The objective of this study was to determine the association between mycotoxins and the quality of spermatozoa in Nigeria. We designed a prospective case-control study involving 136 men diagnosed with reduced sperm count and quality in five infertility clinics in southwest Nigeria and 154 normal fertile controls. Sperm analysis was conducted in accordance with the recommendations of the World Health OrganizationWHO, while Liquid Chromatography–Mass Spectrometry was used to assay three metabolites of mycotoxins (zearalenone, ochratoxin A, and deoxyvinelol) in the urine samples of cases and controls. The data were analysed with descriptive statistics and non-parametric linear regression. The results showed no overall significant difference in levels of these metabolites between the cases and control groups. In contrast, higher levels of zearalenone and ochratoxin A significantly decreased sperm motility in the cases. Similarly, an increase in the level of ochratoxin A decreased sperm morphology in the unadjusted model in the cases. We conclude that exposure to mycotoxins reduces the quality of spermatozoa (motility and morphology) in Nigerian men but may have no effect on sperm count. Efforts to reduce the exposure of men to mycotoxins are important interventions to improve sperm quality and reduce the prevalence of male infertility in the country.

Background:Parabens, which are chemicals used as preservatives in cosmetic and pharmaceutical products, have been reported to be associated with low sperm quality in animal and human models. Despite the high exposure of men to paraben-containing products in Nigeria, there are no known studies that investigate the association of parabens with sperm quality in the country.Objective:To determine the association of urinary levels of metabolites of parabens with sperm count and quality.Design/Setting:A multicenter case-control study among fertile and infertile men in five hospitals in southern Nigeria. A total of 136 men diagnosed with male infertility (cases) were compared with 154 controls with normal fertility. Urinary levels of parabens (ethyl-paraben, methylparaben, propylparaben, and butylparaben) were measured using liquid chromatography mass spectrometry, while semen analysis and hormone assays were carried out using World Health Organization standards and radioimmunoassay, respectively. Data were analyzed with non-parametric statistics and non-parametric linear regression.Results:The results showed high levels of parabens in both cases and controls. However, there was no statistically significant difference in urinary levels of ethyl-paraben, methylparaben, propylparaben, and butylparaben between cases and controls. In contrast, propylparaben had a decreasing association with total motility in both groups, but the effect was only statistically significant in the case of male infertility. The results of the regression analysis showed that a unit increase in propylparaben significantly decreased total motility in the cases (infertile men). Similarly, a unit increase in propylparaben decreased morphology significantly in the unadjusted model for infertile men. Only serum testosterone showed an insignificant correlation with urinary parabens.Conclusion:We conclude that urinary parabens are associated with features of poor sperm quality - motility, morphology, and volume. Measures to reduce exposure of men to agents containing parabens in Nigeria may reduce the prevalence of male infertility in the country.

Background: As the number of older women attempting to conceive through donor oocyte-in vitro fertilization (DO-IVF) rises, their safety in pregnancy needs to be judiciously considered. Aims: This study aims to review the obstetric and perinatal outcomes of pregnancies achieved by DO-IVF. Study Setting and Design: A retrospective study design conducted at a private health facility with services for assisted reproduction and gynecologic endoscopy. Methods: A retrospective comparative study of all pregnancies achieved using DO-IVF and that using Self oocyte In-vitro fertilization (SO-IVF) treatment over a 3 years' period was performed. Statistical Analysis: Comparative analysis of demographic variables, major obstetric, and perinatal complications was done with Chi-square test and Student's t-test as appropriate. Regression analysis was done to determine a significant predictor variable for pregnancy and delivery outcome. The significance level was set at P < 0.05. Results: A total of 343 completed IVF treatment cycles was reviewed; there were 238 DO-IVF and 105 SO-IVF cycles, with clinical pregnancy rate of 41.6% and 37.1%, respectively. The DO-IVF group was significantly older than the SO-IVF group (46.1 years vs. 34.1 years, P < 0.001). Major obstetric complications identified, were hypertensive disorders in pregnancy (23.9%), preterm labor (16.7%), antepartum hemorrhage (11.6%). There was no statistically significant difference between the two groups in terms of obstetric complications and adverse maternal or perinatal outcomes. There were 97 (77.6%) singleton and 28 (22.4%) multiple pregnancies. Pregnancy complications were significantly associated with fetal plurality, P < 0.001. Multiple pregnancy had higher odds of experiencing adverse perinatal 4.96 (1.95–12.58) and maternal 7.16 (2.05–25.03) outcomes compared to singleton pregnancies, P < 0.001. Conclusion: Key obstetric outcomes did not differ between DO or SO IVF achieved pregnancy. Even for older women, satisfactory outcomes can be expected for pregnancies achieved by DO-IVF. It is, however, instructive that for multiple pregnancies, obstetricians should institute appropriate surveillance strategies during pregnancy and delivery period and also to develop institutional capacity for quality neonatal care.

