Ovulation prediction in spontaneous and induced cycles: the role ovarian reserve markers

To evaluate the role of day 3; serum FSH, inhibin-B, estradiol, [biochemical markers], ultrasound measured antral follicle count AFC and ovarian volume OV. [biophysical markers]; as static screening markers of the ovarian reserve in ovulation prediction in induced cycles in infertile patients with different induction protocols; as dynamic performance tests compared to spontaneous cycles in matched fertile patients. Also, to analyze the correlations between these markers and prediction of ovulation success in induced cycles with different induction protocols. Prospective comparative controlled study. Infertility Clinic, University Hospital, El Minia and private IVF center, Egypt. Eighty infertile patients [study group] classified into four subgroups, twenty patients each according to the method of ovulation induction and twenty matched fertile subjects [control group]. Day 3; serum inhibin-B, FSH, estradiol were measured together with transvaginal ultrasound measurements of the antral follicle count and ovarian volume in the study and the control groups. The study group was subdivided into four subgroups according the method of ovulation induction; whether clomiphene citrate [group I], or human menopausal gonadotropine [group II], or low dose follicle stimulating hormone [group III] or long IVF protocol [group IV]. The predictive values of different screening markers in relation to ovulation. Other outcome measures were ovulation rate as detected by progesterone measurement in day 21 of the cycle together with analysis of the correlations between various biochemical and biophysical markers and prediction of ovulation success in induced cycles with different induction protocols. The predictive values [sensitivity, specificity, positive predictive value, negative predictive value and accuracy] in relation to ovulation prediction of FSH [< 10 IU/L] were [96.66, 60.00, 95.60, 66.66 and 93.00%, respectively], serum inhibin-B [> 45 pg/ml] were [97.77, 70.00, 96.70, 77.77 and 95.00%, respectively], estradiol [< 75 pg/ml] were [96.59, 75.00, 96.59, 75.00 and 94.00%, respectively] AFC [> 6] were [97.77, 70.00, 96.70, 77.77 and 95.00%, respectively], and OV [> 3 cm][3] were [96.66, 60.00, 95.66, 66.66 and 93.00%, respectively]. Multivariate analysis of the variables that predict ovulation in induced cycles demonstrated that; of the biochemical variables FSH was the most significant contributor to ovulation [R2 = 0.93, P,

Effects of oral maternal hydration on amniotic fluid index, uteroplacental circulation, fetal blood flow, and urine output in pregnant women with oligohydramnios

To evaluate the effects of oral maternal hydration on amniotic fluid index, uteroplacental perfusion, fetal blood flow and urine output in pregnant women with oligohydramnios. Prospective interventional cross-sectional study. Department of Obstetrics and Gynaecology, El Minia University Hospital, El Minia, Egypt. Thirty pregnant women with third trimester oligohydramnios. Oral maternal hydration with 21 of water. AF index, maternal uterine artery resistance index, fetal umbilical and middle cerebral arteries pulsatility indices together with baseline fetal heart rate and maternal urine specific gravity; were measured before and after oral maternal hydration. Amniotic fluid index increased significantly after oral hydration than before [8.15 +/- # 3.15 +/- 1.23 Cm, respectively, P < 0.01]. Uterine artery resistance index decreased significantly after hydration compared to before [60.8 +/- 4.50 # 56.4 +/- 3.3%, respectively, P < 0.01]. Fetal umbilical artery pulsatility index decreased significantly after hydration compared with before [0.95 +/- 0.21 # 1.07 +/- 0.21, respectively, P < 0.01]. Maternal urine specific gravity decreased significantly after oral hydration compared with before [1010.9 +/- 3.2 # 1020.4 +/- 4.6, respectively, P < 0.01]. Fetal hourly urine production increased significantly after hydration compared with before [3.27 +/- 0.9 # 2.88 +/- 1.1 Cc, respectively, P < 0.01]. Maternal oral hydration is an effective, cheap and non-invasive treatment option in oligohydramnios in the third trimester. This, simple method increases the amniotic fluid volume, uteroplacental blood flow and fetal blood flow. Large scale randomized controlled trials are recommended to establish the guidelines of maternal hydration in the management protocol of oligohydramnios

Management of early missed abortion by methotrexate and/or misoprostol

The purpose of this study was to compare the efficacy and side effects of the use of either intramuscular [i.m.] methotrexate or vaginal misoprostol alone or in combination in women with early 1[st] trimester missed abortion. Ninety women with early missed 1[st] trimester intrauterine pregnancy at < 9 weeks gestation were included in this study. The study sample was randomized into 3 groups. The 1[st] group included 30 women who received 50mg/m[2] i.m. methotrexate on day 1 and then followed up at weekly intervals up to day 21. The 2[nd] group included 30 women who received 800 micro g vaginal misoprostol on day 1 and if there was no response on day 4, they received a repeat dose and were reassessed on day 7. The 3[rd] group included 30 women who received 50 mg/m[2] i.m. methotrexate followed 3 days later by 800 micro g vaginal misoprostol and were reassessed on day 7. All women were recruited from the attendants of Gynecology Department, El-Minia University Hospital. Complete abortion occurred in 53.33% in 1[st] group, 86.66% in 2[nd] group and 93.33% in the 3[rd] group. The complete abortion rate in the 3[rd] group was significantly higher than that of both 1[st] and 2[nd] groups [p < 0.05]. The failure rate was 46.66% in 1[st] group, 13.33% in 2[nd] group and 6.66% in the 3[rd] group. No serious side effects were found in all study groups. The combination of methotrexate and misoprostol is more effective method for early missed abortion than when either drug is used alone