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REVIEW ARTICE
Evaluation of the infertile male
Hajaratu Umar Sulayman, Nkeiruka Ameh, Adebiyi G Adesiyun, Solomon Avidime, Fadimatu Bakari, Ahmed Muhammed
July-December 2016, 1(2):27-34
DOI:10.4103/ajiac.ajiac_7_17  
Infertility in a couple was for a long time, attributed mostly to the female partner. However, recent evidence indicates that the male contributes equally to the the male contributes equally to the problem, hence the need for a review of current evaluation of the infertile male. Common causes of infertility in the male can be due to pretesticular, testicular, and posttesticular factors. This categorization allows for a systematic evaluation ranging from simple semen analysis through serum hormonal assays, radiological investigations, and to testicular tissue biopsy for histological analysis. Following this evaluation, a rational treatment plan can be implemented. Male factor infertility should not be ignored in the management of the infertile couple and requires careful evaluation of the male partner and planning of appropriate treatment.
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ORIGINAL ARTICLE
Outcome of in vitro fertilization procedure at a private fertility center in Nnewi, South-East Nigeria
Joseph Ifeanyichukwu Ikechebelu, George Uchenna Eleje, Kennedy Ibadin, Ngozi Nneka Joe-Ikechebelu, Kester Nwaefulu, Somadina I Okwelogu
January-June 2016, 1(1):2-5
DOI:10.4103/2468-8452.189960  
Background: Infertility has grown to be a major health and social challenge in our environment that a childless marriage is regarded as a failed marriage. Couples are therefore ready to do all within their power to achieve pregnancy and have a baby of their own. This is the yawning gap assisted reproductive technology is fulfilling. Objective: To determine the outcome of in vitro fertilization (IVF) procedures 2 years after the commencement of the IVF program in a private hospital setting in Nnewi, Nigeria. Methods: From October 1, 2010 to September 30, 2012, 115 couples had conventional IVF procedures in batches of 10-15 couples. The outcome measures were clinical pregnancy rate, miscarriage rate, live birth rate, and sex ratio following one or two cycles of treatment. The results were analyzed using Epi info software 2013 version 7.0. Results: The mean age of the participants was 43.7 ± 3.5 years. The maximum number of embryos transferred per woman was four and minimum was one. The rates of clinical pregnancy, live births and multiple pregnancies were 30%, 18.3%, and 6.0%, respectively. Of the 31 women who conceived, 21 (67.7%) delivered live infants and 10 (32.3%) aborted in the first trimester. There was no case of ectopic pregnancy. The male:female sex ratio was 2:1. The mean endometrial thickness at embryo transfer (ET) was 8.9 ± 2.3 mm. Conclusion: The success rate of IVF-ET was good even in low resource settings and optimal endometrial thickness prior to ET may be one of the key success factors. The preponderance of male sex infants in our IVF births is acceptable to the couples who ordinarily have a preference for male infant.
  2,082 253 1
Assisted reproductive technology: Experience from a public tertiary institution in north central Nigeria
Lukman Omotayo Omokanye, Abdulwaheed Olajide Olatinwo, Lateefat Olayinka Saadu, Sikiru Abayomi Biliaminu, Kabir Adekunle Durowade, Abubakar A Panti
July-December 2016, 1(2):23-26
DOI:10.4103/ajiac.ajiac_3_17  
Background: According to the World Health Organization, more than 180 million couples globally suffer from infertility, the majority being residents of developing countries. Assisted reproductive technologies (ARTs) offer a chance at parenthood to couples, who until recently would have had no hope of having a “biologically related” child. Objectives: This study aimed to determine pregnancy outcomes following assisted conception. Materials and Methods: This is a prospective study of 104 clients who underwent the procedure of ART between January 1, 2012 and December 31, 2016 at the ART unit of University of Ilorin Teaching Hospital, Ilorin, Nigeria. Results: Of the 510 clients who had infertility consultation at the ART clinic, 104 (20.4%) underwent ART procedures. The patients aged 27–46 years with a mean age of 33 ± 4.0 years. More than half (58.7%) had primary infertility. Their duration of infertility ranged from 1 to 20 years (4.6 ± 2.9 years). Majority (81.7%) had conventional in vitro fertilization while 19 (18.3%) had intracytoplasmic sperm injection. Thirteen (12.5%) cases of cycle cancellation and 11 (11.7%) cases of mild-to-moderate ovarian hyperstimulation syndrome were recorded. The clinical pregnancy rate per cycle started was 39.4%. However, 9/41 (22%) resulted in spontaneous miscarriages and 32 (6 sets of twin, 25 singleton, and 1 high-order multiple births) were successfully delivered, giving a live birth rate per cycle started of 30.8%. Pregnancy outcomes were not significantly affected by age of the women, types of infertility, and duration of infertility (P > 0.05). Conclusion: The outcomes of ART procedures in a resource-limited country like ours are encouraging. This underscores the need to encourage ART in public tertiary institutions in Nigeria through the support of government and nongovernmental organizations for the benefit of infertile couples who were hitherto hopeless.
