ASSESSMENT OF CERVICAL CYTOMORPHOLOGICAL CHANGES IN INFERTILE WOMEN

Abstract Background: Assessment of cervical cytomorphological changes in infertile women. Methods: The hospital based prospective study was conducted on 50 women of reproductive age group who were in the follicular phase of their cycle and had primary and secondary infertility Results: On pap smear 80.00% patients were present NILM, 12.00% patients were present ASC-US, 4.00% patients were present inflammatory and 2.00% patients were present HSIL & LSIL. Conclusion: We observed that infertile patients, may benefit from cervical cytological screening as they show a higher tendency for cervical cytological abnormalities.


Introduction
Infertility is a global problem, affecting approximately onefifth of couples trying to conceive. 1 with the incidence similar in most countries independent of the level of the country's development.
The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 30-40% of the cases. Problems common to both partners are diagnosed in 10-15% of infertile couples.
Various factors may contribute to the infertility of males and females, including several types of microorganism, e.g., bacteria, fungi, viruses, and parasites. 2 A higher frequency of abnormal cervical smears is expected in subfertile women suffering from a tubal pathology 3 . The presumed increase in promiscuous, precarious sexual behaviour results in sexually active adolescents who are at risk of acquiring HPV and C. Trachomatis infections unaware of the fact that (tubal factor) subfertility and (the treatment of) severe cervical pathology could negatively affect family planning even many years following an infection. 4

Material and Methods
The present study was conducted on 50 women of reproductive age group who were in the follicular phase of their cycle and had primary and secondary infertility Inclusion Criteria • Women of reproductive age group who were in the follicular phase of their cycle and had primary and secondary infertility prior to hormonal treatment (not taken hormonal treatment with in 3 month's).
• Who has given written and informed consent for study.

Exclusion Criteria
• Female with pelvic inflammatory disease at present.
• female with diagnosed genital tract pathologies.
• women who had started hormonal treatment with in 3 month's.
• women who were on immunosuppressive drugs.
• Couple who use any type contraceptive method.
The inclusion and exclusion criteria were applied and patients who are eligible to participate and gave consent were thoroughly interviewed and investigated for etiology of infertilty.
A detailed history was taken regarding age, socioeconomic status, menstrual history, age of marriage and first coitus, duration of infertility, age of 1 st conception, obstetric history, personal history, spouse history, multiple sexual partner, STDs and health cheak up status including liquid base pap smear.
History was taken regarding previous treatment taken for infertility.
After enrolling the patient detailed history of both partner's was taken then complete physical examination including vitals parameter and systemic examination & detailed gynaecological examination was carried out then routine investigation and complete work-up for infertility in both partner & diagnostic procedure was carried out as required for infertility etiology.
After written informed concent pap smear taken by cervical broom, material on cervical broom was rinsed in 10-15 ml of pap spin collection, a buffered methanol preservative solution in vial. Pap spin collection fluid along with collected material was send to laboratory for histopathological reporting.

Observations
Mean age of patients were 24.62±2.49 Yrs. Maximum patients (80.00%) were 18-25 Yrs age group. Out of 50 cases 50.00% patients were lower middle class followed by 20.00% patients were upper middle class.

Discussion
Hospital based descriptive observational study conducted on 50 women of reproductive age group who were in the follicular phase of their cycle and had primary and secondary infertility prior to hormonal treatment (not taken hormonal treatment with in 3 month's) were included in this study.
Infertility is a serious problem to the couple and brings about family unhappiness and mental trauma and is a matter of financial burden. Screening by Pap smear enables for early detection of cervical cell abnormalities and prompt action. Consequently, we observe a significant decrease in the incidence of invasive cervical cancer. This study was designed to evaluate the results of cytology Pap smear test in infertile women. Abnormal epithelial cells were ASCUS (one patient) and LSIL (two cases). The only ASCUS report was reported in 2011 and one LSIL was reported in the same year.