Diminished fertility and poor ovarian response pose a conundrum to the experts in the field of reproductive medicine. There is limited knowledge about the risk factors of diminished ovarian reserve other than the iatrogenic ones. One of the leading causes of infertility in women today is diminished ovarian reserve (DOR). DOR is characterized by a low number of eggs in a woman’s ovaries and/or with poor quality of the remaining eggs, which boils down to impaired development of the existing eggs, even with assisted reproductive techniques. A good number of such women with low ovarian reserve may conceive with their own eggs, if they are given individualized treatment that is tailored for their profile. Such patients should be counseled appropriately for an aggressive approach towards achieving fertility. The sooner the treatment is started, the better the chances of pregnancy.

Introduction Intrauterine contraceptive devices (IUCD) are a commonly used, reversible, contraceptive method. Complications from insertion rarely include migration into the bladder. We report on two cases of intravesical migrated IUCD and present an algorithm for management based on recently published data. Materials and Methods The case records of two patients who underwent surgical procedures for migrated IUCD into the bladder were reviewed. A Pubmed search was performed to identify similar studies. A total of 25 papers met the criteria for inclusion. Results Both cases were managed with laparotomy and partial cystectomy. A review of literature suggests recently reported cases of IUCD migration are rising, with most cases having been reported in the last decade. Bladder calculus developing over the migrated IUCD is the most common presentation. Most cases have been managed using endourological techniques. A small number of cases have required open vesicolithotomy or laparoscopic surgery. Rarely, laparotomy has been required. Discussion IUCD migration into the bladder remains rare, however, recently the number of reported cases has risen. A thorough physical examination and radiological evaluation are warranted. Management is surgical in all cases. Most cases can be managed with endourological techniques. A treatment algorithm has been suggested in this paper based on recent data. Conclusion With the rising use of contraception worldwide, the incidence of IUCD migration is possibly going to increase. Treating doctors need to be aware of the possible complications that may arise from a migrated IUCD, including bladder calculi.

By virtue of insulin resistance being the common etiology for polycystic ovary syndrome (PCOS) and metabolic syndrome, the cardiometabolic risks of these two syndromes are shared. The usual concerns of a PCOS patient are cosmetic or reproductive. However, there are more serious concerns past the reproductive age. Early treatment of insulin resistance, hypertension and hyperlipidemia reduces the long-term risk. This review highlights the unhealthy association of metabolic syndrome with PCOS and emphasizes the importance of early diagnosis, patient education and long-term follow-up beyond the reproductive age into menopause to prevent the long-term serious co-morbidities.

Introduction: Ectopic pregnancy can mimic practically each and every gynaecological disorder as well as many surgical catastrophes. It has always challenged ingenuity of the obstetricians and gynaecologists by its bizarre clinical picture. If it is not diagnosed attended in time, it may lead to maternal morbidity and mortality. Methodology: This study was conducted on 440 patients at Government Medical College, Srinagar between Jan 2018 and March 2020. All study participants consented in writing. The study was approved by the Institutional Ethics Committee. Study participants were grouped into A and B. 220 ectopic pregnancy cases were designated as Group A and their 220 postnatal controls designated as Group B. The aim of this study was to assess the risk factors of ectopic pregnancy and to determine an association between the studied risk factors and ectopic pregnancy. Both groups were compared for various risk factors for ectopic pregnancy by means of detailed history with focus on socio economic characteristics like education, occupation, smoking status, age, gynaecological history, pelvic inflammatory disease (PID), parity, prior abortions, prior ectopic, surgical histories, use of assisted conception and contraception. Results: In this study the main risk factors for ectopic pregnancy were Tuberculosis (OR=11.87), history of infertility (P< 0.001), abortions (P=0.01) and a history of prior ectopic pregnancy (OR=8.129). Other risk factors found to be associated with an increased risk for ectopic pregnancy were PID (OR=2.856) / Chlamydia infection (OR=0.29), endometriosis (P=5.40), induced conception cycle (OR=3.142), intrauterine device usage (OR=3.75), prior Caesarean section (OR=3.85) and appendectomy (OR=2.42). On the contrary, barrier methods (OR=0.25) and oral contraceptive use (OR=0.26) were protective from ectopic pregnancy. Conclusion: PID particularly TB and Chlamydia are major etiological factors for ectopic pregnancy in our setup. Furthermore, prior ectopic pregnancy and infertility may be the result of a PID that might have caused tubal sequalae. As a preventive strategy screening and early treatment for TB and chlamydia in reproductive age group should be done so that tubal damage can be prevented. Advancing maternal age and low socioeconomic status are risk factor for ectopic pregnancy possibly due to increased chances of exposure to sexually transmitted infections (STIs) and PID. Patients with risk factors like pelvic surgeries, endometriosis, induced conception cycle, intrauterine contraception device (IUCD) users should be counselled about the possible risk of ectopic pregnancy once they conceive. So that they are kept under surveillance for early detection.

Despite immense and impressive progress in the field of reproductive medicine, little has been achieved in terms of replenishing aged ovaries and improving their reproductive outcome. Age causes irreversible damage to human eggs in terms of quantity as well as quality. Nature probably designed women to reproduce best in their twenties and thirties. However, due to social, personal, career, educational and financial pressures, women delay pregnancies until their late thirties, by which time the chance of becoming pregnant is compromised by low fecundity rates and an increased risk of miscarriage. Age, unfortunately, is the most detrimental prognostic factor for success of fertility treatment. We have seen an increasing population of older women seeking fertility treatment. The existing evidence does not offer any clear-cut guidelines for the clinical handling of older women seeking fertility treatment. Various strategies have been tried to improve the fertility outcome of such women, but none has met with significant success. This review focuses on what can and what cannot be done in terms of improving fertility rates in older women.