Pub Date : 2024-02-16DOI: 10.59692/jogeca.v36i1.282
Odipo Erick, Dan Rambo, Paul Odila, Deborah Sitrin, Alinda Ndenga, Collins Mukanya
Background: Accurate maternal and child health data are essential for informed decision-making; however, maintaining consistent data quality in postnatal care and live birth records remains a persistent challenge. Since the inception of MCGL, discrepancies within these datasets have compromised the data's quality for decision making. Recognizing this, the need for an effective solution to rectify data integrity issues and enhance reliability became evident. Methods: Mentorship at the facility level was conducted for healthcare staff to ensure a clear understanding of indicators for accurate reporting, focusing on new data elements introduced in the KHIS 2020 revision. In collaboration with health information officers, the project monitoring, evaluation, and learning officer identified sets of indicators, along with closely related proxy indicators, for monitoring. A systematic approach was employed, involving a comparative analysis of primary indicators and corresponding proxy indicators. For instance, if 100 live births were recorded, an expectation of 100 infants receiving postnatal care within 48 hours was anticipated. Regular monthly communication was established with HRIOs to identify and validate discrepancies that emerged during the comparison. Results: Significant improvement in data quality was observed. From October 2020 to September 2021, 6,337 infants received PNC within 48 hours, accounting for 56% of the 11,309 live births. In the subsequent years (October 2021 to September 2022 and October 2022 to September 2023), this p increased to 89% and 92%, respectively. Conclusion: The combined impact of mentorship and regular monthly communication can enhance data quality, instilling increased confidence in data use for informed decision making.
{"title":"Enhancing data accuracy and reliability in maternal and child health: MCGL success story","authors":"Odipo Erick, Dan Rambo, Paul Odila, Deborah Sitrin, Alinda Ndenga, Collins Mukanya","doi":"10.59692/jogeca.v36i1.282","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.282","url":null,"abstract":"\u0000Background: Accurate maternal and child health data are essential for informed decision-making; however, maintaining consistent data quality in postnatal care and live birth records remains a persistent challenge. Since the inception of MCGL, discrepancies within these datasets have compromised the data's quality for decision making. Recognizing this, the need for an effective solution to rectify data integrity issues and enhance reliability became evident.\u0000Methods: Mentorship at the facility level was conducted for healthcare staff to ensure a clear understanding of indicators for accurate reporting, focusing on new data elements introduced in the KHIS 2020 revision. In collaboration with health information officers, the project monitoring, evaluation, and learning officer identified sets of indicators, along with closely related proxy indicators, for monitoring. A systematic approach was employed, involving a comparative analysis of primary indicators and corresponding proxy indicators. For instance, if 100 live births were recorded, an expectation of 100 infants receiving postnatal care within 48 hours was anticipated. Regular monthly communication was established with HRIOs to identify and validate discrepancies that emerged during the comparison.\u0000Results: Significant improvement in data quality was observed. From October 2020 to September 2021, 6,337 infants received PNC within 48 hours, accounting for 56% of the 11,309 live births. In the subsequent years (October 2021 to September 2022 and October 2022 to September 2023), this p increased to 89% and 92%, respectively.\u0000Conclusion: The combined impact of mentorship and regular monthly communication can enhance data quality, instilling increased confidence in data use for informed decision making.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"50 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.306
Wanyoike Gichuhi
Background: Progestins can suppress endogenous luteinizing hormone secretion from the pituitary gland. Progestins can be used orally and are less expensive than gonadotrophin-releasing hormone (GnRH) analogs. However, early endometrial exposure to progestin precludes fresh embryo transfer (ET), but the emergence of vitrification for oocyte cryopreservation cycles allows more opportunities for using progestins for pituitary suppression. Objective: To assess the mechanism of pituitary suppression by progestins, the effectiveness of progestins compared with GnRH analogs, the effect of progestins on oocyte and embryo developmental potential and euploidy status, and the cost-effectiveness of progestin-primed stimulation. Methods: A literature search using the keywords “multiple waves of antral ovarian follicular development, In Vitro Fertilization, Ovarian stimulation ” was performed in the PubMed database. Results: The duration of stimulation, gonadotrophin consumption, and oocyte yield were similar in progestins and GnRH analogs. However, progestins were associated with significantly lower gonadotrophin consumption than their analogs. Overall, live birth and clinical pregnancy rates per ET were similar to those of progestins and GnRH analogs. Studies comparing medroxyprogesterone acetate, dydrogesterone, and micronized progesterone suggest similar ovarian responses and pregnancy outcomes. The euploidy status of embryos and obstetric and neonatal outcomes from progestin-primed cycles are similar to those of embryos from conventional stimulation cycles. Despite the lower cost of progestins than GnRH analogs, the mandatory cryopreservation of all embryos followed by a deferred transfer may increase the cost per live birth with progestins compared with an artificial reproductive technology cycle culminating in a fresh ET. Conclusion: Progestins present an effective option for women who do not contemplate a fresh ET, e.g., fertility preservation, anticipated hyper responders, preimplantation genetic testing, oocyte donors, and double stimulation cycles.