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CASE REPORT
Ovarian hyperstimulation syndrome with Schistosomiasis: A case report
Thompson Odeku, Stephen S Hati, Mopelola K Oluwolade, Ibrahim Wada
January-June 2016, 1(1):6-9
DOI:10.4103/2468-8452.189961  
Ovarian hyperstimulation syndrome (OHSS) is a well-known iatrogenic condition, debatably regarded as rarely occurring, but a serious complication observed during in vitro fertilisation (IVF) treatment. Its manifestations alongside other disease conditions have being mentioned in many case reports, but not with schistosomiasis. We herein present the case of a 33 year old, P 1 + 0 woman with features of moderate OHSS during IVF treatment and subsequently diagnosed with schistosomiasis. Both conditions were treated and resumed to the fertility clinic two months later where frozen embryo replacement was planned for her, using a natural cycle and two embryos were put back. She became pregnant and made good progress with her antenatal. Extensive review of literature showed that schistosomiasis was not reported in association with OHSS; our case report presents an instructive guide to clinicians to always look beyond surgical complications such as bladder and ureteric injuries in IVF patients.
  1,458 192 -
GUEST EDITORIAL
President message
Faye Iketubosin
January-June 2016, 1(1):1-1
DOI:10.4103/2468-8452.189957  
  1,414 202 -
CONFERENCE ABSTRACTS
AFRH Conference 2015 Abstracts

January-June 2016, 1(1):10-15
  1,457 158 -
CONFERENCE ABSTRACT
AFRH Conference 2016 Abstracts

July-December 2016, 1(2):39-44
DOI:10.4103/2468-8452.215112  
  1,279 175 -
CASE REPORT
A rare case of 46XX,t(X;11)(q24;q23.3) with premature ovarian insufficiency
Kanchan Murarka, Deepak Goenka, Mohan Lal Goenka, Parth S Shah
July-December 2016, 1(2):35-38
DOI:10.4103/ajiac.ajiac_9_17  
Here, we report a rare case of chromosomal abnormality with translocation between bands Xq24 and 11q23.3 leading to premature ovarian insufficiency (POI). POI can occur due to various causes. Studies have shown that 10%–12% of women with POI have chromosomal abnormalities. This patient presented to us with secondary amenorrhea for the past 3 years. She had attained menarche at 13 years and had regular menstrual cycles for 9 years before suffering from secondary amenorrhea. She had no family history of POI. Her karyotype revealed 46XX,t(X;11)(q24;q23.3). Other investigations showed hypoestrogenism, raised follicle-stimulating hormone, low volume ovaries, small sized uterus, and cholelithiasis. Laparoscopic cholecystectomy was done along with pelvic laparoscopy and hysteroscopy. Sequential estrogen and progesterone was given to the patient for 3 months. Following that, in vitro fertilization with oocyte donation was done which resulted into positive beta-human chorionic gonadotropin.
