scholarly journals Role of Endometrial Scratch in UnExplained infertility (RESCUE); A Randomized Clinical Trial

2021 ◽  
Author(s):  
reham elkhateeb ◽  
Haitham Bahaa ◽  
Alaa Gamal ◽  
Mahmoud Ibrahim ◽  
Nisreen Toni ◽  
...  
Keyword(s):  
Natural Killer ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
Endometrial Scratch

Abstract Background Endometrial natural killer (NK) is thought to play a role in implantation and maintenance of a healthy pregnancy. However, their immunological role in unexplained infertility is yet unknown. The aim of the current study was to investigate the role of endometrial injury in treatment of unexplained infertility and to have more insight on the potential underlying mechanisms of its action methodology randomized controlled trial (RCT) done at Minia university hospital, diagnostic laparoscopy was done for both study and control group, study group had gentle scratch and specimens were sent for histopathological examination while control group had Laparoscopy only .Patients in both groups were followed up at the outpatient clinic for 3 months to assess if pregnancy achieved or not. Patients in the study group who had not achieved pregnancy had a repeated scratch using a pipelle sampler which was also sent for histopathology. Patients were counselled for intrauterine insemination (IUI) with ovulation induction while patient in control group had been counselled for IUI and ovulation induction only. Patients in both groups were followed up for further 3 months to assess patients who achieved pregnancy either naturally or after IUI . Results Baseline characteristics were comparable in both groups. Clinical pregnancy rate (CPR) was significantly higher in scratch group compared with the control group (22%; vs. 7.4%, P = 0.001) in the first three months of follow up. After second scratch and IUI cycles cumulative pregnancy rate was significantly higher in the scratch group compared with the control group (36.7% , vs. 16.2%,, P = 0.001). The mean time achieve pregnancy was found to be significantly shorter in the scratch group as compared to the control group (102 days vs.49.5 days, P = 0.01). Conclusion: Endometrial natural killer cells might play a crucial role in endometrial receptivity and therefore embryo implantation. Endometrial scratch could promote the recruitment of endometrial NK cells and give a more favourable results as regard clinical pregnancy in patients with unexplained infertility. Registration number PACTR201604001405465

scholarly journals Can Serum Anti-Mullerian Hormone Level and LH / FSH Ratio Be Predictive of Clinical Pregnancy Through Intracytoplasmic Sperm Injection - Embryo Transfer?

2019 ◽  
pp. 1
Author(s):  
Tugba Elgun ◽  
Meric Karacan ◽  
Asiye Izem Sandal ◽  
Tulay Irez
Keyword(s):  
Pregnant Women ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Hormone Level ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Control Group ◽  
Clinical Parameters ◽  
Ovarian Syndrome

<p><strong>Objective:</strong> To compare clinical pregnancy rate through ICSI-ET between polycystic ovarian syndrome patients and women with normal ovaries (control group). We also investigated whether serum Anti-Müllerian hormone level or LH/FSH ratio may predict clinical pregnancy rate in both groups.</p><p><strong>Study Design:</strong> In this retrospective study, endocrine/ clinical parameters and cycle characteristics of women with polycystic ovarian syndrome (n=32) and women with normal ovaries (n=115) aged &lt;40 years were evaluated.</p><p><strong>Results:</strong> Clinical pregnancy rate in polycystic ovarian syndrome group did not differ from that in the control group (31.3% vs. 32.2%, p&gt;0.05, respectively). The LH/FSH ratio was significantly higher in women who conceived compared to women who did not in the polycystic ovarian syndrome group (0.9 vs. 0.6, respectively, p=0.4). The cut-off value of 0.6 in the LH/FSH ratio predicted clinical pregnancy with a specificity of 76% and a sensitivity of 65% in the polycystic ovarian syndrome group. Anti-Müllerian hormone was significantly higher in women who conceived compared to women who did not in the control group (4.0 ng/mL vs. 2.1 ng/mL, respectively, p=0.4).</p><p><strong>Conclusion:</strong> Polycystic ovarian syndrome patients have a similar clinical pregnancy rate with women having normal ovaries through ICSI-ET. The LH/FSH ratio assessed prior to ovulation induction was significantly higher in pregnant polycystic ovarian syndrome patients compared to polycystic ovarian syndrome patients who did not conceive. Anti-Müllerian hormone level was significantly higher in pregnant women compared to non-pregnant women with normal ovaries.</p>

