Comparison of pregnancy rates between patients with and without local endometrial scratching before intrauterine insemination.

OBJECTIVES: To determine the implantation success of local endometrial injury in patients undergoing intrauterine insemination following ovulation induction with gonadotropins as an infertility treatment. MATERIAL AND METHODS: In this prospective randomized controlled trial, ovulation induction was performed with gonadotropins in 80 patients following intrauterine insemination. In 40 patients, local endometrial injury (scratch) was performed in the midluteal phase of the cycle preceding ovarian stimulation with a Novak curette to the posterior side of the endometrial cavity. RESULTS: Fifteen pregnancies (37.5%) and 11 clinical pregnancies (27.5%) occurred in the intervention group, whereas eight pregnancies (20%) and five clinical pregnancies (12.5%) occurred in the control group. Although the pregnancy rates and clinical pregnancy rates were increased in the intervention group, no statistically significant difference was found between the intervention and control groups (pregnancy rates: P=0.084; clinical pregnancy rates: P=0.094). CONCLUSION: Performing local endometrial injury (scratch) in the cycle preceding ovulation induction in patients with a diagnosis of infertility and indication for intrauterine insemination increased the pregnancy and clinical pregnancy rates. This increase was not, however, statistically significant. More randomized, controlled, prospective studies with larger patient numbers are required before the use of iatrogenic induction of local endometrial injury can be recommended in routine clinical practice.

Time-limited hydrotubation combined with clomiphene citrate treatment for unexplained infertility.

PURPOSE: To evaluate time-limited hydrotubation combined with clomiphene citrate as treatment for unexplained infertility. MATERIALS AND METHODS: In this unblinded, randomized controlled trial of patients who had unexplained infertility, 40 patients were treated with time-limited hydrotubation (saline, 20 ml; flushed within 20 to 30 seconds) and clomphene citrate (total, 70 cycles) and 40 patients were treated with clomiphene citrate alone (total, 74 cycles). All women underwent an ovulation induction protocol with clomiphene citrate (100 mg/d orally for five days, from day 3 to day 7 of the cycle). Hydrotubation was performed after detection of the dominant follicle. RESULTS: There were 15 pregnancies in the 80 patients (19%) (total, 144 stimulated cycles; 10% pregnancies per cycle). The frequency of clinical pregnancy per cycle was significantly greater in patients who were treated with hydrotubation and clomiphene citrate (nine pregnancies per cycle [13%]) than those treated with clomiphene citrate alone (two pregnancies per cycle [3%]; odds ratio, 5.3; 95% confidence interval, 1.1 to 25.5; p ≤ 0.05). The frequency of pregnancy per patient (total, clinical, or chemical) was similar for the two treatment groups. The frequency of live birth or abortion per cycle or patient was similar between the two treatment groups. CONCLUSION: Time-limited hydrotubation and clomiphene citrate may increase the frequency of clinical pregnancy per cycle in women who have unexplained infertility.

Tissue damage and oxidant/antioxidant balance.

The oxidant/antioxidant balance in healthy tissues is maintained with a predominance of antioxidants. Various factors that can lead to tissue damage disrupt the oxidant/antioxidant balance in favor of oxidants. In this study, disruptions of the oxidant/antioxidant balance in favor of oxidants were found to be a consequence of the over-consumption of antioxidants. For this reason, antioxidants are considered to be of importance in the prevention and treatment of various types of tissue damage that are aggravated by stress.

Albumin/creatinine ratio for prediction of 24-hour albumin excretion of > or =2 g in manifest preeclampsia.

PURPOSE OF INVESTIGATION: To compare whether albumin/creatinine ratios obtained from random or 8-hour urine collected in different periods of day differ in prediction of albumin excretion > or =2 g in 24-hour urine collection in preeclampsia. METHODS: From a total of 70 women, 24-hour urine collected by three consecutive periods of eight hours and three random urine samples were taken before each period. The variation of albumin-creatinine ratios in samples across the day was analyzed by the Friedman and inter-assay coefficient variation. For each sample, receiver operator characteristic (ROC) curves were constructed to determine an optimal albumin/creatinine ratio value in the prediction of albuminuria > or =2 g. RESULTS: The albumin/creatinine ratio did not vary significantly over time when all samples pooled. However, there was considerable intra-individual variation in both random and timed urine samples. On ROC analysis, the albumin/creatinine ratio in both random and timed urine samples predicted the 24-hour urine results and there was no difference between samples in prediction of albuminuria > or =2 g. A single optimal cut-off point was not available between samples. The positive and negative predictive values for optimal cut-offs ranged from 48%-88% and 94%-100%, respectively. CONCLUSIONS: The random urine albumin/creatinine ratio was a poor predictor for proteinuria a 2 g in patients with preeclampsia.