Background: Hysteroscopy is a standard method for the evaluation and treatment of various gynecological disorders. Its availability and accessibility are limited in our setting owing to resource constraints. Nevertheless, the utilization is on the increase mostly in private health institutions in Nigeria and as an adjunct in infertility management. Objectives: The objective is to document the experience and outcome of hysteroscopy surgeries at a private specialist-assisted reproduction and endoscopy unit. Materials and Methods: A retrospective review of all hysteroscopic procedures conducted at the unit was undertaken. Relevant sociodemographic and clinical information were extracted for analysis. In addition, outcomes of the procedure and outcome for those who eventually had in vitro fertilization (IVF) treatment were documented for analysis. Results: A total of 106 patients had hysteroscopy over the study period. The age of patients ranged from 24 to 55 years. The most common indication for hysteroscopy was uterine synechiae (50%) others were preparatory for IVF (30.2%), uterine fibroid/polyp (10.4%), and abnormal uterine bleeding (9.4%), respectively. The major findings at hysteroscopy were intrauterine adhesions 68.9%. Therapeutic adhesiolysis was done using the scissors in most cases (83%) while two patients (1.9%) had adhesiolysis and resection of uterine polyp. A complication of noncardiogenic pulmonary edema was recorded from fluid overload. Overall most had return to normal menses (65.1%). Thirty-nine (38.8%) women had IVF treatment after hysteroscopy of which outcome was successful in 16 (41%) women. Conclusion: The utilization of hysteroscopic surgeries in management of endometrial pathologies is increasing. It offers a safe and effective treatment and is a useful adjunct for improving IVF outcome especially for those with repeated failed treatment.

Objective To evaluate whether treatment of slow labor progress among term nulliparous women using a 2-hour partograph action line reduces the incidence of prolonged labor versus a 4-hour action line. Methods Randomized controlled trial of nulliparous women with a term singleton, non-macrosomic, cephalic fetus in labor attending a university hospital in Nigeria (2008-2015). For labor supervision, women were randomly assigned to the 2-hour (n=320) or 4-hour (n=320) partograph action line group. slow labor progress was treated with oxytocin augmentation The primary outcome was incidence of prolonged labor (>12 hours). Delivery mode, neonatal outcomes, and maternal satisfaction with treatment were secondary outcomes. Results Prolonged labor rate did not significantly differ between the 2-hour (7/320, 2.2%) and 4-hour (8/320, 2.5%) action line groups. Secondary outcomes did not differ significantly. Oxytocin augmentation to treat slow labor progress was needed for 87 (27.2%) and 61 (19.1%) women in the respective 2- and 4-hour groups (P=0.025). Mean duration of first and second labor stages differed significantly between the groups (P<0.05). Conclusion The 2-hour partograph action line did not reduce incidence of prolonged labor relative to the 4-hour action line. Partograph with a 4-hour action line is recommended for labor supervision in all facilities.