背景：孕激素可抑制垂体分泌内源性促黄体生成素。与促性腺激素释放激素（GnRH）类似物相比，孕激素可口服使用，且价格较低。然而，早期子宫内膜暴露于孕激素会排除新鲜胚胎移植（ET），但卵母细胞冷冻周期玻璃化技术的出现为使用孕激素抑制垂体提供了更多机会。研究目的评估孕激素抑制垂体的机制、孕激素与 GnRH 类似物相比的有效性、孕激素对卵母细胞和胚胎发育潜能及非整倍体状态的影响，以及孕激素刺激的成本效益。 方法：在 PubMed 数据库中以 "多波卵巢前卵泡发育、体外受精、卵巢刺激 "为关键词进行文献检索。结果孕激素和 GnRH 类似物的刺激持续时间、促性腺激素消耗量和卵母细胞产量相似。然而，孕激素的促性腺激素消耗量明显低于其类似物。总体而言，每 ET 的活产率和临床妊娠率与孕激素和 GnRH 类似物相似。比较醋酸甲羟孕酮、地屈孕酮和微粒化孕酮的研究表明，卵巢反应和妊娠结果相似。胚胎的非整倍体状态以及孕激素刺激周期的产科和新生儿结局与传统刺激周期的胚胎相似。尽管孕激素的成本低于 GnRH 类似物，但与以新鲜 ET 为终点的人工生殖技术周期相比，所有胚胎都必须冷冻保存，然后推迟移植，这可能会增加使用孕激素的每个活产婴儿的成本。结论孕激素为不考虑进行新鲜 ET 的妇女提供了一种有效的选择，如生育力保存、预期高反应者、植入前基因检测、卵母细胞捐献者和双刺激周期。
{"title":"Progestins for pituitary suppression during ovarian stimulation in artificial reproductive technology","authors":"Wanyoike Gichuhi","doi":"10.59692/jogeca.v36i1.306","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.306","url":null,"abstract":"Background: Progestins can suppress endogenous luteinizing hormone secretion from the pituitary gland. Progestins can be used orally and are less expensive than gonadotrophin-releasing hormone (GnRH) analogs. However, early endometrial exposure to progestin precludes fresh embryo transfer (ET), but the emergence of vitrification for oocyte cryopreservation cycles allows more opportunities for using progestins for pituitary suppression. \u0000Objective: To assess the mechanism of pituitary suppression by progestins, the effectiveness of progestins compared with GnRH analogs, the effect of progestins on oocyte and embryo developmental potential and euploidy status, and the cost-effectiveness of progestin-primed stimulation. \u0000Methods: A literature search using the keywords “multiple waves of antral ovarian follicular development, In Vitro Fertilization, Ovarian stimulation ” was performed in the PubMed database. \u0000Results: The duration of stimulation, gonadotrophin consumption, and oocyte yield were similar in progestins and GnRH analogs. However, progestins were associated with significantly lower gonadotrophin consumption than their analogs. Overall, live birth and clinical pregnancy rates per ET were similar to those of progestins and GnRH analogs. Studies comparing medroxyprogesterone acetate, dydrogesterone, and micronized progesterone suggest similar ovarian responses and pregnancy outcomes. The euploidy status of embryos and obstetric and neonatal outcomes from progestin-primed cycles are similar to those of embryos from conventional stimulation cycles. Despite the lower cost of progestins than GnRH analogs, the mandatory cryopreservation of all embryos followed by a deferred transfer may increase the cost per live birth with progestins compared with an artificial reproductive technology cycle culminating in a fresh ET. \u0000Conclusion: Progestins present an effective option for women who do not contemplate a fresh ET, e.g., fertility preservation, anticipated hyper responders, preimplantation genetic testing, oocyte donors, and double stimulation cycles.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"273 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.89
Justus Wambugu, F. Oindi, Evan Sequeira
The association between endometriosis and infertility is well established and treatment is challenging. It is a chronic and debilitating disease with multiple pathophysiologic mechanisms. Treatment involves both surgical/medical interventions and ART for those with infertility. Evidence on the ideal approach is inadequate and guidelines vary. The patient’s symptomatology, age, fertility desires and prior surgical interventions are important factors to consider. Fertility preservation is paramount. We present an interesting case of a nulliparous patient who over four years has had recurrent ovarian endometriosis, underwent four laparoscopic surgical/medical interventions, and ultimately achieved a natural conception. Case A 32-year-old female presented in 2019 with symptoms of endometriosis confirmed on pelvic ultrasound. Laparoscopy, the gold standard was performed and the histology confirmed endometriosis. Postoperatively, she was on medical management to control symptoms. However, seven months later, she presented with worsening symptoms despite being on Leuprolide and later Visanne. Ultrasound showed recurrent ovarian endometriosis and uterine fibroids. A Laparoscopic myomectomy, adhesiolysis, and excision of ovarian endometriosis were done. She was then on Visanne but 6 months later her symptoms returned. A scan showed recurrent left ovarian endometriosis and she underwent laparoscopic excision. Her symptoms improved. Two years later she presented with worsening symptoms. A repeat ultrasound scan showed ovarian endometriosis. With a desire to conceive, laparoscopic excision of endometriosis, Adhesiolysis, and chromopertubation were performed. She conceived spontaneously four months later and is currently in her second trimester. Conclusion Treatment for endometriosis is an enigma and has to be individualized. Shared decision-making is important and repeated surgical/medical interventions with fertility preservation are a plausible approach for those keen on child-bearing.
