Background Altered renal function is an essential component of the pathophysiological process in pre-eclampsia. Kidneys play an important role in the turnover of low molecular weight substances such as creatinine, uric acid and cystatin C. The present study was undertaken if these serum markers were characteristically altered in Indian pregnant women. Methods Serum levels were therefore determined in samples from 69 healthy women at term as well as in 27 samples of patients with Pregnancy induced hypertension (PIH) and in 20 patients with pre-eclampsia (PE). Results The levels of all three components were significantly higher in pre-eclamptic patients when compared to healthy controls with the mean ± SD being 1.47 ± 0.9 vs. 1.06 ± 0.2 for cystatin C, 0.95 ± 0.2 vs. 0.67 ± 0.1 for creatinine and 6.13 ± 1.8 vs. 4.28 ±1.1 for uric acid respectively. In PIH cystatin C was significantly higher, 1.25 ± 0.9 unlike creatinine, 0.67 ± 0.14 and uric acid, 4.30 ± 1.0. Receiver operating characteristic (ROC) plots demonstrated that the diagnostic accuracy of serum creatinine was superior to serum uric acid and serum cystatin C and serum uric acid was better than serum cystatin C. Conclusion The maternal serum cystatin C, creatinine and uric acid were all significantly elevated at the end of pregnancy in pre-eclampsia compared to those of healthy pregnant women. If this rise in the above markers during early pregnancy could predict the onset of PIH/PE, needs to be investigated.

Background and objective Hysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility. Methodology This study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study. Results A total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302). Conclusion Compared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.

Background: The method of sperm retrieval for azoospermic patients had evolved in the recent times and micro-dissection TESE being the latest method for the same. Patient selection for TESE has always been an area of concern. Although low level of serum FSH is good indicator for successful sperm retrieval for conventional TESE, its role for micro-TESE is debatable. The primary objective of present study is to determine whether serum FSH level can predict success rate of sperm retrieval by micro-dissection TESE (micro-TESE). In addition, authors have compared the outcome of ICSI-TESE cycles between obstructive and nonobstructive azoospermia.Methods: This is a retrospective study conducted at Guru Hospital, Madurai, India between January 2014 and February 2018. Data collected from the previous hospital records.Results: Out of a total 147 azoospermic patients included in present study 68 (46.3%) were obstructive azoospermic whereas 79 (53.7%) were of nonobstructive variety. While assessing TESE- ICSI outcomes among obstructive versus nonobstructive azoospermic groups, authors found that the two groups had similar clinical pregnancy rates per transfer, chemical pregnancy rates per transfer, implantation rates, live birth rates and abortion rates per transfer. Authors also compared serum FSH level between micro TESE positive and micro-TESE negative groups. But there was no significant difference between the two groups. Authors could not find any definite correlation between serum FSH and sperm retrieval rate.Conclusions: For nonobstructive azoospermic men, TESE-ICSI provides a hope to parenting their genetically own child. Of course, before advising TESE-ICSI, nonobstructive azoospermic men should be counseled regarding the low success rate of sperm retrieval. Serum FSH level cannot predict success rate of sperm retrieval for patients undergoing micro-TESE.

Uterine leiomyomas are the most common pelvic benign tumours affecting women of reproductive age group. Parasitic leiomyoma is a type of leiomyoma which has been completely detached from uterus and is having independent blood supply from nearby structures, it’s attached with. Parasitic leiomyoma is regarded as a sub-type of subserosal fibroid by some authors. While others consider it as a complication of uterine procedures being performed for some type of uterine pathology. Here we are reporting a rare case of primary parasitic leiomyoma with concurrent multiple uterine leiomyomas that were managed by laparoscopic myomectomy. They create clinical dilemma due to their tendency to mimic as other pelvic tumours. So parasitic fibroids must be kept in the differential diagnosis of every case of abdominopelvic mass. Finally, it can be a rare complication of morcellation procedure performed for myoma retrieval and hence caution should exercise during such procedures.

BackgroundDisorders of sex differentiation (DSD) are very important issues in clinical practice, particularly because of their rarity and difficulty pertaining to their diagnosis and management. Persistent Mullerian duct syndrome (PMDS) is a form of disorders of sex differentiation (DSD) caused by a defect in the Mullerian inhibiting substance (MIS) system. Patients are genotypically as well as phenotypically male but with the presence of Mullerian duct derivatives [1]. This entity is often misdiagnosed due to a lack of familiarity with the condition and requires a high B. Kalpana MD (O&G), FNB (Rep. Medicine), FICOG, FIAOG