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Assisted reproduction technology in Nigeria: Challenges and the way forward
Lukman Omotayo Omokanye, Abdulwaheed Olajide Olatinwo, Ganiyu Adekunle Salaudeen, Kabir Adekunle Durowade, Abubakar A Panti, Rabiu Olayinka Balogun
January-December 2018, 3(1):2-5
The challenges associated with infertility have necessitated different healthcare-seeking behaviors ranging from spiritual, traditional/alternative health care to orthodox medical types including biotechnological devices such as assisted reproductive technology (ART). ART is the highest breakthrough in the medical treatment of infertility in the whole world. Its evolution has presented multitudinous ethical, legal, and social challenges resulting in a tectonic shift in the way clinicians and the general population perceive infertility and ethics. Hence, there is a urgent need for stakeholders (fertility specialists, clients, professional organizations, religious bodies, bioethicists, and government) to formulate cultural and context-specific guidelines to help address some of these ethical dilemmas.
  7,902 516 1
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
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.
  6,698 452 2
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
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.
  5,890 546 -
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
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.
  5,201 325 -
Short-term outcome of unaided versus microsurgical inguinal varicocelectomy among infertile men with varicocele
Muhammad Salihu Muhammad, Ahmed Muhammed, Ahmad Bello, Ahmad Tijjani Lawal, Awaisu Mudi, Abdullahi Sudi, Nasir Oyelowo, Musliu Adetola Tolani, Babatunde Kolapo Hamza, Fidelis Lovely, Hussaini Yusuf Maitama
January-December 2018, 3(1):6-9
Objective: The objective was to determine the short-term outcome of unaided and microsurgical varicocelectomy on semen parameters and conception after 6 months in patients with infertility and varicocele. Patients and Methods: This was a randomized, prospective, interventional study that was conducted on men with infertility and varicocele. Patients were randomized into two groups. Patients in Group A underwent open inguinal varicocelectomy, whereas patients in Group B had the same surgery with microsurgical technique using ×3.5 magnification loupes. All the patients had preoperative seminal fluid analysis (SFA) performed on two occasions, a scrotal Doppler ultrasound and a postoperative SFA at 3 months and 6 months posttreatment. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) software package version 23.0, and the level of significance was taken as 0.05. Results: Thirty patients participated in the study, 14 in Group A and 16 in Group B. The mean age in Groups A and B was 40.07 ± 7.7 and 39.44 ± 7.3 years, respectively. About 85.7% of patients in Group A had bilateral varicocele, whereas 14.3% had left-sided varicocele. In Group B, 75% had bilateral, whereas 25% were on the left side. There was a statistically significant improvement in sperm count, motility, and morphology in both the unaided and the microsurgical groups; however, there was no significant difference in the improvement of seminal parameters between the two groups except the morphology. The pregnancy rate was 14.3% in Group A and 25% in Group B. Overall pregnancy rate in this study is 20% after 6 months. Conclusion: Varicocelectomy leads to significant improvement in sperm parameters; however, there is no significant difference in outcome between unaided and microsurgical varicocelectomy.
  4,852 407 -
Awareness and willingness to adopt among infertile women seen at a tertiary hospital in Northern Nigeria
Amina Mohammed-Durosinlorun, Joel Adze, Stephen Bature, Amina Abubakar, Caleb Mohammed, Matthew Taingson, Lydia Airede
January-December 2018, 3(1):10-15
Introduction: Infertility is associated with adverse psychosocial effects and adoption provides a simple and affordable option for managing infertile couples, but are Nigerian women aware or willing to adopt? Methodology: This was a cross-sectional study. Interviewer-administered pretested questionnaires were given to a total of 236 consenting clients seen at their first visit to the gynecology clinic with complaints of inability to conceive, between the period of July 2016 to March 2018. Data on sociodemographics, gynecological, and infertility history was analyzed using the Statistical Package for the Social Sciences computer software version 22. Descriptive analysis was done using frequencies and percentages. Chi-square (and fishers test where relevant) was used as a test of association. Significance level was established at P < 0.05. Results: Majority of clients were aged between 20 and 29 years (44.5%), educated up to secondary level or above (80.9%), Muslims (65%), homemakers, and 59.3% had previous pregnancies. Most were aware about adoption (85.2%), but only 38.1% would consider adoption in the future. Respondents and husbands age, education, religion, respondents and husband's occupation, and knowing someone who had adopted in the past was significantly associated awareness of adoption. However, only order of marriage was significantly associated with willingness to adopt children in the future. Conclusion: Despite high levels of awareness, adoption is underutilized as most women have hope of having their own children or husbands may object. Couple counseling and community education are important for any change.
  4,787 400 -
Prognostic factors and pregnancy outcome in superovulated intrauterine insemination cycles in North Indian women
Rekha Sachan, Munna Lal Patel, Meenakshi Singh, Pushplata Sachan
January-December 2018, 3(1):16-20
Background: Controlled ovarian hyperstimulation (COH) with intrauterine inseminations (IUI) is a commonly used method to treat infertile couples. This study aimed to evaluate prognostic factors responsible for successful pregnancy outcome in COH and IUI cycles. Materials and Methods: A cross-sectional study was carried out over a period of 1 year. A total of 130 women who visited the department of obstetrics and gynecology for the treatment of infertility were included in the study. Ninety-eight women were enrolled for this study, and proper screening protocol was followed. The outcome of COH-IUI cycles was assessed by evaluating many parameters such as age, duration of infertility, body mass index (BMI), etiology of infertility, endometrial thickness, and number of dominant follicles. Results: The mean age of pregnant women (25.40 ± 3.52 years) was significantly lower compared to nonpregnant women (28.01 ± 3.21 years) (P < 0.005). The mean BMI of pregnant women was 23.00 ± 2.41 kg/m2 whereas the mean BMI of nonpregnant group was 25.12 ± 3.32 kg/m2. This difference was statistically significant. Among pregnant women, 86.7% had bilateral patent fallopian tube and 88% in nonpregnant group had bilateral patent fallopian tube. In not getting pregnant group, the most common cause of infertility was unexplained in 80.7%, anovulatory cycles in 9.6%, and male factor infertility in 9.6%, whereas in pregnant group unexplained causes were found in 93.3% and male factor in 6.7%. No significant difference was observed between the two groups in terms of bilateral fallopian tube patency, antral follicular count, and endometrial thickness on the day of ovulation. There was no difference in pregnancy rates using either double IUI or single IUI. In our study, woman's age, BMI, and single dominant follicle were the main prognostic factors for successful outcome. Conclusions: In our study, woman's age, BMI, and single dominant follicle were the main prognostic factors for successful outcome.
  4,725 368 -
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
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.
  4,165 544 2
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
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.
  3,788 630 -
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
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.
  3,626 361 -
AFRH Conference 2017 Abstracts

