Comparison between the effect of coasting when used with both GNRH antagonist and GNRH agonist protocols in control of serum estradiol in prevention of severe ovarian hyperstimulation syndrome

Ovarian hyper stimulation syndrome [OHSS] is an iatrogenic potentially life threatening condition resulting from excessive ovarian stimulation. Coasting has been the most commonly used technique and has become the first choice for prevention of severe OHSS in high risk patients, however, prolonged coasting was found to have adverse prognosis. Combining both the use of a GnRH antagonist protocol, and coasting, and comparing it with coasting in long GnRH agonist protocol in controlling the serum Estradiol [E2] level in patients at risk of developing OHSS. Retrospective randomized study. Private infertility Center. 61 patients were included in the study all with the risk of developing severe OHSS, in which coasting was performed once the serum E2 < 3500 pg/ml, with < 20 follicles, with the leading follicle diameter 16 mm. They were divided into 2 groups according to the stimulation protocol used. Group A [n=33] [Flexible GnRH antagonist HMG-FSH protocol], and Group B [n=28] [Long GnRH agonist HMG-FSH protocol]. Primary outcome measures were the number of stimulation days, E2 level before starting to coast, peak E2 level reached, number of days for E2 to drop to a safe level, number of coasted days, E2 level on day of HCG, and percentage of E2 drop from the peak level. Secondary measures were number of oocytes retrieved, number of high quality embryos, and pregnancy rate, and incidence of severe OHSS in both groups. Coasting is more efficient with the GnRH antagonist protocols, than with the GnRH agonist protocol, without any effect on the pregnancy outcome. This is caused by the better pituitary suppression achieved by the antagonist that ensures E2 drop to safe levels, besides its prevention of premature luteinization that is common in cases of prolonged coasting

Developmental potential of retrieved oocytes for ICSI: the effect of reducing the LH dose during the stimulation phase of the long agonist protocol

Ovarian stimulation is an integral part of assisted reproductive technologies [ART]. Under physiologic conditions, both follicle-stimulating hormone [FSH] and luteinizing hormone [LH] activity is necessary to guarantee follicle growth and maturation, and hence their developmental potential. To test the effect of reducing the LH content in the ovulation induction for infertile pituitary suppressed females undergoing ICSI on the maturity and developmental potential of the retrieved oocytes. Retrospective randomized study. Private infertility Center. 102 patients were included in the study, which were divided into two groups according to the stimulation protocol used. Group A [n=51] [Long agonist HMG-FSH protocol], and Group B [n=51] [Long agonist HMG only protocol]. Comparison between the two groups included, number of stimulation days, number of oocytes retrieved, maturity of oocytes retrieved, fertilization rate, cleavage rate, Embryo grading, and pregnancy rate. Lowering the LH content in the stimulation phase did have a significant positive effect on the fertilization rate, and an insignificant positive effect on the cleavage rate. Although, lower LH doses resulted in less grade 1 embryos, it resulted in an insignificantly higher pregnancy rate, indicating the higher ability of these embryos to implant

Comparative study between the use of rectal misoproostol versus intravenous syntometrine in the active management of the third stage of labour

Postpartum hemorrhage is one of the major maternal killers. The use of uterotonics reduces the occurance of atonic postpartum hemorrhage. Oral Misoprostol [prostaglandin E1 analogue] used for the prevention of peptic ulcer disease was reported to prevent postpartum hemorrhage The present study is to compare between the effectiveness and side effects of rectally administered PG E1 analogue [misoprostol] and IV Syntometrine [0.5 mg a methyl ergometrine plus 5 IU of syntocinon] for prevention of atonic postpartum hemorrhage minimizing blood loss during the early postpartum period. Prospective randomized study. Three hundred cases who attended in El-Shatby Maternity Hospital, Obstetrics and Gynecology Department, Alexandria University were included in the study. All patients had a fuliterm living single fetus, presenting by the vertex, with a smooth course of the 1st and 2nd stages of labour. Cases were categorized into 3 groups: Group A [100 cases]: received Syntometrine in intravenous infusion of 500 ml saline immediately after delivery of the baby. Group B [100 cases]: received 2 tablets of Mesotec [total of 400 ug] rectally immediately after delivery of the baby. Group C [100 cases]: received IV infusion of 500 ml saline without any medications and placebo tablets rectally immediately after delivery of the baby. The amount of blood lost was evaluated by visual estimation, calculation, and lab parameters. Misoprostol with its rapid onset of action was more effective than intravenous infusion of syntometrine and placebo in terms of minimization of the amount of blood loss, shortening the duration of the third stage, in addition to decreasing the rate of postpartum hemorrhage. It is also cheap, more stable, and has less side effects

Role of sonohysterography in evaluation of abnormal uterine bleeding

Transvaginal ultrasound is an excellent method for imaging uterine abnormalities. However, evaluation of the uterine cavity is limited. Hysterosonography, an ultrasound technique in which the endometrial cavity is distended with saline, enables the radiologist to reliably distinguish focal from diffuse endometrial pathologic conditions Study Objective: To evaluate its diagnostic value in the evaluation of endometrial abnormalities, and correlating it to the histopathulogical examination to help determine its role in clinical decision making in patients with abnormal uterine bleeding. Prospective randomized study. Settings: El-Shatby Maternity Hospital, and Radiology department, Alexandria Main University Hospital. This study was carried on 30 married women of different age groups complaining of abnormal uterine bleeding. All patients were examined by transvaginal ultrasound, then hysterosonography by saline infusion, to be followed by a surgical intervention D and C, hysteroscopy, or hysterectomy for which the whole uterus or the biopsied lesion was sent for histopathological examination. Sonohysterography is far more superior than transvaginal ultrasound in diagnosing focal and diffuse endometrial lesions, which did match the final histopathological examination in 80% of cases. Hysterosonography has further enhanced the transvaginal examination of the uterine cavity. This can be used for further evaluation of the site, nature, and even reach a final diagnosis of the lesion yet it could not replace the histopathologic diagnosis, however it can help determine the best mode of the treatment, whether medical or surgical