  1,047 187 -
ORIGINAL ARTICLES
The pattern of male infertility in Kumasi, Ghana
Christian Kofi Gyasi-Sarpong, Patrick Opoku Manu Maison, Adofo Kwame Koranteng
January-December 2017, 2(1):3-5
DOI:10.4103/ajiac.ajiac_3_18  
Background: Male factor infertility is a global health issue that requires further studies to understand its magnitude, especially in developing countries, where the woman is usually blamed for the couple's infertility. Objectives: This study aimed to determine the patterns of male infertility in a teaching hospital in Ghana. Methodology: This was a prospective study of 110 male patients who presented with infertility at the urology outpatient clinic of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, from January 1, 2014, to December 31, 2017. Results: One hundred and ten men reported for the treatment of infertility over the study period. The mean age was 38.5 ± 7.4 years. The majority (58.2%) had primary infertility while the remaining 41.8% had secondary infertility. Four (3.6%) of the men had unilateral or bilateral cryptorchidism while 41 (38.7%) of those with both testes resident in the scrotum had small-sized testes. Varicoceles were present in 24 (22.6%) men, 58.3% of whom had primary infertility while the remaining 41.7% had secondary infertility. Thirty-eight (34.5%) of patients had low semen volume was seen in 38 (34.5%) patients. Azoospermia was seen in 28 (25.5%) patients with 30 (27.3%) patients having no motile spermatozoa. Conclusion: Male infertility in Ghana should receive more recognition, and male participation in reproductive health programs should be encouraged.
  833 153 -
CONFERENCE ABSTRACT
AFRH Conference 2017 Abstracts

January-December 2017, 2(1):23-36
DOI:10.4103/2468-8452.241012  
  753 206 -
EDITORIAL
Managing ovarian hyperstimulation syndrome:Prevention is better
Bolarinde Ola
January-December 2017, 2(1):1-2
DOI:10.4103/ajiac.ajiac_8_17  
  806 149 -
ORIGINAL ARTICLES
Assisted reproduction technology: Comparison of anesthetic techniques for oocyte retrieval in a tertiary health facility in Ilorin, Nigeria
Lukman Omotayo Omokanye, Abdulwaheed Olajide Olatinwo, Lateefat Olayinka Saadu, Sikiru Abayomi Biliaminu, Kabir Adekunle Durowade, Abubakar A Panti, Ganiyu Adekunle Salaudeen
January-December 2017, 2(1):11-15
DOI:10.4103/ajiac.ajiac_1_18  
Background: Transvaginal ultrasound-guided oocyte retrieval (TUGOR) technique is minimally invasive and requires shorter time compared to previous techniques. Yet, it is a potentially stressful and painful procedure and thus requires some form of analgesia with or without sedation. The effects of various anesthetic techniques used for TUGOR on reproductive outcomes remain controversial. Aims and Objectives: This study aimed at comparing the efficacy of paracervical block (PCB) and conscious sedation for pain relief and pregnancy outcomes during TUGOR. Materials and Methods: This is a cross-sectional comparative study of 137 eligible clients that underwent assisted reproduction program in our facility. All clients were treated with antagonist protocol for controlled ovarian hyperstimulation. The choice of analgesia for TUGOR was influenced by clients' and/or clinicians' preference. PCB and conscious sedation were administered for TUGOR in 66 and 71 clients, respectively. Pain was assessed using a 10-cm Visual Analog Scale (VAS), while clients' overall satisfaction was rated using Likert scoring system. Results: There was no statistically significant difference in the clinical pregnancy, miscarriage, and live birth rates between the two groups. The mean VAS 10-point scores at 1, 6, and 24 h postretrieval and on the day of embryo transfer were significantly higher for paracervical group. The mean Likert score for conscious sedation group was significantly higher than that of paracervical group. Conclusion: Conscious sedation is superior to PCB as anesthetic/analgesic agent for pain relief and clients' satisfaction for TUGOR. However, a multimodal approach to anesthesia/analgesia for TUGOR is suggested to further improve overall clients' satisfaction.
