. DESIGN: A longitudinal cohort study. PLACE AND DURATION OF STUDY: The study was conducted at Department of Gynaecology and Obstetrics, PNS Shifa Hospital, Karachi over a period of one year. PATIENTS AND METHODS: Fifty cases of postmenopausal women, aged 45-60 years, who had last menstrual period 2-8 years back, visiting Gynea OPD at PNS Shifa Hospital, Karachi, were included in the study. The subject received raloxifene (Evista) 60 mg once daily. The tests done at the start of study as baseline were serum lipid profile (HDL, LDL, total triglyceride and cholesterol levels), TVS (trans vaginal sonography) for endometrial thickness and mammography. The above tests were again done at the end of study after 12 months. The adverse effects were recorded. RESULTS: Fifty women were enrolled for study out of which 48 completed the study that is 96%. Mean age was 54 years, SD = 3.95. The mean value of LDL, total triglyceride and cholesterol decreased by 15.2%, 1.2% and 10.2 % respectively. The change was statistically significant. (p < 0.001) HDL change was 0.665% and was not statistically significant. TVS, for endometrial thickness, and mammography for breast density showed no change. Adverse effects reported were hot flushes, leg cramps and vaginal symptoms in few cases. CONCLUSION: Raloxifene therapy significantly decreases cardiovascular risk markers LDL, total triglyceride and cholesterol. No abnormal change in breast density and in endometrial thickness indicate good safety profile of this agent.