Background: Vitamin D (25OHD) deficiency has become a modern-day epidemic, being the most common nutritional deficiency worldwide. Many infertile men are experiencing low total sperm count or different semen abnormalities. The aim of this study was to compare serum vitamin D (25OHD) status among fertile and infertile men.Methods: This was an observational (cross sectional comparative) study and was conducted in the Department of Reproductive Endocrinology and Infertility, BSMMU, Dhaka, Bangladesh during the period from April 2019 to March 2020. The sample size was 112 men where 56 participants were in fertile men group and 56 participants were infertile men group. Statistical analyses were carried out by using Windows based Statistical Package for Social Sciences (SPSS, version 23.0).Results: The predictability of vitamin D insufficiency was significant. Holding the effects of vitamin D deficiency constant, males with vitamin D insufficiency were 3.28 times more likely to be infertile than males with vitamin D sufficiency. Subgroup analysis of infertile men was done regarding semen parameters in different vitamin D status categories. There was statistically significant difference in semen volume and sperm concentration between infertile men of different vitamin D status but no significant difference in case of motility and morphology.Conclusions: There was no significant different of serum vitamin D (25OHD) between fertile and infertile men. Men with vitamin D insufficiency (≥20 ng/ml to <30 ng/ml) are more likely to be infertile than men with vitamin D sufficiency.

Background: Some men with severely defective sperm production commonly have excess aromatase activity, reflected by low serum testosterone and relatively elevated estradiol levels. Elevated levels of estrogen lead to feedback inhibition of the hypothalamic -pituitary-gonadal axis, and the end result is a decrease in LH necessary for the production of testosterone, and FSH to optimize sperm production. The aim of this study was to evaluate the effect of aromatase inhibitor, letrozole on the semen parameters of infertile male having oligozoospermia, low serum testosterone level and testosterone to estradiol ratio <10.Methods: This Prospective study was conducted in the Department of Reproductive Endocrinology and Infertility at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from May 2019 to April 2020. The sample size was 30 subfertile men with oligozoospermia (≤ 10 million/ml), low serum testosterone level (<300 ng/dl) and low testosterone to estradiol ratio (<10). All patients were treated with letrozole 2.5 mg daily for 4 months. At the end of the 4 months the semen analysis was performed. Statistical analysis was carried out by using IBM Statistical Package for Social Sciences version 25 for windows (SPSS version 25.0).Results: The sperm concentration, sperm motility and total motile sperm count significantly increased after letrozole treatment. The side effects were mild and well tolerated.Conclusions: This study suggests that some men with oligozoospermia, low serum testosterone levels and normal gonadotropin concentration may have a treatable endocrinopathy. Letrozole may be used to improve sperm parameters in infertile men with low serum testosterone to estradiol ratio.

Background: Endometriosis is a chronic and progressive estrogen-dependent disorder that can result in substantial morbidity, including pelvic pain, multiple operations, and infertility. Endometriosis can be ovarian, peritoneal or deep infiltrative. Blocking estrogen production by inhibiting aromatization, aromatase inhibitor (letrozole) has been shown to reduce the size of endometrioma and endometriosis associated pain. Aim of the study was to evaluate the effect of aromatase inhibitor in reducing the size of endometrioma.Methods: A prospective non comparative observational study was conducted in the Department of Reproductive Endocrinology and Infertility of BSMMU on 30 women with ovarian endometrioma during the period of April 2019 to March 2020. Women were treated with aromatase inhibitor (letrozole) 2.5 mg, norethisterone 5 mg, calcium 1200 mg, and vitamin D 800 IU daily for 6 months. Transvaginal ultrasound was performed at baseline, 3 months and 6 months after treatment to assess the mean diameter and volume of endometriomas. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0.Results: More than 50% reduction in volume occurred in 90% of endometrioma. In one (3.3%) case endometrioma disappeared completely after 6 months. There was statistically significant reduction of size of endometrioma (estimated by mean diameter and volume) and pain. Volume decrease was linearly related to baseline endometrioma volume and inversely related to baseline body mass index (BMI). The side effects were mild and well tolerated by the patients.Conclusions: Treatment of ovarian endometrioma with aromatase inhibitor combined with progestin add-back for 6 months cause substantial reduction in size of endometrioma and associated pain.

Tubal rupture following an ectopic pregnancy is usually associated with profound hemorrhage which can lead to an unstable hemodynamic state that can risk the life of the patient. To explore the pattern of ruptured ectopic pregnancy in a secondary level healthcare facility, this Cross-sectional study was conducted among 100 ruptured ectopic pregnancy cases at 250 Bedded General Hospital, Tangail from January to November 2017. Cases were diagnosed by taking history (short period of amenorrhoea, acute lower abdominal pain and per-vaginal bleeding), clinical examination and relevant investigations (per-abdominal ultrasonography, TVS, CBC, serum ß-hCG level). Postoperatively, all the patients were followed up meticulously till discharge. The mean age of patients was 33.5(±7.8) years and the highest incidence (43%) was recorded in the age group of 26-30 years. All the patients were managed surgically with no record of case fatality. The most common site for the extra-uterine pregnancy was the tubal area (80%), 13% were ovarian pregnancy, 2% were abdominal and 5% were in other sites (rudimentary horn of uterus, cessarian scar). Chronic pelvic inflammatory disease was the most common risk factor (70%). Other risk factors such as, H/O receiving subfertility treatment (assisted reproduction/ ovulation inducing drugs), previous ectopic pregnancy, developmental errors of uterus, caesarean scar pregnancy and unknown cause were 10.0%, 6.0%, 3.0%, 3.0% and 8.0% respectively. The rise of serum ß-hCG level was found ≤1500 IU/L in 72% and >1500 IU/L in 28% of patients. Tubal area found to be the most common site of ruptured ectopic pregnancy in this study and chronic pelvic inflammatory disease was the most common risk factor followed by undergoing subfertility treatment.  Surgical intervention was the choice of treatment in all cases with zero fatality recorded. Bangladesh Med J. 2019 May; 48 (2): 20-23