Background: Intrauterine insemination (IUI) is a widely acceptable fertility treatment modality. GnRH antagonists have been proven effective in restricting the LH surge. The aim of the study was to assess whether the addition of gonadotropin releasing hormone antagonist (Cetrorelix) would improve clinical pregnancy rate in women undergoing IUI.  Methods: This prospective randomized controlled trial was conducted at a Sudha fertility center where 730 women with primary or secondary infertility were subjected to controlled ovarian stimulation with tablet letrozole 5mg once daily for 5 days and then human menopausal gonadotrophins 75 IU/150 IU administered intramuscularly for both the groups and for study group alone Cetrorelix (0.25 mg/day, started when the leading follicle was ≥16 mm; GnRH antagonist) was given additionally. A double insemination was performed at 36 hours and 60 hours after hCG was given (5,000 IU, intramuscularly) in both groups. Chi-square and independent t test was done. Results: Baseline characteristics in both the groups were almost equal without any statistically significant difference. Significant difference (p=0.017) was found on calculating with statistics among both groups on analyzing LH on hCG day. Clinical pregnancy rates (29.3%) were higher among the study group compared with the control group (21.7%). Conclusions: From the present study results it shows that addition of GnRH antagonists to controlled ovarian stimulation IUI significantly decreases the incidence of premature luteinization and increases the clinical pregnancy rates and live birth rate.

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BACKGROUND People who develop end stage renal disease often need dialysis in which a machine performs a basic function of kidney. 1,2 Before a patient begins dialysis treatment, a minor surgical procedure called arteriovenous (AV) fistula is done. Creating an AV fistula allows arterial pressure to enlarge the vein over time better enabling it to receive the volume of blood coming back into the body. The rising prevalence of end stage renal disease (ESRD) and the consequent impact on heathcare economics has resulted in increasing focus on delivery of vascular access care which is considered the Achilles' heel of haemodialysis. The autologous arteriovenous fistula is the acceptable gold standard mode of vascular access for haemodialysis in terms of longevity, patient morbidity and health care costs in developing country like India. Brescia-Cimino Radio Cephalic Arterio-Venous fistula (RC-AVF) at the wrist remains the vascular access of choice for haemodialysis even today 3. Creating an autologous fistula with arteriotomy diameter of 3 mm in longitudinal axis of radial artery gives better success rate and long duration of patent functioning fistula. MATERIALS AND METHODS Hundred patients with ESRD were selected for whom arteriovenous fistula, radio cephalic end to side anastomosis was done. A study was done regarding the long-term patency rate by taking arteriotomy diameter into consideration. In 50 of them, 3 mm arteriotomy was done-group 1; and in another 50 of them <3 mm arteriotomy was done-group 2 patients. Two groups were compared with study variables by mean duration of surgery, intra operative bleeding, obtaining immediate thrill, visibility of immediate pulse and post operative follow up for noting the patency and functioning fistula was done every 1, 3 and 6 months. RESULTS The study results were analysed statistically by means of Mean, Standard deviation, Chi-square test and Fishers exact test for significance. Of the 100 patients, most of them were males with ESRD (74%), mean age of all patients in this study was 49.5+10.9 years., the mean duration of surgery in group was 149.3 min with p value 0.0001. Less intra operative complications were seen in group 1 patients. (p value 0.0001). Immediate pulse was seen in all 50 patients of group 1 on operation table itself. Immediate thrill was observed in 98% in group 1 and 78% of group 2 patients (p value 0.0001). All the patients were followed post operatively every 1, 3 and 6 months during their visit to nephrologist and haemodialysis centre and postoperative functioning of fistula and fistula use in dialysis enquired; observation of the patency of fistula and thrill was done. In the follow up period, patency rate after 6 months was seen in more cases of group 1 (p value 0.00001). CONCLUSION End stage renal disease patients who need a long-life vascular access for haemodialysis, arteriovenous fistula which were created at the distal forearm with end to side radiocephalic anastomosis proved to have long life of more than 6 months with 3 mm arteriotomy diameter...

To study the effect of endometrial polyps in infertility patients and their insinuation in pregnancy rates in patients undergoing ICSI-FET cycles following polypectomy.This is a retrospective study in 345 infertility patients attending Reproductive center of Sudha Hospital, Erode. Infertile women with endometrial polyps diagnosed by transvaginal ultrasound were subjected to hysteroscopic polypectomy. Vitrified embryo transfer was done one to three months following polypectomy and the clinical pregnancy rates were analysed. The age, body mass index, the type of infertility (primary or secondary), duration of infertility, pattern of menstruation, were precisely evaluated. An endometrial polyp based on their location inside the uterine cavity is assessed by hysteroscopy and the significance of the polyp location with pregnancy rates is evaluated.Of the 345 women who underwent hysteroscopic polypectomy 229 became pregnant and 116 women were non pregnant in ICSI-FET cycles. There is a strong positive association between endometrial polypectomy and pregnancy rate in ICSI-FET cycles. The incidence of Endometrial Polyps in pregnant and non-pregnant group was not related to the age, gravida and parity. Pregnancy rate after polypectomy based on polyp location is statistically insignificant. Multiple polyps are common compared to solitary polyp. Polyps are more common in posterior uterine wall than anterior, lateral walls and uterotubal junction.Hysteroscopic polypectomy gives promising results in infertility patients undergoing ICSI cycles prior to vitrified embryo transfer and location of polyps does not determine the pregnancy outcomes.

To present case reports of heterotopic cervical pregnancy successfully treated with conservative transvaginal ultrasound guided aspiration followed by intra-amniotic instillation of KCL. Design: Case report Setting: Advanced ART -ICSI cycle Patients: Two cases of infertility with cervical heterotopic pregnancy following ICSI FET cycle. Intervention: Transvaginal ultrasound guided intra-amniotic aspiration followed by intra-amniotic instillation of KCL. Main outcome measure: Successful outcome of intrauterine pregnancy, decreased maternal and fetal morbidity and recovery of the patients. Result: Successful selective reduction of cervical pregnancy and delivery of the intrauterine pregnancy at term. Conclusion: Transvaginal ultrasound guided aspiration followed by intra-amniotic instillation of KCL can be safely used as a conservative measure to manage cervical heterotopic pregnancy.