{"title":"ENDOMETRIOSIS AND FERTILITY -NATURAL CONCEPTION FOLLOWING MULTIPLE SURGERIES FOR ENDOMETRIOSIS","authors":"Justus Wambugu, F. Oindi, Evan Sequeira","doi":"10.59692/jogeca.v36i1.89","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.89","url":null,"abstract":"The association between endometriosis and infertility is well established and treatment is challenging. It is a chronic and debilitating disease with multiple pathophysiologic mechanisms. Treatment involves both surgical/medical interventions and ART for those with infertility. \u0000Evidence on the ideal approach is inadequate and guidelines vary. The patient’s symptomatology, age, fertility desires and prior surgical interventions are important factors to consider. Fertility preservation is paramount. \u0000We present an interesting case of a nulliparous patient who over four years has had recurrent ovarian endometriosis, underwent four laparoscopic surgical/medical interventions, and ultimately achieved a natural conception. \u0000Case \u0000A 32-year-old female presented in 2019 with symptoms of endometriosis confirmed on pelvic ultrasound. Laparoscopy, the gold standard was performed and the histology confirmed endometriosis. Postoperatively, she was on medical management to control symptoms. However, seven months later, she presented with worsening symptoms despite being on Leuprolide and later Visanne. Ultrasound showed recurrent ovarian endometriosis and uterine fibroids. A Laparoscopic myomectomy, adhesiolysis, and excision of ovarian endometriosis were done. She was then on Visanne but 6 months later her symptoms returned. A scan showed recurrent left ovarian endometriosis and she underwent laparoscopic excision. Her symptoms improved. Two years later she presented with worsening symptoms. A repeat ultrasound scan showed ovarian endometriosis. With a desire to conceive, laparoscopic excision of endometriosis, Adhesiolysis, and chromopertubation were performed. She conceived spontaneously four months later and is currently in her second trimester. \u0000 \u0000Conclusion \u0000Treatment for endometriosis is an enigma and has to be individualized. Shared decision-making is important and repeated surgical/medical interventions with fertility preservation are a plausible approach for those keen on child-bearing.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139962585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.171
E. Gulavi, Alfred Murage
In recent years, the rising costs associated with in vitro fertilization (IVF) have become a significant concern, limiting access to assisted reproductive technologies for many aspiring parents. The rising financial burden on patients seeking assisted reproductive technologies necessitates a focused exploration of potential causes and strategic interventions to make IVF more economically accessible. The escalating cost of IVF poses a multifaceted challenge rooted in several contributing factors. Advances in reproductive technologies, the need for specialized medical expertise, and stringent regulatory requirements collectively drive up the overall expenses associated with IVF procedures. Increased demand for specialized personnel, sophisticated laboratory equipment, and adherence to stringent quality assurance measures. Moreover, the intricate nature of IVF procedures, coupled with the need for extensive hormonal stimulation and monitoring, adds to the economic burden on both healthcare providers and patients. There is a need to delve into pragmatic approaches to lower IVF costs, emphasizing collaboration and innovation. Optimization of laboratory processes, integration of artificial intelligence for predictive modeling, and standardization of protocols to streamline procedures without compromising success rates. Additionally, discussions encompass potential collaborations between the public and private sectors to foster shared responsibility and explore avenues for cost sharing. By fostering collaborative efforts and implementing innovative strategies, the aim is to make assisted reproductive technologies more financially feasible for a broader spectrum of individuals, ultimately advancing accessibility and affordability in reproductive medicine.
