Diabetes mellitus and abnormalities in semen analysis.

AIM: The aim of this study was to compare the semen parameters of diabetic husbands of infertile couples with those of non-diabetic husbands of proven fertility. MATERIAL AND METHODS: Assuming a 5% fall in DNA integrity of sperms would affect fertility, the required sample size calculated was 103, with 80% power and 5% level of significance. During the study period (January 2010 to May 2012), 52 husbands were found to have diabetes mellitus, by 2-h/post 75 g of glucose load (≥ 200 mg %). Glycosylated hemoglobin level in each case was found to be more than 6.5% (study group). During the same period, six couples with infertility conceived spontaneously while undergoing evaluations, 60 couples conceived following treatment of ovulatory disorders in wives and all had ongoing pregnancies (more than 12 weeks). Husbands of these 66 couples were found to be non-diabetic (control group). Conventional semen analysis (World Health Organization criteria), hypo-osmotic swelling test and DNA integrity test (Acridine Orange test) were done in all cases. Body mass index was measured in each case. RESULTS: There were no differences in the mean age and body mass index between the two groups but significant differences were found in the following parameters: volume of the ejaculate (P = 0.004); total cells per ejaculate (P = 0.01); percent motility (P = 0.0001); total motile cells per ejaculate (P = 0.0001); percent of rapid progressive motility (P = 0.0001); percent normal morphology (P = 0.02); percent hypo-osmotic swelling test (0.0001); and percent normal DNA integrity (P = 0.0001). CONCLUSION: Diabetes mellitus can affect spermatogenesis at various levels, which can cause male-factor infertility.

Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome.

OBJECTIVE: To compare the effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone, in polycystic ovary syndrome (PCOS), after 6 and 12 months of therapy. DESIGN: Double-blind randomized controlled trial. SETTING: Gynecologic clinic of the first author. PATIENT(S): Women (n = 171) with PCOS (Androgen Excess Society criteria, 2006). INTERVENTION(S): The three-arm trial involved 58, 56, and 57 cases in desogestrel, cyproterone acetate, and drospirenone groups, respectively. Body mass index, abdominal circumference, hirsutism score (modified Ferriman Galwey), acne and acanthosis nigricans scores, and blood pressure were noted. Blood levels of total T, sex hormone-binding globulin, fasting glucose, and fasting insulin were measured. Free androgen index, glucose-insulin ratio, and homeostasis model assessment-insulin resistance were calculated. Follow-up was after 6 and 12 months of treatment. MAIN OUTCOME MEASURE(S): Primarily, absolute change in the Free Androgen Index score between the three groups and, secondarily, changes in the clinical and other hormonal and biochemical parameters were studied. RESULT(S): Six months of treatment showed similar effects. After 12 months, cyproterone acetate significantly decreased the modified Ferriman Galwey score (change = -5.29) compared with both desogestrel (change = -1.69) and drospirenone (change = -2.12); cyproterone acetate significantly increased sex hormone-binding globulin (change = 142.91) compared with desogestrel (change = 99.53); drospirenone significantly increased sex hormone-binding globulin (change = 131.52) compared with desogestrel; and cyproterone acetate significantly decreased the Free Androgen Index (change = -10.57) compared with desogestrel (change = -5.58). CONCLUSION(S): No difference in effects after 6 months. At 12 months, cyproterone acetate showed the strongest antiandrogen activities. Effects on metabolic parameters were identical. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2010/091/000332.

Effects of ethinyl estradiol and desogestrel on clinical and metabolic parameters in Indian patients with polycystic ovary syndrome.

AIM: The aim of this study was to examine the therapeutic effects of an ethinyl estradiol (EE) and desogestrel (DSG) combination pill in polycystic ovary syndrome (PCOS). METHODS: A total of 42 women with PCOS were treated with an EE 30 mcg and DSG 150 mcg (EE/DSG) combination pill for 12 cycles. The following parameters were studied at 0, 6, and 12months: body mass index, abdominal circumference, Ferriman-Gallwey score, presence of acne and acanthosis nigricans, serum testosterone and sex-hormone-binding globulin levels, fasting glucose and fasting insulin levels. Free androgen index and glucose:insulin ratio were calculated. RESULTS: There were significant improvements in Ferriman-Gallwey score, incidence of acne, serum testosterone and sex-hormone-binding globulin levels and free androgen index values at the 6-month follow up. But there were no further beneficial changes in the above parameters at the 12-month follow up. There were no significant changes in body mass index, abdominal circumference, incidence of acanthosis nigricans, fasting glucose and insulin levels and glucose:insulin ratio during treatment. CONCLUSION: Significant improvements in hyperandrogenic parameters were seen only in the first 6months of treatment with EE/DSG in PCOS. Further continuation with this pill did not produce any significant improvement. There were no adverse effects on insulin sensitivity.

