Abstract Objective To compare the efficacy and safety of intravenous paracetamol with intramuscular tramadol hydrochloride as intrapartum analgesia in primigravida women during the active phase of labour. Design Prospective, single-blind, randomised controlled trial. Setting Labour ward of a tertiary care hospital in India. Population or Sample Primigravida women aged 18–30 years with term, singleton, vertex pregnancies in spontaneous active labour, meeting strict inclusion criteria. Methods A total of 9,945 women were randomised into two groups: Group 1 received 1000 mg intravenous paracetamol; Group 2 received 100 mg intramuscular tramadol. Pain was measured using the Visual Analogue Scale (VAS) at baseline, 10 minutes, and one hour post-intervention. Labour outcomes, maternal side effects, and neonatal parameters were recorded and analysed. Main Outcome Measures Reduction in VAS pain scores, duration and mode of delivery, maternal side effects, Apgar scores, neonatal respiratory status, and NICU admissions. Results Both medications effectively reduced labour pain. At one hour, the tramadol group showed significantly greater pain relief (VAS 4.70 ± 0.86 vs. 5.02 ± 0.78; p = 0.0063). However, the paracetamol group experienced fewer side effects, including significantly less vomiting (10% vs. 23%; p = 0.0222), and had better neonatal outcomes. Apgar scores at 1 and 5 minutes were significantly higher in the paracetamol group ( p = 0.0001 and p < 0.0001), with fewer cases of neonatal respiratory depression. Conclusions Intravenous paracetamol is a safe, effective, and accessible alternative to tramadol for labour analgesia, especially suited to low-resource settings due to its ease of use and favourable safety profile. Funding No funding was received for this study. Trial Registration Clinical Trials Registry – India (CTRI/2018/06/014589) Keywords Paracetamol, Tramadol, Labour analgesia, Intrapartum pain, Randomised controlled trial, Low-resource settings

Background Systemic testosterone therapy is increasingly prescribed to peri- and postmenopausal women, often for symptoms beyond its established indication. While testosterone is evidence-based for hypoactive sexual desire disorder (HSDD), its role in vasomotor symptoms (VMS) and other menopausal domains remains unclear, contributing to a gap between evidence and clinical practice. Objective To evaluate the efficacy and safety of systemic testosterone therapy for vasomotor symptoms and other menopausal outcomes in peri- and postmenopausal women using randomised controlled trial (RCT) evidence. Search Strategy MEDLINE, Embase, and Cochrane CENTRAL were searched from January 1995 to November 2025, supplemented by trial registries and citation tracking. Selection Criteria Double-blind RCTs of ≥12 weeks duration evaluating systemic testosterone (oral, transdermal, injectable, or implant) in peri- or postmenopausal women, compared with placebo or active hormonal comparators, were included. Data Collection and Analysis Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed where appropriate. Certainty of evidence was assessed using GRADE. This review was conducted in accordance with PRISMA 2020 and prospectively registered with PROSPERO (CRD420251170997). Main Results Forty studies (36 RCTs; 8,480 women) were included. Testosterone showed no benefit for vasomotor symptoms (pooled MD 0.01, 95% CI −0.08 to 0.10), regardless of formulation, menopausal type, or estrogen use. In contrast, testosterone significantly improved sexual function in postmenopausal women with HSDD, increasing satisfying sexual events (MD +0.85 per 28 days, 95% CI 0.52–1.18) and reducing sexual distress. Effects on mood, cognition, bone, and physical function were neutral or inconsistent at physiological doses. Non-oral formulations demonstrated a favorable cardiometabolic safety profile, with mild, reversible androgenic effects. Conclusions Systemic testosterone should not be used to treat vasomotor symptoms but is an effective, evidence-based therapy for postmenopausal HSDD. Guideline-aligned, indication-specific prescribing is essential, and off-label use for unproven menopausal symptoms should be discouraged.

Background Non-obstructive azoospermia (NOA) poses a challenge for sperm retrieval, and conventional testicular sperm extraction (TESE) often lacks precise anatomical targeting. We investigated whether an ultrasound-guided, anatomically structured approach—delineating four testicular zones (Zone 1: upper third; Zone 2A: anterior mid third; Zone 2B: posterior mid third; Zone 3: lower third)—affects fertilization and reproductive outcomes in NOA patients undergoing in vitro fertilization with intracytoplasmic sperm injection (ICSI). Material and methods In this prospective trial, 878 men with NOA underwent ultrasound-guided percutaneous TESE. Sperm were retrieved in 696 cases (79.3%), and after excluding cycles without viable embryos, 426 couples proceeded to ICSI and embryo transfer. Patients were stratified by retrieval zone: Zone 1 (n=54), Zone 2A (n=124), Zone 2B (n=154), Zone 3 (n=94). Outcomes included fertilization rate, embryo development (cleavage and blastocyst formation), clinical pregnancy, and live birth rates. Results Fertilization and embryo development rates varied significantly by zone (p < 0.001). Zone 2B (posterior mid testis) sperm yielded the highest fertilization rate (95.5%) and blastocyst formation rate (77.3%), while Zone 3 (lower third) had the lowest (46.8% fertilization; 42.6% blastocyst). Clinical pregnancy occurred in 73–75% of cases in Zones 2B/3 versus approximately 50% in Zones 1/2A (p < 0.001). Live birth rates (81.7–91.2%) did not differ significantly by zone (p = 0.28). Conclusions Ultrasound-guided, zone-targeted TESE significantly improves early embryologic outcomes (fertilization, cleavage, blastocyst formation) for sperm from mid-posterior testicular regions. Although live birth rates were similar across zones, anatomically guided sperm retrieval may optimize the efficiency of ART in NOA patients.