{"title":"Lowering the cost of fertility treatments; a reality or a mirage?","authors":"E. Gulavi, Alfred Murage","doi":"10.59692/jogeca.v36i1.171","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.171","url":null,"abstract":"In recent years, the rising costs associated with in vitro fertilization (IVF) have become a significant concern, limiting access to assisted reproductive technologies for many aspiring parents. The rising financial burden on patients seeking assisted reproductive technologies necessitates a focused exploration of potential causes and strategic interventions to make IVF more economically accessible. The escalating cost of IVF poses a multifaceted challenge rooted in several contributing factors. Advances in reproductive technologies, the need for specialized medical expertise, and stringent regulatory requirements collectively drive up the overall expenses associated with IVF procedures. Increased demand for specialized personnel, sophisticated laboratory equipment, and adherence to stringent quality assurance measures. Moreover, the intricate nature of IVF procedures, coupled with the need for extensive hormonal stimulation and monitoring, adds to the economic burden on both healthcare providers and patients. There is a need to delve into pragmatic approaches to lower IVF costs, emphasizing collaboration and innovation. Optimization of laboratory processes, integration of artificial intelligence for predictive modeling, and standardization of protocols to streamline procedures without compromising success rates. Additionally, discussions encompass potential collaborations between the public and private sectors to foster shared responsibility and explore avenues for cost sharing. By fostering collaborative efforts and implementing innovative strategies, the aim is to make assisted reproductive technologies more financially feasible for a broader spectrum of individuals, ultimately advancing accessibility and affordability in reproductive medicine.\u0000","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"12 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.169
Sahil Omar, Mital Vaya, K. Omanwa
INTRODUCTION Primary ovarian insufficiency is rare, affecting 1-2% of those under 40 with only 0.1% of cases below 30 years. Etiology is mainly idiopathic, however chromosomal defects, autoimmune processes, and iatrogenic causes are associated. Symptoms are those of menopause but of intermittent durations and severities; and management targets the symptoms and complication prevention. CASE PRESENTATION We present two 18-year-old patients of African and Indian descent with an eight and five-month history of amenorrhea respectively with otherwise unremarkable history and physical exams. Investigation showed elevated FSH levels of 45.07 and 88.73 mIU/ml done four weeks apart in the first patient and 68.69 in the second patient. All other parameters were normal. DISCUSSION Aetiology is mainly idiopathic. 10-12% of diagnosed patients have chromosomal abnormalities such as Turner’s syndrome, fragile X syndrome, and genetic permutations of FMR 1 gene. Autoimmune causes are mainly autoimmune adrenal diseases. Autoimmune thyroiditis, Dermatomyosistis and Diabetes Mellitus type 1 also show association. Mumps Oophritis is the main infectious cause. Laparoscopic surgical procedures that involve the ovaries or affect their blood supply, pelvic radiotherapy, and chemotherapy all comprise the iatrogenic causes. Lifestyle and environmental factors such as smoking and heavy metals exposure also contribute. Diagnosis is by serum FSH levels of above 25 IU/l in two separate readings four weeks apart with a four-month history of amenorrhea occurring before 40 Years. Both patients were under 30 and met the criteria. Management involves hormone replacement therapy for symptoms, prevention and treatment of osteoporosis, oocyte donation for infertility, and counseling for both the psychological impact of the disease and the numerous complications living with the disease. CONCLUSION Multidisciplinary care is necessary for management of this rare and challenging illness
{"title":"PRIMARY OVARIAN INSUFFICIENCY, A CHALLENGING DIAGNOSIS. A CASE SERIES","authors":"Sahil Omar, Mital Vaya, K. Omanwa","doi":"10.59692/jogeca.v36i1.169","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.169","url":null,"abstract":"INTRODUCTION \u0000Primary ovarian insufficiency is rare, affecting 1-2% of those under 40 with only 0.1% of cases below 30 years. Etiology is mainly idiopathic, however chromosomal defects, autoimmune processes, and iatrogenic causes are associated. Symptoms are those of menopause but of intermittent durations and severities; and management targets the symptoms and complication prevention. \u0000CASE PRESENTATION \u0000We present two 18-year-old patients of African and Indian descent with an eight and five-month history of amenorrhea respectively with otherwise unremarkable history and physical exams. Investigation showed elevated FSH levels of 45.07 and 88.73 mIU/ml done four weeks apart in the first patient and 68.69 in the second patient. All other parameters were normal. \u0000DISCUSSION \u0000Aetiology is mainly idiopathic. 