Effects of drospirenone pill in Indian women with polycystic ovary syndrome.

OBJECTIVE: To study the effects of treatment with a drospirenone pill (DRSP) (with ethinyl oestradiol, EE) in Indian women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Fifty-one women with PCOS (Androgen excess society criteria, 2006), with preset inclusion-exclusion criteria, treated with a combination of EE 30 mcg and DRSP 3 mg cyclically in the traditional (21+7) regimen, were evaluated at baseline and after six and twelve cycles of treatment. Parameters studied were - body mass index (BMI), abdominal circumference (AC), Ferriman Galwey (FG) score, presence of acne and acanthosis nigricans, serum testosterone, sex hormone binding globulin (SHBG), fasting glucose and fasting insulin levels. Free Androgen Index (FAI) and Glucose: Insulin ratio (G: I) were calculated. RESULTS: Significant improvements in clinical and biochemical hyperandrogenic parameters were found at the two points of study. There were no significant changes in BMI, AC, incidence of acanthosis, or metabolic parameters studied. CONCLUSION: EE/DRSP improves hyperandrogenic parameters significantly without affecting the insulin resistance adversely in Indian women with PCOS.

Prevalence of metabolic syndrome in women with polycystic ovary syndrome, using two proposed definitions.

AIM: To compare the prevalence rate of metabolic syndrome (MS) in women with polycystic ovary syndrome (PCOS) using the Adult Treatment Panel III (ATP III) criteria, with that using the International Diabetes Federation (IDF) criteria and also to assess the metabolic risk factors for this syndrome. METHODS: This was a cross-sectional study, 198 women with PCOS were studied. MS was diagnosed as per the ATP III and IDF criteria, separately. RESULTS: MS was found in 37.9% cases (ATP III criteria) and 47.5% cases of PCOS (IDF criteria) (p = 0.02). In adolescents, prevalence of MS was more with the IDF criteria (p = 0.009) but in adults, the prevalence rates were similar between the two criteria (p = 0.08). Women with MS had significantly higher body mass index, irrespective of age and the definition used. Dyslipidemia was found more common than elevated fasting glucose abnormality, using either of the criteria. CONCLUSION: Prevalence rate of MS in PCOS depends on the definition used. With IDF criteria, in the whole group, the prevalence was significantly higher. A universally accepted definition of MS, suitable for adolescents and adults, is urgently needed.

A comparison of health-related quality of life (HRQOL) after natural and surgical menopause.

OBJECTIVE: To compare the health-related quality of life (HRQOL) of women at surgical menopause with that of women at natural menopause, utilizing the Menopause Rating Scale (MRS-II). STUDY DESIGN: An institution-based cross-sectional study design was used, with 32 participants in each of two groups: women who had undergone surgical menopause of 9-12 months previously; and women who were more than 40 years of age and had had oligomenorrhoea for at least 1 year. The MRS-II was used to assess HRQOL. None of the women had received any hormonal therapy before assessment. MAIN OUTCOME MEASURES: Total MRS-II scores along with the scores on the somato-vegetative, psychological and urogenital sub-scales were compared between the two groups. RESULTS: HRQOL was rated as worse by the surgical menopause group than by the natural menopause group: the total MRS-II scores were much higher for the surgical menopause group (mean=29.4, SD=6.7) than for natural menopause group (mean=20.7, SD=6.5), and this difference was significant (p<0.0001). Similar results were obtained on the three sub-scales-somato-vegetative (p=0.030), psychological (p<0.0001) and urogenital (p<0.0001). CONCLUSION: HRQOL is worse after surgical than in natural menopause. Routine surgical castration at hysterectomy should be avoided because of adverse short-term effects and, potentially, long-term consequences.

Prevalence and risk of depressive disorders in women with polycystic ovary syndrome (PCOS).

