From,Date : 12/11/08
Dr. Sudha RPlace : Bellary
PG Student in MS (Obstretrics & Gynecology)
Department of OBG
Vijayanagar Institute of Medical Sciences
Bellary
To,
The Principal
Vijayanagar Institute of Medical Sciences
Bellary
Through Proper Channel
Respected Sir;
Subject : Submission and forwarding of Synopsis for
Registration of Dissertation Topic
In accordance with the below cited topic, I, the undersigned studying in PG course in MS OBG has been allotted the dissertation topic ``LAPAROSCOPIC EVALUATION OF PRIMARY INFERTILITY PATIENTS – A CROSS SECTIONAL STUDY’’ under the guidance of Dr. Joshi Suyajna, Professor, Department of OBG, VIMS, Bellary.
I am requesting you to forward the dissertation topic in the prescribed form to the Registrar, Rajiv Gandhi University Of Health Sciences, Bangalore, Karnataka for approval.
Thanking you
Yours faithfully,
(Dr. Sudha)
Signature of the guide, Signature of the HOD,
Dr. Joshi Suyajna D , Dr. A.A.Khazi Professor, Professor and HOD
Department of OBGDepartment of OBG VIMS,Bellary VIMS, Bellary
From,12/11/08
Professor and HODBellary
Department of OBG
VIMS,Bellary
To,
The Registrar
RajivGandhiUniversityof Health Sciences,
Bangalore,
Through Proper Channel
Respected Sir;
Subject : Submission of Synopsis for Registration of
Dissertation Topic
As per the regulations of the University for Registration of Dissertation Topic the following Postgraduate Student in MS OBG has been allotted the dissertation topic as follows by the official registration committee of all qualifies and eligible guides of the Department of OBG.
Name / Topic / GuideDr. Sudha.R / LAPAROSCOPIC EVALUATION OF PRIMARY INFERTILITY PATIENTS – A CROSS SECTIONAL STUDY’’ / Dr. Joshi Suyajna D,
Professor,
Department of OBG,
VIMS,
Bellary
Therefore I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG Student at an early date.
Thanking you,
Yours faithfully,
Dr A. A.Khazi
Professor and HOD
Department of OBG
VIMS, Bellary
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF TOPICS FOR DISSERTATIONS
(To be submitted in duplicate)
1 / NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) / Dr. SUDHA RPG STUDENT IN MS (OBSTRETRICS & GYNECOLOGY)
DEPARTEMENT OF OBG,
VIMS,
BELLARY – 583 104
2 / NAME OF THE INSTITUTE / VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY
3 / COURSE OF THE STUDY AND SUBJECT / MS (OBSTRETRICS & GYNECOLOGY)
4 / DATE OF THE ADMISSION COURSE / 14- 03 -2008
5 / TITLE OF THE TOPIC / LAPAROSCOPIC EVALUATION OF PRIMARY INFERTILITY PATIENTS – A CROSS SECTIONAL STUDY’
6 BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Infertility affects 10 – 15 % of couples is an important part of clinical practice for many clinicians.
The overall incidence of infertility has remained relatively unchanged over the past few decades. However, the evaluation and treatment of infertility has changed dramatically.
Major causes of infertility include ovulatory dysfunction (15%), tubal and peritoneal pathology (30-40%), and male factors (30-40%). Uterine pathology is generally uncommon, and the rest is largely unexplained.
The fact that fecundity affected by the etiology of infertility draws the conclusion regarding the need for evaluation of one of the common causes of infertility i.e., tubal and peritoneal factors.
Hysterosalpingogram and laparoscopy are the two classic methods for evaluation of tubal factors and are complementry rather than mutually exclusive.
Laparoscopy is generally regarded as definitive test for evaluation of tubal factors. It provides both panoramic view of pelvic reproductive anatomy and a magnified view of uterine , ovarian, tubal and peritoneal surfaces and its pathology.
Therefore laparoscopy is an important tool to assess the reproductive pathology including tubal patency ( chromotubation) in infertile women.In the same setting therapeutic interventions like adhesiolysis,PCOD drilling,cystectomy etc can be performed in these patients
Thus laparoscopy offers both diagnostic and therapeutic advantage to the infertile patients.
With bulk of patients belonging to lower socioeconomic status this study offers the advantage of laparoscopy to needy infertile patients
6.2REVIEW OF LITERATURE
Review of literature revealed that laparoscopy allows for comprehensive evaluation of the pelvis in infertile women including confirmation of tubal patency, evaluation of tubo ovarian relationships,pelvic adhesions and endometriosis.