  653 117 -
Reproductive hormonal profile patterns among male partners of infertile couples at the University of Ilorin teaching hospital
Waliu Olatunbosun Oladosu, Sikiru Abayomi Biliaminu, Ishola Musbau Abdulazeez, Gbagirimojo Ganiyu Aliyu, Ademola Adelekan, Adekunle Bashiru Okesina
January-December 2017, 2(1):6-10
DOI:10.4103/ajiac.ajiac_2_18  
Background: Seminal fluid analysis (SFA) is the most important investigation of the infertile males but limited in revealing the etiologies of the various spermatozoa abnormalities observed on microscopy. Increasing prevalence of male infertility and the challenges of diagnosis require biochemical investigations such as reproductive hormonal profile. Aims: The aim of this study is to determine the reproductive hormonal profile patterns among infertile males in Ilorin. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A total of 130 male partners of infertile couples served as subjects and 50 fertile males as controls. Serum reproductive hormonal assay was done using ELISA method. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA) was used. Normally distributed data were expressed as mean ± standard deviation. Results: The mean age of the subjects who were majorly civil servants was 38.6 ± 6.6 years. The prevalence of reproductive endocrinopathies in this study was 46.9%. Mean serum concentrations of follicle-stimulating hormone, luteinizing hormone, and prolactin were elevated in our subjects than control. Mean serum testosterone concentration was significantly lower in our infertile subjects. Patterns of hormonal profile abnormalities among our subjects were 2 (1.5%) with hypogonadotropic hypogonadism, 15 (11.5%) with hypergonadotropic hypogonadism, 23 (17.7%) with hypergonadotropic normogonadism, 21 (16.2%) with normogonadotropic hypogonadism, and 69 (53.1%) with normogonadotropic normogonadism. This showed 59 (45.4%) subjects with primary testicular failure/resistance and 2 (1.5%) with secondary testicular failure. Twenty (15.4%) of the subjects had hyperprolactinemia. Conclusions: Reproductive hormonal profiling of male partners of infertile couples is an important adjuvant to SFA, in diagnosis and monitoring responses to treatment.
  638 120 -
CASE REPORTS
A successful gestational surrogacy in Southeast Nigeria
Joseph Ifeanyichukwu Ikechebelu, Kennedy Ibadin, Ngozi Nneka Joe-Ikechebelu, Louis Anayo Nwajiaku, Kester Nwaefulu, Somadina I Okwelogu
January-December 2017, 2(1):19-22
DOI:10.4103/ajiac.ajiac_10_17  
Infertility is a major public health problem and imposes major physical and psychological burden to couples as well as to their relatives. Infertility due to the absence of uterus can be difficult to manage and could even be more challenging in our environment where couples insist on having children with their own genetic component. We present a case of a 35-year-old married graduate trader with primary infertility of 7-year duration due to Mullerian dysgenesis. She had a successful surrogacy.
  663 69 -
Partial hydatidiform molar gestation following assisted conception
John Chukwuzitelu Ekweani, Adekunle O Oguntayo, AO D. Kolawole, Marliyya S Zayyan
January-December 2017, 2(1):16-18
DOI:10.4103/ajiac.ajiac_6_16  
Molar gestation, with its attendant risk to progress to frank choriocarcinoma, has been reported in the literature. It can follow both spontaneous and assisted conceptions. With the growing popularity of assisted conception techniques for the management of infertility in our setting, it is important to bring to the fore that similar complications could occur and hence should inform the counseling of patients before and during such procedures. We present a 39-year-old nullipara who had in vitro fertilization and frozen embryo transfer. Eight weeks later, she was diagnosed with missed abortion and had manual vacuum aspiration at a private hospital in Zaria. Histopathological examination revealed partial hydatidiform mole, and she was subsequently managed at a tertiary health center in Zaria with six cycles of methotrexate chemotherapy because she was low risk based on the International Federation of Gynecologists and Obstetricians criteria. She was monitored with monthly serum beta-human chorionic gonadotropin (β-HCG) and was placed on combined oral contraceptive pills. The serum β-HCG levels fell to almost undetectable levels and remained so after four cycles of the chemotherapy regimen. Molar pregnancy can follow assisted conception in our environment. This underscores the importance of pretransfer cytogenetic and histopathological assessment of any specimens aspirated following every incomplete/missed abortion. This case also brings to the fore the importance of referral of similar cases to higher levels of care for expert/multidisciplinary management.
  431 55 -