This comparative cross-sectional study found that women with polycystic ovary syndrome are at a significantly higher risk of depression compared with non-PCOS women. The study fails to find enough evidence to explain the high prevalence of depression among PCOS patients by the selected sociodemographic, clinical, and biochemical parameters.

Insulin resistance and overweight-obese women with polycystic ovary syndrome.

AIM: To estimate (1) the prevalence of insulin resistance (IR) by fasting glucose: insulin ratio (G:I) (G:I or= 23 kg/m(2)) were studied. PCOS was diagnosed as per the Rotterdam 2003 criteria. BMI, abdominal circumference (AC), hirsutism (Ferriman Gallway score >or=6), presence of acne and acanthosis nigricans (AN) were noted in each case. Serum testosterone, sex hormone binding globulin (SHBG), fasting plasma glucose and insulin levels were measured. RESULTS: 23.5% women were found to have IR. There were no differences in age, frequency of hirsutism, acne, serum testosterone and fasting glucose levels between insulin-resistant and insulin-sensitive women. However, there were significant differences in BMI, AC, frequency of AN, SHBG levels, fasting insulin levels and FAI between the two groups. CONCLUSION: PCOS women with IR are more obese; they have more upper body adiposity and AN. They are more hyperandrogenic. Simple clinical parameters will help to suspect IR in PCOS women.

Hyperandrogenism in oligomenorrhoea with minimal or nil 'unwanted hair growth'.

AIM: To detect whether oligomenorrhoea with minimal or nil 'unwanted hair growth' is a hyperandrogenic problem. MATERIALS AND METHODS: Fifty-nine women with oligomenorrhoea with modified Ferriman Gallway score (m FG) = <5 (Group A), 40 women with oligomenorrhoea with m FG score = > 6 (Group B) and 22 eumenorrhoeic non-hirsute 'control' women (Group C) were studied. Body mass index, Waist-hip ratio were noted during clinical examination. Serum testosterone, Sex hormone binding globulin, fasting insulin levels were measured in each woman. Free androgen index (FAI) was calculated. RESULTS: No significant differences were noted in the clinical parameters. Though serum testosterone levels were within the normal ranges in Group A and Group B, they were significantly higher than that of Group C. Groups A and B had significantly higher FAI values and fasting insulin levels than Group C. Between Groups A and B there were no significant differences in any of the androgenic parameters studied. CONCLUSION: Oligomenorrhoea without definite hirsutism is an androgen excess disorder. Definition of biochemical hyperandrogenism needs more clarity. Hirsutism is not a sensitive indicator of hyperandrogenism. The role of insulin in this type of hyperandrogenism needs further studies.

Health-related quality of life following surgical menopause and following gonadotrophin-releasing hormone analogue-induced pseudomenopause.

OBJECTIVE: To compare the health-related quality of life (HRQOL) following surgical menopause with that following gonadotrophin-releasing hormone analogue (GnRHa)-induced pseudomenopause. MATERIALS AND METHODS: Thirty-one women who received 3.75 mg of triptorelin injection subcutaneously every 4 weeks for 12 weeks after conservative surgery for severe endometriosis were reviewed (Group A). Thirty women who had surgical menopause for non-malignant conditions were reviewed after 12 weeks (Group B). Menopause-rating scale (MRS II) was used to assess the HRQOL. RESULT: Surgical menopause caused significant deterioration of HRQOL after 12 weeks, as compared to that caused by the pseudomenopause induced by the GnRHa injection (total MRS score: Group A, 16.60; Group B, 20.41; p = 0.04). Among the three subscales, there were no differences in the scores of somato-vegetative symptoms (Group A, 6.63; Group B, 6.90; p = 0.72) and urogenital symptoms (Group A, 3.50; Group B, 4.80; p = 0.06). Psychological symptoms showed significant difference (Group A, 6.46; Group B, 8.70; p = 0.01). CONCLUSION: Surgical menopause causes significant deterioration of HRQOL than that caused by the pseudomenopause state of GnRHa injection. Psychological symptoms are more pronounced in surgical menopause.

Association of various sperm parameters with unexplained repeated early pregnancy loss--which is most important?

