Thyroid Disorders-A common Cause of Infertility: A Review

Undiagnosed and untreated thyroid disease can be a cause for infertility as well as sub-fertility. Both these conditions have important medical, economical, and psychological implications in our society. Thyroid dysfunction can affect fertility in various ways resulting in anovulatory cycles, luteal phase defect, high prolactin (PRL) levels, and sex hormone imbalance. Thyroid hormones are instrumental in reproductive physiology. In hypothyroidism, there is decreased synthesis of factors VII, VIII, IX and XI and estrogen break through bleeding secondary to anovulation, which may explain the frequent, prolonged and heavy menstruation. Hyperthyroidism may be characterized by infrequent scanty menstuation or amenorrhea. Thyrotoxicosis increases the risk of spontaneous abortions and especially if on methimazole, there is an amplified risk of congenital anomalies and aplasia cutis. In males, thyrotoxicosis cause abnormal sperm motility, while hypothyroidism may result in abnormal sperm morphology and both may cause erectile abnormalities. Faridpur Med. Coll. J. 2020;15(2): 95-97

Effectiveness of Cabergoline therapy in hyperprolactinemic infertility

Background: Hyperprolactinemia may be associated with ovulatory dysfunction and resultant subfertility. Hyperprolactinemia affects the pulsatile release of GnRH, which in turn impairs the secretion of FSH and LH. It may also affect the endocrine activity of ovarian follicles, resulting into luteal phase defect and ovulatory dysfunction. Hyperprolactinemia may be associated with infertility in up to one-third of women undergoing infertility workup. Women with hyperprolactinemia are generally treated with dopamine receptor agonists to reduce serum prolactin levels and regularisation of menses. The aim of this study was to study the effectiveness of cabergoline therapy in hyperprolactinaemic infertility.Methods: This prospective study was performed from June 2017 to July 2018 in women with Hyperprolactinemic infertility attending the infertility clinic at INHS Patanjali. In this study, 20 women with hyperprolactinemic infertility who satisfied the inclusion and exclusion criteria were started on four week cabergoline therapy. The effectiveness of therapy was evaluated on the basis of normalization of prolactin levels, regularization of menses, reduction in galactorrhea, successful conception and adverse effects if any.Results: The women on Cabergoline therapy showed marked improvement in menstrual irregularity, near normal prolactin levels and reduced galactorrhea. After the four week Cabergoline therapy the frequency of galactorrhea and irregular menses was reduced in 8 (80%) and 14 (93.3) per cent, of women respectively. Successful conception was achieved in 17 (85%) women after regularization of menses with no any major adverse effects.Conclusions: This study shows the effectiveness of cabergoline therapy both on lowering the serum prolactin levels and successful Conception with no any major adverse effects. Cabergoline therapy is a cost effective and safe option in hyperprolactinaemic infertility.

Sonographic Folliculometry and Endometrial Echocomplex as an Evidence of Ovulation in Infertility Cases

ABSTRACT Objectives To study the diagnostic accuracy of folliculometry and endometrial echo complex as an evidence of ovulation in infertility. Materials and methods This clinical study was conducted on 100 infertile women. The women were subjected to follicular monitoring by transvaginal sonography (TVS) from cycle day 8 or 10 of menstruation with 7.5 MHz vaginal probe of Siemens ultrasound machine. Evidence of follicular growth, ovulation, and morphology of endometrial echo complex with its thickness was noted. Endometrial biopsy was performed premenstrually as a day care procedure after excluding pregnancy. Results Out of 100 women, 81 cases were with evidence of ovulation on TVS and 68 were confirmed on histopathology. All the studied patients were also evaluated for endometrial thickness on the day of ovulation, echo complex of endometrium suggestive of ovulation was seen in 64 cases, out of these 59 cases were confirmed on histopathology. On histopathological study of 100 cases, we found 69 cases with secretory endometrium, 18 with proliferative endometrium, 10 patients with endometritis, one each with luteal phase defect, irregular shedding of endometrium, and hormonal imbalance. Conclusion We found folliculometry predicted ovulation 86% accurately with a specificity of 58.60% and sensitivity of 98.55%. Similarly, appearance of endometrium predicted ovulation 85% accurately with a specificity of 83.80% and sensitivity of 85.50%. Thus, TVS has undeniable advantages in terms of cost, time, acceptability, risk, convenience, and could easily diagnose signs of ovulation in cases of infertility. The TVS has quintessential role as the first diagnostic modality in patients presenting with infertility. How to cite this article Katiyar S, Arya SB, Goel JK, Sinha M. Sonographic Folliculometry and Endometrial Echocomplex as an Evidence of Ovulation in Infertility Cases. J South Asian Feder Obst Gynae 2017;9(4):331-335.