10-12% of diagnosed patients have chromosomal abnormalities such as Turner’s syndrome, fragile X syndrome, and genetic permutations of FMR 1 gene. Autoimmune causes are mainly autoimmune adrenal diseases. Autoimmune thyroiditis, Dermatomyosistis and Diabetes Mellitus type 1 also show association. Mumps Oophritis is the main infectious cause. Laparoscopic surgical procedures that involve the ovaries or affect their blood supply, pelvic radiotherapy, and chemotherapy all comprise the iatrogenic causes. Lifestyle and environmental factors such as smoking and heavy metals exposure also contribute. \u0000Diagnosis is by serum FSH levels of above 25 IU/l in two separate readings four weeks apart with a four-month history of amenorrhea occurring before 40 Years. Both patients were under 30 and met the criteria. \u0000Management involves hormone replacement therapy for symptoms, prevention and treatment of osteoporosis, oocyte donation for infertility, and counseling for both the psychological impact of the disease and the numerous complications living with the disease. \u0000CONCLUSION \u0000Multidisciplinary care is necessary for management of this rare and challenging illness","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"12 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.308
P. Koigi, Kamau Koigi, M. K. Koigi
Background: There is a relatively poor understanding of the pathogenesis of pelvic endometriomas, as is the whole subject of endometriosis. The pathophysiological basis of endometriosis remains enigmatic, especially for endometriomas. Diagnostic acumen has remained low; therefore, a standardized objective treatment approach is elusive. Objective: To elucidate possible pathogenetic processes and collate them with clinical and treatment outcomes. Results: This is a relatively neglected pathologic process that affects the ovary. It is a composite component of pelvic peritoneal endometriosis with a heavier predilection toward the ovary as the target organ. Infertility is a very common outcome because of reduced ovarian reserve and the inflammatory processes that often accompany the pelvic peritoneal component. Endometriomas are very common, as reflected by the finding that 17-44% of patients with ovarian cysts have endometriomas, and endometriomas constitute 35% of benign ovarian cysts. Conclusion: The propensity of the condition, coupled with the pathophysiological impact, dictates a need for a better understanding of pathogenesis and conservative treatment that targets fertility preservation.
{"title":"Pathogenesis of pelvic endometriomas: Lessons learned from surgical management ","authors":"P. Koigi, Kamau Koigi, M. K. Koigi","doi":"10.59692/jogeca.v36i1.308","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.308","url":null,"abstract":"Background: There is a relatively poor understanding of the pathogenesis of pelvic endometriomas, as is the whole subject of endometriosis. The pathophysiological basis of endometriosis remains enigmatic, especially for endometriomas. Diagnostic acumen has remained low; therefore, a standardized objective treatment approach is elusive. \u0000Objective: To elucidate possible pathogenetic processes and collate them with clinical and treatment outcomes. \u0000Results: This is a relatively neglected pathologic process that affects the ovary. It is a composite component of pelvic peritoneal endometriosis with a heavier predilection toward the ovary as the target organ. Infertility is a very common outcome because of reduced ovarian reserve and the inflammatory processes that often accompany the pelvic peritoneal component. Endometriomas are very common, as reflected by the finding that 17-44% of patients with ovarian cysts have endometriomas, and endometriomas constitute 35% of benign ovarian cysts. \u0000Conclusion: The propensity of the condition, coupled with the pathophysiological impact, dictates a need for a better understanding of pathogenesis and conservative treatment that targets fertility preservation.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"393 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139893887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.284
Cyprian Mabonga, Linge Kavoo, Joseph Kweri, Karani Maguta, Richard Mogeni
Background: Diabetes of the bearded women was first described by Achard and Theirs in 1921 and since then insulin resistance and hyperinsulinemia in women with polycystic ovary syndrome (PCOS) remains one of the commonest metabolic problems. Insulin resistance and type II diabetes mellitus occurs in 70% of women with PCOS. The mechanism of insulin resistance has not been well established and inconsistent study results have complicated treatment modalities and management of insulin resistance and PCOS in general. There is evidence that 80% of women with PCOS are deficient in Vitamin D and this could be the missing link between Vitamin D and insulin resistance. Objective: To determine the correlation of Vitamin D, AMH and glycemic status in infertile PCOS, infertile non PCOS patients and fertile non PCOS attending Mediheal Fertility Center in Western Kenya as there is dearth of such studies within Kenyan population. Methods: A case control design with 20 patients per group for infertile PCOS, infertile non PCOS and fertile non PCOS which served as normal controls. Quantification of HbA1c was done at AMPATH reference laboratories using fluorescence immunoassay while Vitamin D and AMH was done at MTRH laboratories using ECLIA Roche. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results: The mean HbA1c and median serum AMH in infertile PCOS, infertile non PCOS and infertile non PCOS were 6.1±0.4 and 7.5(6.2, 11.1), 5.5±0.3, and (1.2, 4.4), 5.6±0.3 and 2.0(1.7, 2.3) respectively. The study revealed statistically significant increase in HbA1c and serum AMH in infertile PCOS as compared to infertile non PCOS and fertile non PCOS (F=15.7, p<0.001 and F=46.7, p<0.001) respectively. In addition, Vitamin D was significantly deficient among infertile PCOS versus infertile non PCOS and fertile non PCOS (F=41.8, p<0.001). Conclusion: Infertile patients with PCOS have deficiency in Vitamin D and increase in HbA1c and AMH hence there might be a link of Vit D and AMH in pathophysiology of insulin resistance among PCOS patient
{"title":"Vitamin D, anti-Mullerian hormone and glycemic status in infertile polycystic ovarian syndrome (PCOS), infertile non PCOS and fertile non PCOS at Mediheal Fertility Center - Western Kenya","authors":"Cyprian Mabonga, Linge Kavoo, Joseph Kweri, Karani Maguta, Richard Mogeni","doi":"10.59692/jogeca.v36i1.284","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.284","url":null,"abstract":"Background: Diabetes of the bearded women was first described by Achard and Theirs in 1921 and since then insulin resistance and hyperinsulinemia in women with polycystic ovary syndrome (PCOS) remains one of the commonest metabolic problems. Insulin resistance and type II diabetes mellitus occurs in 70% of women with PCOS. The mechanism of insulin resistance has not been well established and inconsistent study results have complicated treatment modalities and management of insulin resistance and PCOS in general. There is evidence that 80% of women with PCOS are deficient in Vitamin D and this could be the missing link between Vitamin D and insulin resistance. \u0000 Objective: To determine the correlation of Vitamin D, AMH and glycemic status in infertile PCOS, infertile non PCOS patients and fertile non PCOS attending Mediheal Fertility Center in Western Kenya as there is dearth of such studies within Kenyan population. \u0000Methods: A case control design with 20 patients per group for infertile PCOS, infertile non PCOS and fertile non PCOS which served as normal controls. Quantification of HbA1c was done at AMPATH reference laboratories using fluorescence immunoassay while Vitamin D and AMH was done at MTRH laboratories using ECLIA Roche. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. \u0000Results: The mean HbA1c and median serum AMH in infertile PCOS, infertile non PCOS and infertile non PCOS were 6.1±0.4 and 7.5(6.2, 11.1), 5.5±0.3, and (1.2, 4.4), 5.6±0.3 and 2.0(1.7, 2.3) respectively. The study revealed statistically significant increase in HbA1c and serum AMH in infertile PCOS as compared to infertile non PCOS and fertile non PCOS (F=15.7, p<0.001 and F=46.7, p<0.001) respectively. In addition, Vitamin D was significantly deficient among infertile PCOS versus infertile non PCOS and fertile non PCOS (F=41.8, p<0.001). \u0000Conclusion: Infertile patients with PCOS have deficiency in Vitamin D and increase in HbA1c and AMH hence there might be a link of Vit D and AMH in pathophysiology of insulin resistance among PCOS patient","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.307
Wanyoike Gichuhi
Background: A greater understanding of the menstrual cycle and multiple waves of antral ovarian follicular development has challenged traditional concepts of female reproductive physiology and the foundations of assisted reproductive technologies (ART). Approximately two-thirds of women develop two follicle waves throughout an interovulatory interval, and the remainder exhibit three waves of follicle development. Major and minor waves of follicle development have been observed. Major waves are those in which a dominant follicle develops; dominant follicles either regress or ovulate. In minor waves, the physiological selection of a dominant follicle is not manifested. Knowledge of the waves of antral follicular development has led to the global adoption of novel ovarian stimulation strategies in which stimulation can be initiated at various times throughout the cycle. Random-start and luteal-phase ovarian stimulation regimens have important clinical applications in women requiring urgent oocyte or embryo cryopreservation for fertility preservation before chemotherapy. Objective: To evaluate the role of multiple waves of the antral ovarian follicular in the menstrual cycle in ovulation induction in ART. Methods: A literature search using the keywords “multiple waves of antral ovarian follicular development, In Vitro Fertilization, Ovarian stimulation ” was performed in the PubMed database. Outcome: Random start and luteal phase of ovulation induction in ART offer the same results in fertilization and pregnancy rates as conventional early follicular phase start. Conclusion: The primary benefits of the random-start protocol include a patient-oriented approach to care, timely and efficient treatment, and a lower dropout rate. Women with poor ovarian reserve and those diagnosed with cancer will have a greater chance of successful assisted reproduction with the use of these strategies.
{"title":"Ovarian follicular waves in ovulation induction in assisted reproduction techniques","authors":"Wanyoike Gichuhi","doi":"10.59692/jogeca.v36i1.307","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.307","url":null,"abstract":"Background: A greater understanding of the menstrual cycle and multiple waves of antral ovarian follicular development has challenged traditional concepts of female reproductive physiology and the foundations of assisted reproductive technologies (ART). Approximately two-thirds of women develop two follicle waves throughout an interovulatory interval, and the remainder exhibit three waves of follicle development. Major and minor waves of follicle development have been observed. Major waves are those in which a dominant follicle develops; dominant follicles either regress or ovulate. In minor waves, the physiological selection of a dominant follicle is not manifested. Knowledge of the waves of antral follicular development has led to the global adoption of novel ovarian stimulation strategies in which stimulation can be initiated at various times throughout the cycle. Random-start and luteal-phase ovarian stimulation regimens have important clinical applications in women requiring urgent oocyte or embryo cryopreservation for fertility preservation before chemotherapy. \u0000Objective: To evaluate the role of multiple waves of the antral ovarian follicular in the menstrual cycle in ovulation induction in ART. \u0000Methods: A literature search using the keywords “multiple waves of antral ovarian follicular development, In Vitro Fertilization, Ovarian stimulation ” was performed in the PubMed database. \u0000Outcome: Random start and luteal phase of ovulation induction in ART offer the same results in fertilization and pregnancy rates as conventional early follicular phase start. \u0000Conclusion: The primary benefits of the random-start protocol include a patient-oriented approach to care, timely and efficient treatment, and a lower dropout rate. Women with poor ovarian reserve and those diagnosed with cancer will have a greater chance of successful assisted reproduction with the use of these strategies.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"334 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139893870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.188
P. Koigi, Akanksha Tripathi
Introduction: Assisted Reproductive Technology (ART) is beyond the economic reach of most of those inflicted by infertility in Africa. Uptake of low-cost in-vitro fertilization (LCIVF) may improve financial access of patients to advanced fertility care. Methodology: Systematic review of open-access full articles published in English from January 2000 to May 2023. Articles were sourced via PubMed, Medline, Embase and Google Scholar databases on June 1st 2023. Search keywords used were “Mild stimulation” OR “Low-cost IVF” AND “Africa”. Ethics: This project was subjected to Ethics review by the University of South Wales Ethics review Committee. Results: 5 publications included out of 647 results. These were historical reports in contextualized narrative reviews with no statistics provided. Because of this, only qualitative synthesis was undertaken, and meta-analysis was not possible due to lack of statistics for comparison. Published results indicated significant financial restriction of access and no objective demonstration of actual uptake and outcomes of mild ovarian stimulation in Africa. Discussion: There was no actual open-access published evidence regarding uptake of mild stimulation for low-cost IVF in Africa. If there is such material, it is not available to those that would actually need the information to inform providers’ practice or patient choices. This is the case despite growing evidence of increasing utility of LCIVF outside Africa. Uptake of LCIVF may potentially ameliorate financial restrictions of access to ART in Africa.