OBJECTIVES: To study the relationship of various sperm characteristics with repeated unexplained early pregnancy loss. BASIC PROCEDURE: Semen samples from husbands of 74 couples with the history of repeated early pregnancy loss were analyzed as per WHO criteria, and DNA integrity was studied in each case by Acridine Orange staining test. Semen samples from 65 husbands of proven fertility were also studied for comparison. MAIN FINDINGS: No statistically significant differences were noted in the age of the husbands, sperm concentration, total count per ejaculate, and rapid progressive motility of sperms between the two groups. On the other hand, significant differences were found in total motile sperms per ejaculate, percentage of motile sperm and, most importantly, in the DNA integrity value. CONCLUSION: The sperm DNA-integrity damage is an important paternal factor associated with repeated embryonic or early fetal loss and should be included in the evaluation of these couples.

Fasting or two-hour postprandial plasma glucose levels in early months of pregnancy as screening tools for gestational diabetes mellitus developing in later months of pregnancy.

PURPOSE: The present study was done to find out whether the fasting or 2-hour postprandial plasma glucose (PPPG) levels in early months of pregnancy can be used as screening tools for gestational diabetes mellitus (GDM) developing in later months of pregnancy. BASIC PROCEDURE: Fasting and 2-hour PPPG levels were measured in the early months of pregnancy in 246 women attending the antenatal clinic of the author. All of the women underwent glucose challenge tests with 50 grams of glucose at 24-28 weeks and if the value exceeded 140 mg%, a three-hour oral glucose tolerance test (OGTT) with 100 grams of glucose was performed to diagnose GDM. MAIN FINDINGS: The present study found that the incidence of GDM was 10.5% in the third trimester. Statistical analysis did not show any correlation between fasting and the PPPG values in the early months and GDM in later months of pregnancy. CONCLUSION: Fasting or PPPG values cannot be used as efficient screening tools for GDM developing in the later months of pregnancy.

B-Lynch Brace Suturing in primary post-partum hemorrhage during cesarean section.

Primary atonic post-partum hemorrhage during lower segment cesarean section, which was not controlled by ecbolics--oxytocin, methylergometrine, 15-methyl-prostaglandinF2alpha--was managed by applying a B-Lynch Brace Suture. The test of potential efficacy was the control of hemorrhage by bimanual uterine compression. Six primigravida patients at their term gestation, who underwent emergency cesarean section, all except one under spinal anesthesia, received this type of suture. Interestingly, in every case hemorrhage was controlled successfully with the compression suture. None of them received blood or blood products transfusions or developed disseminated intravascular coagulopathy. Postoperative recovery was good and all patients are in follow-up to assess their future reproductive activity. B-Lynch Brace Suturing is an invaluable procedure for the control of atonic primary post-partum hemorrhage following cesarean delivery.

Glucose screening test results in first and early third trimester of pregnancy: is there any correlation?

OBJECTIVE: This study aims to find correlation between glucose screening test (GST) results done in the first trimester and again in the early third trimester of pregnancy. METHODS: Analysis of the records of 458 cases of pregnant women (non-diabetic in early pregnancy as detected by glucose screening test and glucose tolerance test) between 22 and 35 years of age with a body mass index of less than 25 kg/m2 was done. These women underwent GST in the first trimester (GST-1) and again in the early third trimester (GST-2). When the GST-2 was 140 mg% or above, a standard '3 hour glucose tolerance test' was done (GT TEST) with 100 g of glucose. The GST was done by measuring the plasma glucose level 1 hour after taking 50 g of glucose, irrespective of food intake. RESULTS: A substantial correlation between the two groups of measurements was found. Based on the available data, a GST-1 value of 99 mg% or less was seldom associated with GST-2 value of 140 mg% or more (GT TEST was positive in none). It was observed that 100% of cases with GST-1 value of 140 mg% or more had GST-2 of 140 mg% or more. Out of those having GST-2 value of 140 mg% or more, 72% had GT TEST positive. In the intermediate group (i.e. those patients having GST-1 value of 100 mg%-139 mg%), 51.7% had GST-2 values of 140 mg% or more. Out of these 51.7% cases, only 23% cases turned out to be GT TEST positive. The correlation coefficients (CC) worked out to be 0.38 (substantial correlation for 0.20 < CC < 0.70). CONCLUSION: From the observations stated above, it is concluded that for women with GST-1 of 99 mg% or less, a GST-2 is not necessary. For those having GST-1 of 140 mg% or more, a GT TEST is absolutely necessary instead of repeating the screening test again in the third trimester. But it is in the intermediate group (i.e. with GST-1 value of 100 mg%-139 mg%) where the glucose screening test should be repeated in the early third trimester and GT TEST as and when necessary.