Background: Currently, none of the diagnostic procedures for detecting female genital tuberculosis (FGTB) are 100 percent reliable, and the same is true for endoscopic results. There are several studies accessible on hysteroscopic and laparoscopic findings that are suggestive of TB. However, no study to our knowledge summarises the findings of laparoscopic and hysteroscopic examination in subfertile female patients with biopsy, culture, or other laboratory test-proven endometrial tuberculosis. Objective: Evaluation of hysteroscopic and laparoscopic findings in subfertile women suffering from proven endometrial tuberculosis. Materials and methods: 16,784 infertile women had a diagnostic hysterolaparoscopy between February 2014 and June 2021, among which 1084 patients were prescribed anti-tubercular medication based on the results of their findings; however, only 309 individuals had endometrial tuberculosis verified via positive on histopathology examination, AFB demonstration, Culture, and GeneXpert MTB/RIF. We retrospectively observed the diagnostic hysterolaparoscopy findings in those proven cases of subfertile women suffering from FGTB. Results: The major findings on hysteroscopy were periosteal fibrosis (209/309,67.63%), pale endometrium(179/309,57.92%), and micro polyp(138/309,44.66%). Other notable hysteroscopic findings were intrauterine adhesions (88/309,28.47%), endometrial tubercle (78/309,25.24%), endometrial polyp(54/309,14.88%), caseation(42/309,13.59%), focal hyperemia(29/309,9.38%) and diffuse hyperemia(18/309,5.82%). The most common finding on laparoscopy was abdominopelvic adhesions of various grades (297/309,96.11%). The major findings of laparoscopy were tubercle (155/309,50.16%), isthmo ampullary block (118/309,38.18%), tubal diverticula (116/309,37.54%), hydrosalpinx (97/309,31.39%) and TO mass (96/309,31.06%). 5.50% (17/300) had a normal appearance on hysteroscopy, and 1.29% (4/309) had a normal-looking pelvis on laparoscopy. Conclusions: In proven endometrial tuberculosis, significant hysteroscopic findings are periosteal fibrosis, pale endometrium, micro-polyp, and intrauterine adhesions, whereas major laparoscopic findings are various grades of abdominal pelvic adhesions, including perihepatic adhesions, miliary tubercle, isthmo ampullary block, tubal diverticula, caseous material, and hydrosalpinx. Tuberculosis should be considered if these signs are discovered during a diagnostic work-up in infertile people.

Objectives To determine fertility outcomes after diagnosing genital tuberculosis followed by anti-tubercular therapy (ATT) and response to different subfertility treatment modalities. Hysteroscopy and laparoscopy data were also analysed to determine whether or not starting ATT early on in the course of tuberculosis treatment was more effective. Study design Among the infertile women, presented in department Reproductive Medicine in Bansal Hospital, Bhopal from Feb 2014 to June 2022, who underwent diagnostic hysteroscopy and laparoscopy, 1083 women having positive finding(s) suggestive of tuberculosis were received anti-tubercular therapy for at least six months. Retrospectively, we analysed the pregnancy outcome of these women after receiving anti-tubercular therapy followed by different subfertility treatments. Results In vitro fertilization (IVF) was a primary modality of treatment. 551(55.88%) women undergoing IVF with their oocytes resulted in 348(63.15%) clinical pregnancies, 264(47.91%) ongoing pregnancies, 84(15.24%) first-trimester miscarriages, and live birth in 246(44.64%) women. Clinical pregnancy rate, ongoing pregnancy rate, and live birth rate all show a statistically significant (P = 0.039) improvement when illness is diagnosed early through hystero-laparoscopy and treated with ATT, followed by fertility therapy. Conclusions Diagnostic hysteroscopy and laparoscopy may be performed to examine high-risk infertile individuals by analysing the reproductive system, including tubal factor. This helps choose a treatment strategy and forecast its success. This study shows that if ATT initiated at early stage as suggested by endoscopy findings IVF reproductive outcomes equivalent to the background population. Late-stage ATT results are often quite dismal, despite the fact that IVF and other adjuvant therapy may improve fertility.

BACKGROUND Accessory cavitated uterine malformations, or mass (ACUM) is a Mullerian anomaly which increasingly recognized as a cause of severe dysmenorrhoea and pelvic pain. OBJECTIVE To know what ACUMs are and recognize their clinical presentation, able to diagnose an ACUM using ultrasound or MRI; and counsel patients with ACUMs on the different management options, including conservative, medical, and surgery. CONCLUSION AND WIDER IMPLICATION ACUMs are less rare than previously believed; hence ACUM diagnosis is essential in clinically suspicious cases via ultrasound and MRI, and intra-operative assessment of uterine morphology and laparoscopic surgical excision is the definitive treatment for ACUM.