{"title":"UPTAKE AND OUTCOMES OF MILD OVARIAN STIMULATION FOR IN-VITRO FERTILIZATION IN AFRICA: A SYSTEMATIC REVIEW","authors":"P. Koigi, Akanksha Tripathi","doi":"10.59692/jogeca.v36i1.188","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.188","url":null,"abstract":"Introduction: Assisted Reproductive Technology (ART) is beyond the economic reach of most of those inflicted by infertility in Africa. Uptake of low-cost in-vitro fertilization (LCIVF) may improve financial access of patients to advanced fertility care. \u0000Methodology: Systematic review of open-access full articles published in English from January 2000 to May 2023. Articles were sourced via PubMed, Medline, Embase and Google Scholar databases on June 1st 2023. Search keywords used were “Mild stimulation” OR “Low-cost IVF” AND “Africa”. \u0000Ethics: This project was subjected to Ethics review by the University of South Wales Ethics review Committee. \u0000Results: 5 publications included out of 647 results. These were historical reports in contextualized narrative reviews with no statistics provided. Because of this, only qualitative synthesis was undertaken, and meta-analysis was not possible due to lack of statistics for comparison. Published results indicated significant financial restriction of access and no objective demonstration of actual uptake and outcomes of mild ovarian stimulation in Africa. \u0000Discussion: There was no actual open-access published evidence regarding uptake of mild stimulation for low-cost IVF in Africa. If there is such material, it is not available to those that would actually need the information to inform providers’ practice or patient choices. This is the case despite growing evidence of increasing utility of LCIVF outside Africa. Uptake of LCIVF may potentially ameliorate financial restrictions of access to ART in Africa.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"407 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.59692/jogeca.v36i1.309
K. J. Sonigra, A. R. Juma, K. Omanwa, Jael Obiero, David K Mwaura, A. Nyachieo
ackground: Male infertility affects a significant proportion of couples trying to conceive because of a variety of factors, such as low sperm count, abnormal sperm morphology, erectile dysfunction, varicocele, infections, and hormonal imbalances. This study aimed to assess the prevalence of male infertility in Nairobi, Kenya, and to better understand the causes of male infertility and improve outcomes for couples struggling to conceive. Methods: A retrospective study was conducted at an infertility clinic in Nairobi, Kenya between February 2021 and September 2022. 115 men who underwent semen analysis were chosen. Descriptive statistics were calculated for demographics and sperm parameters using SPSS version 27. Results: The average age range of study participants was 21-56 years. In most cases, 63% had progressive sperm motility, 28.3% had nonprogressive motility, and 8.7% had sperm immotility. A sperm concentration of <15 million/ml was reported in 24% of men. Of these, 40% had abnormal forms of sperm morphology. 25% had abnormal sperm vitality (<54% of sperm are alive). 32.7% of men had normozoospermia, 20.6% had asthenozoospermia, 11.5% had oligospermia, 6.06% had azoospermia, 21.2% had teratozoospermia, 7.27% had hypospermia, and 0.606 had hyperspermia. All semen abnormalities were more common among middle-class and upper-class males with an income of more than 150,000 per month, aged >35 years, and smokers. Conclusion: Male infertility is an increasing problem in lives of married couples. Age, occupation, stress, and lifestyle have a significant impact on the quality and quantity of sperm. Couple education on factors affecting male infertility should be encouraged. Clinicians should investigate males for the cause of infertility in couples.
{"title":"A retrospective analysis of semen parameters among males at an infertility clinic in Nairobi, Kenya","authors":"K. J. Sonigra, A. R. Juma, K. Omanwa, Jael Obiero, David K Mwaura, A. Nyachieo","doi":"10.59692/jogeca.v36i1.309","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.309","url":null,"abstract":"ackground: Male infertility affects a significant proportion of couples trying to conceive because of a variety of factors, such as low sperm count, abnormal sperm morphology, erectile dysfunction, varicocele, infections, and hormonal imbalances. This study aimed to assess the prevalence of male infertility in Nairobi, Kenya, and to better understand the causes of male infertility and improve outcomes for couples struggling to conceive. \u0000Methods: A retrospective study was conducted at an infertility clinic in Nairobi, Kenya between February 2021 and September 2022. 115 men who underwent semen analysis were chosen. Descriptive statistics were calculated for demographics and sperm parameters using SPSS version 27. \u0000Results: The average age range of study participants was 21-56 years. In most cases, 63% had progressive sperm motility, 28.3% had nonprogressive motility, and 8.7% had sperm immotility. A sperm concentration of <15 million/ml was reported in 24% of men. Of these, 40% had abnormal forms of sperm morphology. 25% had abnormal sperm vitality (<54% of sperm are alive). 32.7% of men had normozoospermia, 20.6% had asthenozoospermia, 11.5% had oligospermia, 6.06% had azoospermia, 21.2% had teratozoospermia, 7.27% had hypospermia, and 0.606 had hyperspermia. All semen abnormalities were more common among middle-class and upper-class males with an income of more than 150,000 per month, aged >35 years, and smokers. \u0000Conclusion: Male infertility is an increasing problem in lives of married couples. Age, occupation, stress, and lifestyle have a significant impact on the quality and quantity of sperm. Couple education on factors affecting male infertility should be encouraged. Clinicians should investigate males for the cause of infertility in couples.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"298 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：