Frozen thawed embryo transfer cycles; a comparison of pregnancy outcomes with and without prior pituitary suppression by GnRH agonists: an RCT

Background: To perform an in-vitro fertilization cycle, pretreatment with gonadotropin-releasing hormone [GnRH] agonist is widely used as a part of controlled ovarian hyper-stimulation protocols to prevent endogenous luteinizing hormone surge and spontaneous ovulation. GnRH agonist pretreatment is relatively costly and there is a risk of hypo estrogenic side effect. It would also lengthen the preparation period until pituitary desensitization occurs

Objective: Our study is aimed at evaluating the pregnancy outcome rate of frozen thawed embryo transfer with and without GnRH agonists pretreatment

Materials and Methods: Women with documented infertility who were candidate for frozen thawed embryo transfer were recruited and randomly assigned to two groups. In group A [n=100], patients received GnRH agonist, Buserelin, to induce pituitary desensitization prior to endometrial preparation and embryo transfer. Individuals in group B [n=100] received steroid manipulation without prior down-regulation of the pituitary. Chemical pregnancy, implantation rate, clinical pregnancy and ongoing pregnancy were measured and statistically compared between the two groups

Results: None of the outcome measures including clinical and chemical pregnancy rates, implantation rate, and ongoing pregnancy rate showed significant difference between the two groups. Similarly, the rate of miscarriage did not vary between the two groups

Conclusion: In this study, we found that removing the GnRH agonists pretreatment from the programmed cycles did not negatively influence the pregnancy outcome or implantation rate. Moreover, it will cause a considerable reduction in cost of assisted reproductive technology as well as adverse effects related to GnRH agonists, while having a favorable implantation and pregnancy outcomes

comparative study of potassium hydroxide versus CO[2] laser vaporization in the treatment of female genital warts: a controlled clinical trial

Background: genital warts are the most common viral sexually transmitted disease affecting 1% of the population. A prospective, open-label controlled trial was performed to compare topical 5% potassium hydroxide [KOH] solution with CO[2] laser in the treatment of female genital warts

Methods: seventy patients were enrolled in the study after convenience sampling. Right-sided lesions of the patients were treated by CO[2] laser every 3 weeks. The left-sided lesions of the same patients were treated by topical 5% KOH solution twice a day using a toothpick with cotton wrap on the tip. The patients were visited at 3, 6, and 9 weeks after initiation of the treatment and followed up for 6 months after the last visit

Results: out of seventy patients, sixty three completed the study and were analyzed. A total of 56 KOH treated-patients [88.9%] showed complete response. On the other hand, 56 laser-treated patients [88.9%] presented complete clearing of the lesion. There was not any difference in response to both modalities of treatment. Complications of KOH solution and CO[2] laser were 24% and 19% respectively [P>0.05], but serious adverse events were not observed. The patients under KOH treatment displayed a recurrence rate of 11.1% [7 cases], while the same patients with CO[2] laser therapy demonstrated a recurrence rate of 7.9% [5 cases] [P=0.54]

Conclusion: topical 5% KOH solution was as effective as CO[2] laser in the treatment of female genital warts. There was not any serious complication in the application of KOH solution. This could be used as a new treatment for genital warts

Determinants of successful non-operative management of intra- peritoneal bleeding following blunt abdominal trauma

Objectives: To identify the predictive factors of successful non-operative management of patients with intraperitoneal bleeding following blunt abdominal trauma

Methods: This was cross-sectional study being performed in our Level I trauma center in southern Iran between 2010 and 2011. We included adult [>14 years] patients with blunt abdominal trauma and intraperitoneal hemorrhage detected by CT-Scan who were hemodynamically stable and did not require any surgical intervention. Patients were managed conservatively in ICU. Those who required laparotomy during the study period were named as non-operative management failure [NOM-F] while the other were nonoperative management success [NOM-S]. The baseline, clinical and laboratory characteristics were compared between two study groups in order to detect the predictors of successful NOM of intra-peritoneal bleeding

Results: Overall we included 80 eligible patients among whom there were 55 [68.7%] men and 25 [31.3%] women with mean age of 30.63.6 +/- years. Finally, 43 [53.8%] were successfully managed conservatively [NOM-S] while 37 [46.2%] required laparotomy [NOM-F]. We found that those who underwent emergency laparotomy had significantly higher [delta]Hb [p=0.016] and lower base deficit [p=0.005] when compared to those who were successfully managed conservatively. Those who required surgical intervention had significantly lower baseline systolic blood pressure [p<0.001] and higher shock index [p=0.002]. The other parameters such as pulse rate and respiratory rate were comparable between two study groups

Conclusion: In patients with intra-peritoneal bleeding following blunt abdominal trauma, the most reliable predictive clinical and para-clinical factor of successful non-operative management are shock index and systolic blood pressure on arrival, base deficit and hemoglobin drop within first 12 hours of admission