January-December 2017, 2(1):23-36
  3,490 463 -
Managing ovarian hyperstimulation syndrome:Prevention is better
Bolarinde Ola
January-December 2017, 2(1):1-2
  3,150 737 -
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
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.
  3,362 395 -
AFRH Conference 2015 Abstracts

January-June 2016, 1(1):10-15
  3,340 345 -
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
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.
  3,144 419 -
AFRH Conference 2016 Abstracts

July-December 2016, 1(2):39-44
  3,129 379 -
A new dawn: AJIAC is growing slowly but surely
Preye Fiebai
January-December 2018, 3(1):1-1
  2,964 396 -
President message
Faye Iketubosin
January-June 2016, 1(1):1-1
  2,837 358 -
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
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.
  2,828 347 -
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
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.
  2,385 245 -
AFRH Conference 2018 Abstracts

January-December 2018, 3(1):21-28
  1,906 224 -
Covid-19 pandemic: Impacts survey of fertility practitioners in Nigeria
Lateef Adekunle Akinola
0, 0(0):0-0
Background: COVID-19 pandemic has created a huge disruption to the activities of physicians and other healthcare providers all over the world. Fertility centers, fertility practitioners and patients alike are not left out. Infertile couples and families also face significant disruptions to their treatment schedules, financial plans as well as uncertainty about when their fertility treatments will begin. This survey evaluates the impacts that COVID-19 pandemic will have on the budgetary and operational activities of Fertility Centre's and practitioners in Nigeria. Methodology: A question-based, cross-sectional survey of registered fertility practitioners of the Association for Fertility and Reproductive Health of Nigeria (AFRH) carried out on the 10TH to 15TH of April 2020. Results: Majority of the respondents felt that their fertility centers made a good adaptation to the new working environment. Majority agreed that services have been negatively impacted, while 64.42% of responding practitioners felt the pandemic had not resulted to staff retrenchments. Also, majority believe that business continuity and plan is not been disrupted by the pandemic. A third of the respondents use travel and exposure histories, physical examinations and taking temperature for diagnostic assessments. AFRH and Nigerian Center for Disease Control (NCDC) performance and response to Covid-19 pandemic were rated to be above average. Conclusion: Majority of the AFRH fertility practitioners surveyed felt that Covid-19 pandemic and its containment strategies negatively impacted work, services and budgetary needs of fertility practitioners in Nigeria, with no significant impact on staff employments. Response and guidance from the Association for fertility and reproductive Health and the NCDC towards curtailing the spread of Covid-19 infections to their members and the Nigerian communities, respectively, were rated above average.
  730 10 -
Enforcement of In vitro fertilization standards among practitioners of ART in Nigeria
Richardson Ajayi
0, 0(0):0-0
  520 15 -
Are there possible predictors of pain during office hysteroscopy among infertile women in Port Harcourt Nigeria?
Kennedy Tamunomie Nyengidiki, Vaduneme Kingsley Oriji, Inusa Amike
0, 0(0):0-0
Context: Invasive office procedures such as office hysteroscopy are usually carried out without analgesia as they are thought to cause minimal or no pain to the patient. Hysteroscopy has been found to be a cause of significant pain in some patients. Aims: To determine factors inherent in infertile patients experiencing pain during office hysteroscopy in Port Harcourt, Nigeria. Settings and Design: A cross-sectional comparative study amongst infertile women undergoing office hysteroscopy. Methods and Material: Assessment of Pain perceptions using a numerical pain scale in 101 women following office hysteroscopy. Demographic, Social, and gynecological factors of these patients were analysed for association with to pain perception. Statistical Analysis Used: Bivariate logistic regression analysis was conducted for associations between pain perception and suspected factors with P≤ 0.05 as statistically significant. Results: The mean age of the patients was 35.95±4.65 years. 53(52.5%) and 48(47.5%) of the patients experienced moderate/severe pain and mild/no pain respectively. Moderate/severe pain in participants was not associated with age, parity, type or period of infertility, dysmenorrhea or previous pregnancy terminations. However, it was associated with education below secondary level (OR=1.82; P value=0.21, 95%CI 0.81-4.11) and over one previous miscarriages (OR=1.11, P value = 0.948.;95% CI 0.51-2.43). Conclusions: Moderate/severe pains at office hysteroscopy occurred in more than one half of the patients increased risk of pain occurred in patients with miscarriages and those with less than secondary education. We recommend analgesia for patients undergoing office hysteroscopy.
  328 14 -
Fetal self-defense or maternal immune tolerance
Manish Raturi
0, 0(0):0-0
  319 16 -