Tubal and peritoneal pathology is the primary diagnosis in 30-35 % of infertile couples.1
Gary P. wood3 conducted a study in 1983 where he subjected 50 infertile women to laparoscopic examination and found that 28 patients (56%) had significant pelvic pathology that had not been detected during prior investigations
Al – Badawai et al 4 assessed the value of laparoscopy in 265 woman with infertility and found that 49% had abnormal laparoscopic findings.In a classic study of 204 women with unexplained infertility .
Peterson and Behrman 4discovered endometriosis in 33% and pelvic adhesions or tubal disease in 25% using laparoscopy.
Lorson Sl, Chenq A,Gutmann JN 5 conducted a study at womens institute, Philadelphia, USA in 2000 to determine of reproductive pathology in a group of 100 infertile women using diagnostic loparoscopy and found that 68 had pathology of reproductive significance ;Intrinic tubal disease – 24 peritubal adhesive disease -34 and endometriosis-43,some in combination.
Ochoea Capelo et al 6(2003) performed diagnostic laparoscopy in 92 patients after 4 failed cycles of ovulation induction with clomiphene citrate and observed endometriosis and are pelvic adhesions in 50 and 33% respectively .
In a study conducted by Abdul rahmen w .el- Yahia 7 in 2008 laparoscopy was used to evaluate 130 women and found that overall 75(57.7%) had evidence of pelvic disease .Pelvic endometriosis -27.7%, pelvic adhesions – 20.8% and minimal pelvic inflammatory disease – 6.2%. the outcome of the study suggested that additional pregnancies do occur as a direct result of laparoscopic examination and subsequent therapy.
6.3 OBJECTIVES OF THE STUDY
/1.To determine the reproductive pathology in infertile women using diagnostic laparoscopy
2. To formulate the line of management in such patients.
7
/MATERIAL AND METHODS
7.1 (a) SOURCE OF DATA
/It is a cross sectional study conducted on infertile women attending OPD , department of OBG at VIMS, Bellary. Patients with primary infertility are subjected to laparoscopic examination of the pelvis under general anesthesia and the reproductive pathology is noted. Tubal patency will be confirmed by trans cervical instillation of the methylene blue dye .
(b) STUDY SUBJECTS
/Patients with primary infertility attending OPD at VIMS satisfying inclusion criteria.
[c] INCLUSION CRITERIA
/Patients with primary infertility
(d) EXCLUSION CRITERIA
/1. Patients with secondary infertility.
2. Patients with cardiac disease.
3. Patients with severe anemia.
4. Patients with severe obstructive lung disease.
( e) SAMPLE SIZE
/100 .
The data obtained will be analysed by appropriate statistical tests.
7.2 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS? IF SO DESCRIBE BRIEFLY .
/YES. Prior to laparoscopy routine investigations like Hb,Tc, Dc,ESR, chest x – ray , ECG, RBS, blood urea , serum creatinine will be done. Patients will be investigated by laparoscopy . it will be performed under general anaesthesia .
.
7.3 IS ETHICAL CLEARENCE OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.2
/Yes .Ethical clearance has been obtained from VIMS Ethical committee.
8 LIST OF REFERENCES
a) TEXT BOOK REFERNCES
1. Text book of clinical Gynaecologic Endocrinology and infertility.
Leon speroff and Marc A.Fritz ,7thedition , page no 1046.
2. Berek and Novak’s Gynecology. 14 th edition page no 1215-16.
b)JOURNAL REFERENCES
3. Gary P.Wood Laparoscopic examination of the normal infertile women.Journal of Obstetrics and Gynecology.1983; vol 62(5)
4.Surrey ,Eric S,Endoscopy in the evaluation of women experiencing infertility.Journal of clinical Obstetrics and Gynecology.december 2000; vol 43(4) pp 889-896.
5.CorsenSL, Chenq A, Gutmann JN,Laparoscopy in normal infertile patient ; a question revisited. Journal of American Association of Gynecologic laparoscopy. August2000 ; 7(3); 317-24.
6.Jan Bosteels etal , the position of diagnostic laparossopy in current fertility practice. Journal of Human Reproduction Update,2003; vol 13(5) pp 477-485.
7.Abdul rahan w.E l . yahia , Laparoscopic evaluation of apparently normal infertile women. Feb 2008 vol 34(4) pp440-442.
9 / SIGNATURE OF THE CANDIDATE10 / REMARKS OF THE GUIDE /
This study will give an insight in to the etiopathology of infertility and also offer therapeutic benefit.
11 / 11.1 NAME AND DESIGNATION OF THE GUIDE (IN BLOCK LETTERS) / Dr. JOSHI SUYAJNA MDProfessor,
Department of OBG,
VIMS, Bellary
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT / Dr. A.A. KHAZI. MD(OBG)
Professor and HOD
Department of OBG
VIMS, Bellary
11.6 SIGNATURE
12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE