Pregnancy outcome after difficult embryo transfer in IVF-ET cycles

Background: Embryo transfer [ET] is one of the most crucial steps in IVF/ICSI treatment. Although it, apparently, seems simple, it is an integral part of IVF/ICSI and can affect the outcome of the whole treatment cycle. The majority of couples [approximately 80%] who undergo IVF reach the ET stage, yet few pregnancies occur. The pregnancy rate after ET is dependent on multiple factors including embryo quality, endometrial receptivity, and the technique of the ET

Aim of the Work: The aim of the current study is to investigate the clinical and ongoing clinical pregnancy rates in women who experience difficult embryo transfer [ET] after IVF/ICSI cycle

Patients and Methods: This prospective cohort study was conducted at Dar Al-Teb Infertility and IVF Center between January 2017 and January 2018. The study included 417 women planned to undergo ET

Results: The biochemical, clinical and ongoing clinical pregnancy rates were significantly lower in women who had difficult ET when compared to women who had easy ET [ORs 0.5, 95% CI [0.31 to 0.83]; 0.48, 95% CI [0.29 to 0.79]; 0.36, 95% CI [0.21 to 0.62]; respectively]

Conclusion: Difficult ET is associated with significantly reduced biochemical, clinical and ongoing clinical pregnancy rates

Recommendations: ET should be smooth with easy passage of the transfer catheter. Since any uterine manipulation during ET adversely affects IVF results, therefore precaution should be taken to identify possibly difficult ET cases in advance

Diagnostic Validity of serum and peritoneal TNF-alpha, high sensitivity CRP and plasma cell-free nuclear DNA [ccf nDNA] as biomarkers of pelvic endometriosis- a case control study

Introduction: Endometriosis is a disease defined by the presence of endometrial glands and stroma located outside the uterine cavity. These ectopic implants can be found throughout the pelvis, on and within the ovaries, abutting the uterine ligaments, occupying the rectovaginal septum, invading the intestinal serosa, and along the parietal peritoneum. Endometrial implantation at distant sites such as the pleura, lung, within surgical scars, and along the diaphragm also has been reported. [1] . It results often in subfertility and pain, occurs mainly in women of reproductive age [16-50 years] and has a progressive character in at least 50%, but the rate and risk factors for progression are unknown. Endometriosis can be classified into four stages: minimal, mild, moderate and severe. The gold standard for the diagnosis of endometriosis is laparoscopic inspection, ideally with histological confirmation. [2], however, is an invasive technique and should be performed only after imaging techniques prove insufficient for confident diagnosis. [3] Lack of a non-invasive diagnostic test contributes to the long delay between onset of symptoms and diagnosis of endometriosis. [2] Additional tools are needed for non-invasive classifications in order to reduce the number of unnecessary laparoscopies without adversely affecting outcomes. Finding specific and more sensitive biomarkers in endometriosis is critical, because endometriosis is usually diagnosed only in advanced stages, and there is a high rate of morbidity for this disease. [4]

Aim of the work: The aim of the current study is to assess the validity of serum and peritoneal high sensitivity CRP and TNF-alpha and plasma cell-free nuclear DNA [ccf nDNA] as biomarkers in early diagnosis of pelvic endometriosis

Methods: This study was conducted at the Obstetrics and Gynecology department, Maternity Hospital, Ain Shams University. This is a case control study of 120 women scheduled for diagnostic laparoscopy. Laparoscopy was indicated in these women whether for various causes of subfertility or for chronic pelvic pain between January 2011 and January 2012. The patients were divided into the following groups: Group I [endometriosis group/ study group] consisted of 80 patients diagnosed to have endometriosis during laparoscopy. Group I cases were subdivided into two subgroups, Group IA: consisted of 34 cases with stage 1or minimal endometriosis and Group IB: consisted of 46 cases with stage 2 or mild endometriosis. Group II [non-endometriosis group/Control group]: consisted of 40 cases with no detected pelvic pathology. During the laparoscopy procedure, both peripheral venous blood and peritoneal samples were withdrawn. Serum and peritoneal levels of high sensitivity CRP and TNF-alpha as well as plasma levels of ccf nDNA were compared in both groups and in early stages [minimal and mild] of endometriosis within the study group

Results: Serum TNF-a, serum hs-CRP and plasma ccf DNA were significantly elevated in cases compared with the control group. They were also elevated in patients with group IA and group IB as compared to control group. However, there was no statistically significant difference between cases and control group as regards peritoneal TNF-a and peritoneal hs-CRP. There was no significant difference between the group IA and group IB as regards all biomarkers

Conclusion: Our results showed that serum TNF-alpha , serum hs-CRP and plasma ccf DNA are highly reliable biomarkers for screening and early diagnosis of endometriosis, but they can not be used to discriminate between stage I and stage II. On the other hand, peritoneal TNF-a and peritonealhs-CRP are non reliable for early diagnosis of endometriosis and can not be used to discriminate between stage I and stage II of endometriosis

prostaglandin E1, analogue [misoprostol] versus oxytocin in labor induction

Sixty-five patients with an indication for induction of labor were randomly assigned to induction with intravaginal misoprostol or IV oxytocin infusion. In the latter group, prostaglandin E2 vaginal tablets were used prior to infusion if necessary. Among 65 patients evaluated, 33 were assigned to the misoprostol group and 32 to the oxytocin group. PGE2 vaginal tablets were needed in 12 patients in the oxytocin group with unfavorable cervix. Uterine tachysystole occurred more frequently in the misoprostol group [33.3%] than the oxytocin group [15.6%]. However, no statistically significant differences were noted between the two groups regarding mode of delivery and neonatal or maternal adverse outcome. The induction to delivery interval was significantly short in the misoprostol group [10.2 versus 16.3 hours]. In 68% of patients in the misoprostol group, only one intravaginal dose was required for successful labor induction