Background: In-vitro fertilization (IVF) has established its place in the management of infertility cases that has defied conventional treatment. A successful In-vitro fertilization outcome is based on a good ovarian response to gonadotrophin stimulation. Body mass index has been identified as one factor that can affect ovarian response however; there is no consensus about its impact outcome.Objectives: To determine the effect of body mass index (BMI) on ovarian response in an Invitro fertilization cycle.Method: A Prospective cohort study to determine the response to Controlled Ovarian Hyperstimulation (COH) in women with normal and abnormal BMI in an IVF cycle. One hundred and four (104) consenting women undergoing non-donor IVF cycles in a university teaching hospital were recruited for the study. Selected participants had their body mass indices (BMI) assessed and classified into 3 groups: Normal weight (18.5-24.9kg/m2), overweight (25-29.9kg/m2) and obese (≥30kg/m2). There were no underweight women-BMI <18.5kg/m2. All the participants had Controlled Ovarian Hyperstimulation with the long agonist protocol.Selected participants had follicular count assessed using a transvaginal sonography on day 3, 5, 10 and at retrieval. The effect of ovarian response with the IVF treatment assessed based on total number of follicles and oocyte yield on the day of retrieval.Results: Female participants with normal weight women were thirty-six (34.6%), overweight were forty (38.5%) and obese, twenty-eight (26.9%). There was no statistical significant difference when the ages of women at presentation, total gonadotrophins requirements, duration of stimulation and number of oocytes retrieved were compared in the three groups.Conclusion: Increase in body mass index does not appear to have an adverse effect on ovarian response in an In-vitro fertilization cycle._________________________________________________________________________Keywords: body mass index, infertility, ovarian stimulation, gonadotrophins, IVF cycle.

Background: In-vitro fertilization (IVF) is associated with increased multiple pregnancy and its attendant complications. This study evaluates the attitude and acceptance of single embryo transfer (SET) and multifetal pregnancy reduction (MFPR) by clients assessing assisted reproduction in this region.Methods: A cross sectional survey of patients selected for IVF was conducted. Information on demography, knowledge of IVF procedure and their perception, attitude and acceptability of multiple pregnancy as well as their knowledge, attitude and perception to single embryo transfer and multifetal pregnancy reduction were extracted for statistical analysis.Results: Seventy-three women participated in the study. The mean age was 39 years and mean duration of infertility was 8.6 years. Only 3 (4.1%) respondents agreed to have SET as the overwhelming majority (70) 95.9% preferred 2 or more and they felt the more number of embryo transferred the better the chances of achieving pregnancy. Similarly most respondents, 38.4% (28) did not accept MFPR. Most respondents considered age (63%) and duration of infertility (78.1%) as major influencing factor for rejecting SET. Over 75% of respondents said they will still accept multiple embryos transferred despite knowledge of the possible complications.Conclusions: While most infertile women in our sub region appear to recognize the risks with multiple pregnancy, they are less interested in SET or MFPR because they perceive more embryos transferred as a means to maximize treatment outcome. Government funding, client education and a blastocyst transfer protocol may improve acceptability as well as overall preference for less number of embryos transferred in our environment.

BACKGROUND:Infertility as well as obesity are risng global concern. Whilst there is an established association between female obesity and infertility, a similar link is yet to be proven in men.OBJECTIVE:To determine the effects of elevated body mass index (BMI) on semen quality among male partners of infertile couples attending an infertility clinic.MATERIALS AND METHODS:In this cross-sectional study, 206 men who met the inclusion criteria were recruited for the study. Selected participants were grouped according to their BMI (kg/m2): normal BMI (18.5-24.9 kg/m2) and elevated BMI (≥25 kg/m2). The effect of weight on semen quality was assessed based on sperm count, percentage motility, and morphology.RESULTS:The number of participants with normal BMI was 110 (53.4%) while those with elevated BMI were 96 (46.6%). Of the participants in elevated BMI group, 52 (25.2%) were overweight and 44 (21.4%) were obese. There was no statistically significant difference in the semen quality as well as the pattern of semen parameter abnormalities between males with normal and elevated BMI (overweight or obese) (p=0.813).CONCLUSION:Elevated BMI did not significantly influence semen quality.

