use of gabapentin in the control of endometriotic pain

Endometriotic pain is a combined nociceptive and neuropathic pain. Nociceptive endometriotic pain is caused by infiltrating endometrtotic lesions as well as fibrotic traction on different pelvic contents. Neuropathic endomnetriotic pain is due to nerve infiltration by endometriotic lesions, fibrotic traction on the nerve, and nerve irritation by inflammator mediators and cytokines in peritoneal fluids. The study was conducted on 33 patients with pain as the only or main symptom. All patients received hormonal and NSAIDs [ +/- Tramadol] treatment for at least 6 months and pain failed to be controlled. All patients received gabapentin for 3 months. Pain was evaluated using SF McGill mean overall pain score and NRS to evaluate the intensity of deep dyspareunia and dysmenorrhea. Serum IL-6 and CA-125 were evaluated. There is a significant improvement of SF McGill mean overall pain score. deep dyspareunia and dysmenorrhea 2 weeks, 4 weeks and 3 months after treatment. SF McGill mean overall pain score showed significant improvement with the rates of 46.54%, 56.18% and 59.31% at 2 weeks. 4 weeks and 3 months respectively. Also, deep dyspareunia showed significant improvement in the rates of 30. 76%, 52.14% and 58.12% at 2 weeks, 4 weeks and 3 months respectively. Dysmenorrhea showed improvement with the rates of 18.87%. 2 7.52% and 35.85% at 2 weeks. 4 weeks and 3 months respectively [All shows P value < 0.01]. This was associated with different degrees of clinical improvement in 72.73% of patients. Serum levels of IL6 showed significant decrease after 3 months with the treatment [P-value < 0.05] while CA-125 showed insignificant decrease of serum levels with treatment [P-value> 0.05]. This study proved an effective role of GABAPENTIN, not only in controlling the mean overall endometriotic pain, but also in deep dyspareunia and dysmenorrhea. This pain control is associated with significant decrease in the level of IL-6, but not CA-125

Double IUI does it offer extra benefit over single IUI?

To evaluate the efficacy of performing two intrauterine inseminations per cycle, in comparison with single insemination, as well as with timed intercourse. Prospective, randomized, controlled study. 300 hundred patients with unexplained infertility, or with mild male factor infertility were enrolled in the study, were divided in three groups, the first, underwent controlled ovarian stimulation [COS] with timed intercourse, the second underwent COS, with single IUI performed 34 to 36 hours after human chorionic gonadotrophin [HCG] injection, and the third group underwent COS and double inseminations performed 18 and 36 hours after hCG injection. Pregnancy rates in the double insemination group were significantly higher than those with single insemination, [21% clinical pregnancy rate versus 13%], [28% versus 18% cumulative pregnancy rate] respectively. It is worth doing double insemination in patients with unexplained infertility, or with mild male factor infertility