Multiple transvaginal ascitic fluid aspirations improves the clinical and reproductive outcome in patients undergoing in vitro fertilisation treatment complicated by severe early ovarian hyperstimulation syndrome.

The objective of this study is to examine the effect of repeated transvaginal ascitic fluid aspiration on the reproductive outcome in patients undergoing in vitro fertilisation treatment complicated with severe ovarian hyperstimulation syndrome. A total of 65 women with severe early OHSS were hospitalised and managed with transvaginal ascitic fluid aspiration either in < 3 occasions (control group; n = 29) or ≥ 3 occasions (multiple aspirations) (study group; n = 36). All patients in both groups received intravenous fluid, human albumin and thromboprophylaxis. Patients in the study group received significantly lower amounts of parenteral fluid (p < 0.05), human albumin (p < 0.01), and LMWH (p < 0.001). In addition, they had significantly lower days of hospitalisation (p < 0.01) as compared with the control group. There was no significant difference in the cancellation rate between the two groups, but patients who underwent multiple aspiration had a significantly higher pregnancy rate (82.8% vs 41.7%, p < 001) and significantly lower abortion rate (10.3% vs 40%, p < 0.05) compared with the control group. Repeated transvaginal asitic fluid aspiration even with large amounts is safe and effective in the treatment of symptomatic patients with severe OHSS. The pregnancy rate increased significantly along with a significant decrease in the abortion rate was observed after multiple aspirations compared with < 3 aspirations.

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.

Low-molecular-weight heparin in the treatment of recurrent IVF-ET failure and thrombophilia: a prospective randomized placebo-controlled trial.

INTRODUCTION: Recently, thrombophilia (acquired and inherited) has been implicated in recurrent IVF-ET failure. The objective of this study was to determine the effect and safety of thromboprophylaxis using low-molecular-weight heparin (LMWH) in women with recurrent in vitro fertilization (IVF)-embryo transfer (ET) failure and thrombophilia. METHODS: Eighty-three women with history of three or more previous IVF failures and who had at least one thrombophilic defect were eligible for this study. Patients were randomly allocated into two groups: Group A (n = 42) received enoxaparin 40 mg/day, and group B (n = 41) received placebo (NaCl 0.9%). Both treatments started on the day of ET and continued until delivery or foetal demise was diagnosed. The primary outcomes were the implantation, pregnancy and live birth rates. RESULTS: Patients who received LMWH for thromboprophylaxis had a significant increase in the implantation and pregnancy rates compared with the placebo group (20.9% vs. 6.1% and 31% vs. 9.6%, respectively; p < 0.001 and p < 0.05, respectively). A significant increase in the live birth rate was observed in the heparin-treated group compared with placebo (23.8% vs. 2.8%, respectively; p < 0.05). The abortion rate was significantly higher in the placebo-treated group compared to the heparin-treated group (p < 0.05). The frequency of treatment complications did not differ between the two study groups. CONCLUSIONS: LMWH is a safe and effective thromboprophylactic treatment for women with thrombophilia and recurrent IVF-ET failures. The implantation rate, pregnancy and live birth rates are significantly increased with such treatment.

Investigations on the activity concentrations of 238U, 226RA, 228RA, 210PB and 40K in Jordan phosphogypsum and fertilizers.

The activity concentrations of naturally occurring radionuclides ((238)U, (226)Ra, (228)Ra, (210)Pb and (40)K) in Jordanian phosphate ore, fertilizer material and phosphogypsum piles were investigated. The results show the partitioning of radionuclides in fertilizer products and phosphogypsum piles. The outcome of this study will enrich the Jordanian radiological map database, and will be useful for an estimation of the radiological impact of this industrial complex on the immediate environment. The activity concentration of (210)Pb was found to vary from 95 +/- 8 to 129 +/- 8 Bq kg(-1) with a mean value of 111 +/- 14 Bq kg(-1) in fertilizer samples, and from 364 +/- 8 to 428 +/- 10 Bq kg(-1) with a mean value of 391 +/- 30 Bq kg(-1) in phosphogypsum samples; while in phosphate wet rock samples, it was found to vary between 621 +/- 9 and 637 +/- 10 Bq kg(-1), with a mean value of 628 +/- 7 Bq kg(-1). The activity concentration of (226)Ra in fertilizer samples (between 31 +/- 4 and 42 +/- 5 Bq kg(-1) with a mean value of 37 +/- 6 Bq kg(-1)) was found to be much smaller than the activity concentration of (226)Ra in phosphogypsum samples (between 302 +/- 8 and 442 +/- 8 Bq kg(-1) with a mean value of 376 +/- 62 Bq kg(-1)). In contrast, the activity concentration of (238)U in fertilizer samples (between 1011 +/- 13 and 1061 +/- 14 Bq kg(-1) with a mean value of 1033 +/- 22 Bq kg(-1)) was found to be much higher than the activity concentration of (238)U in phosphogypsum samples (between 14 +/- 5 and 37 +/- 7 Bq kg(-1) with a mean value of 22 +/- 11 Bq kg(-1)). This indicates that (210)Pb and (226)Ra show similar behaviour, and are concentrated in phosphogypsum piles. In addition, both isotopes enhanced the activity concentration in phosphogypsum piles, while (238)U enhanced the activity concentration in the fertilizer. Due to the radioactivity released from the phosphate rock processing plants into the environment, the highest collective dose commitment for the lungs was found to be 1.02 person nGy t(-1). Lung tissue also shows the highest effect due the presence of (226)Ra in the radioactive cloud (0.087 person nGy t(-1)).

Luteinized unruptured follicle syndrome: incidence and recurrence rate in infertile women with unexplained infertility undergoing intrauterine insemination.

BACKGROUND: The objective of this study was to determine the incidence and recurrence rate of luteinized unruptured follicle (LUF) syndrome in women with unexplained infertility undergoing intrauterine insemination (IUI). METHODS: A total of 167 women with unexplained infertility who underwent 292 cycles of IUI were enrolled in the study. All patients were treated with clomiphene citrate, 50-150 mg/daily from day 5 to 9 of their menstrual cycle. Ultrasound examination to confirm ovulation was performed on the day of IUI (day 0) and every day thereafter for another 3 days (days 1, 2 and 3). A total of 69 women who failed to conceive in the first cycle and 56 women who failed to conceive in the second cycle underwent second and third cycles, respectively. RESULTS: Of the total 167 patients who underwent first cycle, 42 (25%) had LUF. The incidence of LUF was 56.5% in 69 patients who underwent a second cycle of IUI treatment, of whom 33 patients had LUF in the first cycle with recurrence rate of 78.6%. In 56 patients who underwent 3 consecutive cycles, the incidence of LUF was 58.9% and recurrence rate of 90%. No pregnancies were recorded in patients with LUF during the study period. CONCLUSION: The incidence and recurrence rate of LUF are significantly increased in subsequent cycles of IUI. In these patients, other options of infertility treatment might be justified.