Objective: The objective of the study is to evaluate the effect of female age on the outcome of ovarian stimulation (OS) and intrauterine insemination (IUI) treatment. Methodology: This was a 36 months' retrospective analysis of all IUI treatment cycles with prior OS. Based on the age of the women, 4 groups were identified for comparative analysis, namely women below 30 years, between 30 and 34; 35–39 years, and women aged 40 years and beyond. Results: Two hundred and seventeen IUI procedures were conducted during the study and 39 had a positive pregnancy test outcome (a pregnancy rate of 18%). Majority of the women were 35–39 years (41.5%), while 12% were 40 years and above. The pattern showed that the pregnancy rate was highest in the younger age group who were below 30 years, 6/18 (33.3%) and 30–34 years, 19/83 (22.9%) compared with women 35–39 years, 12/90 (13.3%) and ≥40 years, 2/26 (7.7%). The difference in the linear association of each age class compared to the next was significant (P = 0.06 and P = 0.007, respectively). The trend revealed that baseline follicle stimulating hormone increased with age and the youngest age group required significantly fewer units of human menopausal gonadotropin to achieve adequate response to OS compared to the oldest age group (P < 0.001). Conclusion: Advanced age negatively affects OS and IUI outcome. Treatment is associated with better pregnancy outcome in women under 35 years compared to women who were 40 years and beyond. This fact should be clearly emphasized at counseling of the 40-year-old that may opt for IUI treatment.

Gonadal dysgenesis represents a congenital developmental disorder of the reproductive system, with its main gynaecologic manifestations being amenorrhea and infertility. We present a unique case of pure gonadal dysgenesis in an ‘about to be’ married lady resident in a society where high premium and success in marriage is dependent on childbirth. With astute evaluation and counseling, assisted reproductive technology (ART) was safely and successfully used in this case with eventual triplet pregnancy and delivery. Our index experience shows that situations with compromised fertility the availability and access to ART aids effective treatment planning and births a re-invigorated hope for family life.

AIMS AND OBJECTIVES:To determine the prevalence of sleep disorders in a population of Nigerian women during pregnancy and to evaluate the frequency of these sleep disorders according to the three trimesters of pregnancy. SUBJECTS AND METHODS:A prospective cross-sectional design. Participants' were interviewed at the antenatal clinic with a questionnaire to evaluate their sleep during and before pregnancy and to appraise disturbance in their sleep according to the trimester. RESULTS:Two hundred and three pregnant women participated in the survey and were evaluated at one of three points in pregnancy: 1st trimester (n=57), 2nd trimester (n=71) and 3rd trimester (n=75). Overall, the prevalence of sleep disorder in the population surveyed was 35.5% (72/203), more women experienced sleep disturbances in the first (42.1%) and third (40%) trimester of pregnancy compared to the second (25.3%). In terms of types of sleep disorders; 96(47.3%) reported insomnia, 32(15.8%) sleep breathing disorders, 86(42.4%) excessive daytime sleepiness, 172(84.7%) mild sleepiness and 64(31.5%) significant specific awakenings. The most common reason for specific awakening was frequent urination (78.6%). These sleep disorders were more common in the third trimester of pregnancy but only insomnia and specific awakenings showed statistical significance, p=0.007 and 0.031 respectively. Logistic regression model showed that nulliparity, increased BMI and previous adverse obstetric events had significant independent associations with sleep disorders. CONCLUSION:Sleep disorders are common in pregnancy, notably in the first and third trimesters.

It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of the essence and purpose of the partograph. The partograph is a form on which labor observations are recorded to provide an overview of labor, aiming to alert midwives and obstetricians to deviations in labor progress as well as maternal and fetal wellbeing. When deviations in labor progress are recognized early and corrected, complications are prevented and normal labor and delivery can occur. The earliest deviation in labor progress is slow labor progress, for which the partograph alert line is a prompt for early recognition by the midwives and other non-obstetric staff. The intervention to correct the deviation is at the action line by the staff with the requisite skill. In the circumstance in which the partogram was produced, the action to correct the deviation in labor progress was after 4 h, represented by the 4-h action line, but other workers have attempted with 2- and 3-h action lines and have had equally good results. However, in all these, the action at the action line was instituted by the staff with the appropriate skill, irrespective of whether the action line was 2, 3 or 4 h. As long as the action at the action line is by the staff with the requisite training, the deviation in labor progress will be corrected by either medical or surgical means irrespective of the action line location at 2, 3 or 4 h. In conclusion, the essence and purpose of the partograph is to ensure that labor progress is monitored to identify slow labor by the alert line but appropriate treatment must begin at the action line by the staff with the cognate skill, whether at 2, 3 or 4 h. The appropriateness of the intervention at the action line is the determinant of the outcome and not the delay.

Objective: To assess the results of an in vitro fertilization program newly established within a conventional infertility program at a university hospital in Nigeria. Methods: From June 1, 2007, to June 30, 2011, following unsuccessful conventional treatments, 600 couples were offered in vitro fertilization with (if needed) intracytoplasmic sperm injection in batches of 30 couples. The outcomes measured were duration of ovarian stimulation and rate of ovarian hyperstimulation syndrome; numbers of follicles aspirated, oocytes retrieved, oocytes fertilized, and embryos transferred; and clinical pregnancy rate. Results: The mean duration of stimulation was 11.8 +/- 1.6 days and 1% of the women had severe ovarian hyperstimulation syndrome. The mean number of follicles aspirated was 8 +/- 2.8; of oocytes retrieved 6 +/- 3.2; and fertilized 3 +/- 1.8. The maximum number of embryos transferred per woman was 3. The rates of clinical pregnancy and multiple pregnancy were 30% and 6.0%. The rates of abortion and ectopic pregnancy were 6.6% and 0.6%. The preterm delivery rate was 2.5%. Conclusion: Successfully conducting an assisted reproduction program at a public health facility is feasible in a low-resource country. Treating couples in batches was cost effective, with a low complication rate. (C) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Background: Membrane rupture may be integral to labour initiation in paturients with premature rupture of membranes [PROM] and therefore, it may be logical to expect that their labour characteristic and pattern should differ from those with intact membrane undergoing induction of labour. This study compared the ′a′bour characteristics in patients with PROM who had stimulation of uterine contractions with oxytocin with ′tose parturients with intact membranes who underwent induction of labour. Wtethod: This was a retrospective study conducted at the Obstetrics and Gynaecology department of the University of Benin Teaching Hospital (UBTH). The case files of 463 consecutive patients for induction/stimulation of labour from October 2008 to September 2009 were reviewed. Paturients were located into two groups; those with term premature rupture of membranes (PROM) and those with intact membranes who underwent induction of labour. Comparison was made between the labour characteristics of groups, mode of delivery, intrapartum complications and neonatal outcome. Results: During the study period a total of eligible 284 paturients with intact membranes had induction of labour [IOL], while 179 paturients with PROM had stimulation of labour [SOL]. Both groups were comparable in their sociodemographic and clinical characteristics. Majority of the PROM cases were contracting at admission [40.8% to 22.5%], also they had significantly shorter latent period [3.3hrs to 5hrs], required less use of higher oxytocin dose [3.9% to 7.4%] and had shorter labour duration (induction f c delivery interval: 6.7hrs to 9.1hrs). There was no difference in their mode of delivery or caesarean section rate. There were no significant differences in intrapartum complications and neonatal outcome measures. Conclusion: The finding of a significant shorter latent period, requirement for less oxytocin dose and overall shorter duration of stimulated labour cases with PROM compared to induction of labour for those with intact membranes suggest that PROM may be a means of labour initiation by some parturients and thus implies that these two groups of paturients are different obstetric entities and should therefore be treated as such in their labour management and research consideration.

Background: In-vitro fertilisation and embryo transfer (IVF-ET) treatment for infertility was only available in a few private hospitals in Nigeria until recently when two government hospitals including University of Benin Teaching Hospital commenced IVF-ET services. The socio-demographiccharacteristics of patients seeking IVF-ET treatment in Nigeria have not been sufficiently documented.Objective: To describe the socio-demographic characteristics of patients seeking IVF-ET treatment in a public hospital in Nigeria.Methodology: A descriptive study of 187 partners who attended UBTH between April 2007 and October 2008. Outcome measure: Mean age, parity, duration of infertility, social class, indications for infertility.Results: The mean ages of the women and their husbands or male partners were 36.7 and 43.7 years respectively. 82.4% of the women were nullipara while 17.6 were multipara. Twelve point two percent had at least a living child. All the couples were in social class I-III. Tubal blockage was the commonest single indication for IVF-ET while ovulation disorder and male factor as single indications accounted for 12.2 and 8.1% respectively. Almost 17% of the women had multiple female factors while 39.9% had both male and female factors responsible for their infertility.Conclusion: Majority of patients seeking IVF-ET are advanced in age with longstanding infertility and have no children. The poor are not accessing IVF-ET yet.Keywords: Infertility, socio-demograhic characteristics, IVF-ET

CONTEXT:Pregnancy - induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focused on early onset pregnancy induced hypertension/eclampsia in Nigerian women.OBJECTIVES:To determine the incidence, clinical features and outcome of cases of early onset pregnancy-induced hypertension /eclampsia in a Nigerian tertiary hospital, and compare maternofetal outcome in early and late onset disease. Methods : A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital.MAIN OUTCOME MEASURES:Severity of disease, rates of induction of labour, caesarean section rate, maternal mortality, abruptio placenta, still births, severe birth asphyxia and early neonatal deaths.RESULTS:Early onset pregnancy induced hypertension/eclampsia contributed 6.3% of all cases of hypertensive disorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3%) The disease was severe at presentation or rapidly progressive in 39 cases (84.8%) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7% of cases. The perinatal survival rate was 34.0%. Early onset pregnancy induced hypertension was associated with significantly higher risk of presenting with eclampsia, having induction of labour and worse perinatal outcome than late onset disease.CONCLUSION:Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease.

The role of Chlamydia trachomatis in the pathogenesis of Pelvic inflammatory disease and majority of cases of salpinigitis are well acknowledged in women. A total of 213 sera from infertile women were tested for antibodies to Chlamydia trachomatis by using an indirect solid phases enzyme Immuno absorbent commercial ELISA test. Women with confirmed Hysterosalpinographic report suggesting tubal occlusion (tubal factor infertility) had 92 (43.2%) followed by 63 (29.6%) infertile women with infertile male partner and 58 (27.2%) were having unexplained infertility. Out of the tubal factor (TF) infertile women 40 (18.8%) were seropositive for Chlamydia trachomatis antibodies, as against 19 (8.9%) in the group of women with normal patent tubes and 10 (4.6%) women with infertile male partner. In this study there was a statistical significant correlation between the infertile women with tubal factor infertility in relation to seroevidence of Chlamydia trachomatis infection with p<0.05. There was no age bias in the serodetection of Chlamydia trachomatis antibodies. The seropositivity of Chlamydia trachomatis is an indication that the organism may be an independent risk factor in the development of an inflammatory process leading to scaring of the uterine tubes in women and thereby causing infertility.