Miscarriage and clinical correlates of leukocyte count in patients with ovarian hyperstimulation syndrome.

SUMMARY: This study was conducted to determine the pregnancy outcome in women with ovarian hyperstimulation syndrome and leukocytosis. From a total of 944 women who underwent IVF-ET, 89 (9.4%) developed OHSS, of whom 67 underwent embryo transfer. The criteria of the study were met by 53 women and underwent WBC count and haematological, hormonal and biochemical tests were performed on the day of HCG administration. Statistical comparison was made between women with a WBC count of >15,000 and those with a WBC count of <15,000. Patients with WBC count of >15,000 at the time of HCG administration (n = 24) had significantly increased rate of early pregnancy loss than women who had WBC count of <15,000 (n = 29). No other blood, chemical and hormonal parameters were different between the two groups. It is concluded that women with ovarian hyperstimulation syndrome in an IVF-ET cycle are more likely to miscarry if they have a WBC count of >15,000 on the day of HCG administration.

Metformin in the treatment of clomiphene citrate-resistant women with polycystic ovary syndrome undergoing in vitro fertilisation treatment: a randomised controlled trial.

This study was conducted to determine the efficacy of metformin vs placebo in women with polycystic ovary syndrome (PCOS) undergoing IVF treatment. A total of 66 CC-resistant patients were studied prospectively. The women were randomly assigned to receive 850 mg of metformin (n = 34) or placebo (n = 32) twice daily that started 1 month before commencing the IVF treatment and continued to the day of the pregnancy test. Compared with the metformin-treated group, women who received a placebo had a significant increase in terms of days of stimulation with HMG, number of HMG ampoules, number of follicles >14 mm, number of oocytes retrieved, number of mature eggs, fertilisation rate and oestradiol level on the day of hCG administration. Similarly, women in the placebo group showed a significant increase in poor quality embryos, cancellation rate and the rate of ovarian hyperstimulation syndrome, as compared with the metformin-treated group. On the other hand, women who received metformin showed a significantly higher number of good quality embryos and implantation rate when compared with the placebo controls. Despite the transfer of a similar number of embryos, an insignificant increased in the pregnancy rate along with significant reduction in the abortion rate was observed in the metformin-treated group as compared with the placebo controls. No fetal abnormalities were encountered in the babies born in the metformin-treated group. It is concluded that metformin affects positively the quality of both oocytes and embryos without a significant increase in the pregnancy rate. It decreases significantly the rates of abortion and ovarian hyperstimulation syndrome.

Blood transfusion in obstetrics: the pregnant women's point of view.

The objective of this study was to determine the views and compliance of a group of pregnant women regarding obstetric-related blood transfusion. In this prospective questionnaire-based analysis, a total of 300 pregnant women who attended the antenatal care clinic were included. The mean age and gestational age of patients were 31.6 years and 27.4 weeks, respectively. All demographic and questionnaire data were recorded and analysed. A total of 41% of participants were aware of the possible need for blood transfusion in pregnancy and 88% of all women would accept blood transfusion when necessary. The remaining 12% would refuse blood transfusion, even if it was life-saving, because of the fear of blood transfusion complications. It is concluded that counselling and a management plan should be scheduled for pregnancy, and management protocols should be developed for women who refuse blood transfusion. Transfusion alternatives should be discussed with women who will not accept the allogenic blood transfusion.

Toxoplasmosis and habitual abortion.

We set out to determine the role of toxoplasmosis, detected by serological tests, in habitual abortion. A total of 280 pregnant women aged 15-46 years with parity ranged from 0-9 were studied prospectively between January 2000 and May 2001 at King Hussein Medical Center. Analyses for IgG and IgM anti-toxoplasma were carried out using indirect fluorescent antibody assay (IFAT) and enzyme-linked immunosorbent assay (ELISA). Titres of the order of 1:16-1:2048 were considered positive. According to the results, women were divided into two groups; seropositive (n=132) and seronegative (n=148). One hundred and thirty-two (47.1%) pregnant women showed seropositivity to IgG anti-toxoplasma; of them, two (1.5%) developed IgM anti-toxoplasma during the second trimester. A statistically significant increase in the rate of seropositivity to toxoplasma with increasing age and parity was found (P<0.05). There was no significant difference in the rate of habitual abortion between seropositive and seronegative women. The seropositivity was higher among women living in rural areas (P<0.02), who are using rainwater to drink (P<0.02), ingesting undercooked meat (P<0.001) and who have contact with soil (P<0.02). Toxoplasma antibodies detected by positive serological tests tend to be higher with increased age and parity. It seems that they have no role in habitual abortion.