Effect of granulocyte colony stimulating factor on pregnancy rate in women with unexplained infertility after intrauterine insemination: a randomized clinical trial

2020 ◽  
Author(s):  
Shahintaj Aramesh ◽  
Maryam Azizi Kutenaee ◽  
Fataneh Najafi ◽  
Parvin Ghafari ◽  
seyed abdolvahab taghavi
Keyword(s):  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Intervention Group ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Biochemical Pregnancy ◽  
Significant Difference

Abstract Background The cause of infertility has not been found in unexplained infertile patients,, and perhaps one of the possible reasons is impairment of fetal implantation, as well as the multiple role of GCSF in improving implantation and quality of blastocyst. Therefore, the aim of this study was to investigate the role of GCSF in the pregnancy rate of patients undergoing IUI.Methods The patients with unexplained infertility were divided into two groups: one group was received GCSF in their IUI cycle and the other group had the routine IUI. Both groups were stimulated by letrozole, metformin, and monotropin during the cycle. When at least one follicle was greater than 18 mm, 5000 IU hCG intramuscularly was administered for ovulation induction and IUI was performed 34–36 hours later. In intervention group, 300 ug GCSF subcutaneously administrated in two days after IUI. Biochemical pregnancy rate was evaluated two weeks after IUI and clinical pregnancy rate was identified by the presence of a gestational sac on ultrasonography 8 weeks after IUI.Results There was no significant difference in demographic and clinical characteristics between the two groups. The chemical pregnancy rate(16.3% vs 12.2%) and the clinical pregnancy rates (16.3% vs 8.3%) were improved in patients receiving GCSF compared to controls, but these differences was not significant (P = 0.56) and (P = 0.21).Conclusion Systemic administration of a single dose of 300 µg GCSF subcutaneously two days after IUI may slightly improve clinical pregnancy rate in patients with unexplained infertility. Nevertheless, our findings do not support routine use of G-CSF in unexplained infertility women with normal endometrial thickness.

scholarly journals The effect of local endometrial injury on the success of intrauterine insemination

2021 ◽  
Vol 38 (4) ◽  
pp. 521-524
Author(s):  
Gazi YILDIZ ◽  
Didar KURT ◽  
Emre MAT ◽  
Pınar YILDIZ
Keyword(s):  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Control Group ◽  
Study Group ◽  
Randomized Controlled ◽  
Endometrial Injury ◽  
Significant Difference ◽  
Infertile Patients

To determine the effect of local endometrial injury on implantation success in patients diagnosed with unexplained infertility and undergoing intrauterine insemination (IUI) after ovulation induction with gonadotropins. In this prospective randomized controlled trial, 82 infertile patients underwent IUI following ovulation induction with gonadotropin. In the study group (n:40), local endometrial injury (stratch) was performed to the posterior side of the endometrial cavity with a biopsy catheter between the 21-26th days of luteal phase of the cycle preceding ovarian stimulation. There was no statistically significant difference between the study and the control groups in terms of age of female, age of male, duration of infertility, BMI, serum FSH and LH levels, mean dose of gonadotropin and mean duration of ovulation induction (p>0.05). Clinical pregnancy was achieved in two patients (4.76%) in control group and four (10%) patients in the study group, with no significant difference between groups (p=0.18). All pregnancies achieved in the control and the study groups passed 12th gestational weeks and continued. Ectopic pregnancy, multiple pregnancy and abortion was not observed in any patient in both groups. In the study group, pain level immediately after endometrial biopsy procedure was evaluated with visual analog scale (VAS) and it was established that only one (2.5%) patient experienced severe pain after the procedure. Although local endometrial damage in the menstural period before ovulation induction and IUI cycle increases clinical pregnancy rates in the infertile patients, this increase is not statistically significant. Multi-center randomized controlled studies are needed for local endometrial damage to be recommended routinely in clinical practice.

scholarly journals A comparative study of efficacy of letrozole and clomiphene citrate for ovulation induction

2018 ◽  
Vol 7 (10) ◽  
pp. 4133
Author(s):  
Shaveta Jain ◽  
Pushpa Dahiya ◽  
Jyoti Yadav ◽  
Nitin Jain
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Primary Treatment ◽  
Ovulation Rate ◽  
Control Group ◽  
Study Group ◽  
Follicle Size ◽  
And Control

Background: This study was conducted to evaluate the efficacy of letrozole as an ovulation inducing agent and to compare it with clomiphene citrate (CC) in infertile women.Methods: This study includes 100 women referred to gynecology OPD of Pt. B.D Sharma, PGIMS, Rohtak with   infertility due to dysovulation. The patients were divided in two groups each comprised of 50 patients, Alternate women were enrolled in study group (Letrozole). Ultrasonic follicular monitoring was done on day 10, 12, 14, 16 of menstrual cycle to measure the number, size of mature follicles. Endometrial thickness and trilaminar pattern of endometrium was compared in between the groups. Inj. Gonadotrophin (hCG) was given as a trigger intramuscularly when follicle size was between 18 to 21mm. After 36 hours of hCG administration ovulation was confirmed on ultrasound.Results: Mean age, parity, and the duration of infertility were similar in both groups. Ovulation rate was 81.6% in letrozole group and was higher than control group(p<.01). The average number of follicles in the control group was 1.90±0.77and 1.17±0.47 in the study group(p<.001). Endometrial thickness in the study group was 7.55±1.12mm and in the control group it was 6.06±0.87(p<.01). Pregnancy rate in study group was 48 % and control group 16%(p<.05).Conclusions: Aromatase inhibitors (Letrozole) is a new group of drugs to join the arsenal of infertility treatments. The result of this preliminary study suggests that letrozole is associated with higher ovulation rate, higher endometrial thickness and trilaminar pattern thus resulting in higher pregnancy rate. Clomiphene citrate may be replaced by letrozole as primary treatment for ovulation induction in infertile patients.

scholarly journals Two different timing of intra uterine insemination in patients of unexplained infertility: a randomized clinical trial

2017 ◽  
Vol 6 (3) ◽  
pp. 1071
Author(s):  
Mervat A. Elsersy
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Prospective Comparative Study ◽  
Group 2 ◽  
Β Hcg ◽  
Intra Uterine Insemination ◽  
Group 1

Background: Unexplained infertility is diagnosed when the basic infertility workup is found to be normal. The objective was to compare between the results of IUI performance at 24 hours or 36 hours after hCG injection in couples with unexplained infertility.Methods: A prospective comparative study was conducted on 250 patients diagnosed with unexplained infertility who were randomly allocated in two equal groups. Each patient received ovulation induction. Follicular growth scanning was performed, patients received 10.000 hCG injection when there was mature follicle equaled to or more than 18mm. Then they randomly allocated to either group 1 who underwent IUI 24 hours after hCG injection or group 2 who underwent IUI 36 hours after hCG injection.Results: The positive qualitative serum β -hCG test was higher in group 1 who received IUI  24 hours after hGC injection, 24%, while in group 2 who received IUI  36 hours after hGC injection, it was 16.8% but no statistical differences between the two studied groups  could be observed. The most important finding in this study is that the clinical pregnancy rate in group 1 was significantly higher than in group 2.Conclusions: Earlier IUI procedures increased the clinical pregnancy rate in patients with unexplained infertility during ovulation induction with gonadotropins. Correct timing of insemination is essential.

Experience of using time-lapse microscopy in IVF and ICSI programs

2020 ◽  
pp. 47-50
Author(s):  
N. V. Saraeva ◽  
N. V. Spiridonova ◽  
M. T. Tugushev ◽  
O. V. Shurygina ◽  
A. I. Sinitsyna
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Selection Procedure ◽  
Time Lapse ◽  
Single Embryo Transfer ◽  
Main Group ◽  
Clinical Pregnancy ◽  
Control Group ◽  
Time Lapse Microscopy

In order to increase the pregnancy rate in the assisted reproductive technology, the selection of one embryo with the highest implantation potential it is very important. Time-lapse microscopy (TLM) is a tool for selecting quality embryos for transfer. This study aimed to assess the benefits of single-embryo transfer of autologous oocytes performed on day 5 of embryo incubation in a TLM-equipped system in IVF and ICSI programs. Single-embryo transfer following incubation in a TLM-equipped incubator was performed in 282 patients, who formed the main group; the control group consisted of 461 patients undergoing single-embryo transfer following a traditional culture and embryo selection procedure. We assessed the quality of transferred embryos, the rates of clinical pregnancy and delivery. The groups did not differ in the ratio of IVF and ICSI cycles, average age, and infertility factor. The proportion of excellent quality embryos for transfer was 77.0% in the main group and 65.1% in the control group (p = 0.001). In the subgroup with receiving eight and less oocytes we noted the tendency of receiving more quality embryos in the main group (р = 0.052). In the subgroup of nine and more oocytes the quality of the transferred embryos did not differ between two groups. The clinical pregnancy rate was 60.2% in the main group and 52.9% in the control group (p = 0.057). The delivery rate was 45.0% in the main group and 39.9% in the control group (p > 0.050).

Safety and Efficacy of Single-Dose Ketorolac for Postoperative Pain Management After Primary Palatoplasty: A Prospective Cohort Study With Historical Controls

2021 ◽  
pp. 105566562110128
Author(s):  
Jason R. Stein ◽  
Esperanza Mantilla-Rivas ◽  
Marudeen Aivaz ◽  
Md Sohel Rana ◽  
Ishwarya Shradha Mamidi ◽  
...  
Keyword(s):  
Single Dose ◽  
Postoperative Pain Management ◽  
Postoperative Hemorrhage ◽  
Bleeding Complications ◽  
Control Group ◽  
Study Group ◽  
Safety And Efficacy ◽  
Opioid Dose ◽  
Historical Controls

Objective: To analyze safety and efficacy of single-dose ketorolac after primary palatoplasty (PP). Design: Consecutive cohort of patients undergoing PP, comparing to historical controls. Setting: A large academic children’s hospital. Patients, Participants: A consecutive cohort of 111 patients undergoing PP (study n = 47) compared to historical controls (n = 64). Interventions: All patients received intraoperative acetaminophen, dexmedetomidine, and opioids while the study group received an additional single dose of ketorolac (0.5 mg/kg) at the conclusion of PP. Main Outcome Measures: Safety of ketorolac was measured by significant bleeding complications and need for supplementary oxygen. Efficacy was assessed through bleeding, Face Legs Activity Cry Consolability (FLACC) scale, and opioid dose. Results: Length of stay was similar for both groups (control group 38.5 hours [95% CI: 3.6-43.3] versus study group 37.6 hours [95% CI: 31.3-44.0], P = .84). There were no significant differences in all postoperative FLACC scales. The mean dose of opioid rescue medication measured as morphine milligram equivalents did not differ between groups ( P = .56). Significant postoperative hemorrhage was not observed. Conclusions: This is the first prospective study to evaluate the safety and efficacy of single-dose ketorolac after PP. Although lack of standardization between study and historical control groups may have precluded observation of an analgesic benefit, analysis demonstrated a single dose of ketorolac after PP is safe. Further investigations with more patients and different postoperative regimens may clarify the role of ketorolac in improving pain after PP.

scholarly journals The Role of CD68 (+) Histiocytic Macrophages in Nasal Polyp Development

2020 ◽  
Author(s):  
Nuray Bayar Muluk ◽  
Osman Kürşat Arikan ◽  
Pınar Atasoy ◽  
Rahmi Kiliç ◽  
Eda Tuna Yalçinozan
Keyword(s):  
Nasal Cavity ◽  
Nasal Polyp ◽  
Nasal Polyps ◽  
Deep Layer ◽  
Ethmoid Sinus ◽  
Adult Patients ◽  
Control Group ◽  
Study Group ◽  
Deep Layers

Abstract Objectives The aim of this study was to investigate the role of CD68 (+) histiocytic macrophages (H-M) in the nasal polyp pathogenesis. Materials and Methods The study group consisted of 24 adult patients with nasal polyposis. The control group consisted of 11 adult patients without nasal polyps. A total of 36 nasal polyp samples (10-nasal cavity, 10-maxillary sinus, and 16-ethmoid sinus) from the study group and 11 inferior turbinate samples from the control group were analyzed by immunohistochemical staining, with monoclonal antibodies against CD68 (+) H-M. Results CD68 positivity was significantly higher than the control group in the subepithelial (SE) layer of the ethmoid sinus, and deep layers of nasal cavity, maxillary, and ethmoid sinuses. In SE and deep layers of ethmoid and maxillary sinuses, CD68 positivity was significantly higher than that of the epithelial layer. In the deep layer, histiocytic macrophages tended to gather around eosinophils. Conclusion The high numbers of CD68 (+) histiocytic macrophages mainly located in deep layer of lamina propria may be responsible for the phagocytosis of eosinophils within the polyp tissue. Therefore, it may be concluded that increased macrophages in nasal polyps do not trigger the growth of nasal polyps. Instead, they may serve to reduce the number of eosinophils in already-developed nasal polyps.

scholarly journals Aerobic Vaginitis—Underestimated Risk Factor for Cervical Intraepithelial Neoplasia

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 97
Author(s):  
Olga Plisko ◽  
Jana Zodzika ◽  
Irina Jermakova ◽  
Kristine Pcolkina ◽  
Amanda Prusakevica ◽  
...  
Keyword(s):  
Histological Finding ◽  
Intraepithelial Neoplasia ◽  
Vaginal Microbiota ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
Aerobic Vaginitis ◽  
Abnormal Cervical Cytology ◽  
Low Education ◽  
Independent Risk Factors

The aim of this study is to analyse the association between vaginal microbiota and the histological finding of CIN. From July 2016 until June 2017, we included 110 consecutive patients with abnormal cervical cytology results referred for colposcopy to Riga East Clinical University Hospital Outpatient department in the study group. 118 women without cervical pathology were chosen as controls. Certified colposcopists performed interviews, gynaecological examinations and colposcopies for all participants. Material from the upper vaginal fornix was taken for pH measurement and wet-mount microscopy. Cervical biopsy samples were taken from all subjects in the study group and in case of a visual suspicion for CIN in the control group. Cervical pathology was more often associated with smoking (34.6% vs. 11.0%, p < 0.0001), low education level (47.2% vs. 25.5%, p = 0.001), increased vaginal pH (48.2% vs. 25.4%, p < 0.0001), abnormal vaginal microbiota (50% vs. 31.4%, p = 0.004) and moderate to severe aerobic vaginitis (msAV) (13.6% vs. 5.9%, p = 0.049) compared to controls. The most important independent risk factors associated with CIN2+ were smoking (OR 3.04 (95% CI 1.37–6.76), p = 0.006) and msAV (OR 3.18 (95% CI 1.13–8.93), p = 0.028). Bacterial vaginosis (BV) was found more often in CIN1 patients (8/31, 25.8%, p = 0.009) compared with healthy controls (8/118, 6.8%), or CIN2+ cases (8/79, 10.1%). In the current study msAV and smoking were the most significant factors in the development of CIN in HPV-infected women, especially high grade CIN. We suggest that AV changes are probably more important than the presence of BV in the pathogenesis of CIN and progression to cervix cancer and should not be ignored during the evaluation of the vaginal microbiota.

Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1173-1173
Author(s):  
JEFFREY M. PERLMAN ◽  
JEFF DAWSON
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Metabolic Alkalosis ◽  
Complex Disease ◽  
Disease Process ◽  
Control Group ◽  
Study Group

In Reply.— We appreciate the interest in our report published in Pediatrics (1986;77:212-216). The three letters raise similar questions, and in response we would like to make three points. First, including the two infants in the control group who died with the infants in the study group still resulted in significant differences between the two groups regarding duration of furosemide (Lasix) therapy, hypochloremia, or metabolic alkalosis (P &gt; .001). Second (as noted in our discussion), bronchopulmonary dysplasia is a complex disease process.

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