Luteal phase support with estrogen in addition to progesterone increases pregnancy rates in in vitro fertilization cycles with poor response to gonadotropins.

In this study, our objective was to determine the effect of adding estradiol hemihydrate (E2) to progestin (P) for luteal phase support on pregnancy outcome in in vitro fertilization (IVF) cycles with poor response to gonadotropins. Ninety-five women with poor ovarian response who underwent controlled ovarian hyperstimulation (COH) with gonadotropin releasing hormone (GnRH) agonist or GnRH antagonist plus gonadotropin protocol for IVF were prospectively randomized into three groups of luteal phase support after oocyte retrieval. Group 1 (n = 33) received only intravaginal progesterone gel (Crinone 8% gel). Group 2 (n = 27) and Group 3 (n = 35) received intravaginal progesterone plus oral 2 and 6 mg estradiol hemihydrate, respectively. Main outcome measures were overall and clinical pregnancy rates (PRs) per patient. Serum LH, E2 and P levels at 7th and 14th days of luteal phase were also measured. Overall and clinical PRs were significantly higher in 2 mg E2 + P than P-only group (44% versus 18% and 37% versus 12.1%, respectively). There were no statistically significant differences between 6 mg E2 + P versus P-only and 2 mg E2 + P versus 6 mg E2 + P groups regarding PRs. Addition of 2 mg/day E2 in addition to P for luteal support significantly increase overall and clinical PRs in cycles with poor response to gonadotropins after IVF.

Postoperative pain control after cesarean section: can diclofenac sodium be used instead of meperidine?

OBJECTIVE: To determine the advantages and disadvantages of the use of diclofenac sodium instead of meperidine for postcesarean section pain control. METHODS: A total of 130 patients who had undergone cesarean section at the Department of Obstetrics and Gynecology of Gazi University Hospital were prospectively randomised to receive one of two postoperative pain control regimens. The first group of patients received intramuscular diclofenac sodium at a dose of 2 x 75 mg and additional breakthrough meperidine was given intramuscularly at 50 mg dosages each time, if necessary. Patients in the second group received only 6 x 50 mg meperidine. RESULTS: Twenty-seven of the 65 patients in the diclofenac group complained of unrelieved pain within the subsequent 24 h postoperatively. Patients receiving diclofenac alone or a combination of diclofenac + meperidine were less sedated and the time to the first passing of flatus was shorter than that in the patients treated with only meperidine. CONCLUSIONS: Diclofenac alone was safe and effective for the majority of the patients and it decreased the opioid requirements in the remaining patients.

Recurrent mucinous cystadenoma: a laparoscopic approach.

The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8-10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst.