Is There any Role for Granulocyte Colony Stimulating Factor in Improvement of Implantation in Intrauterine Insemination? A Prospective Double-Blind Randomized Control Trial.

BACKGROUND: Granulocyte colony stimulating factor (GCSF) has been introduced as an immunomodulatory agent by increasing implantation rate in vitro fertilization (IVF) patients but it has not been studied in intrauterine insemination (IUI) patients. The aim of this study is to answer the role of GCSF in implantation rate of IUI. MATERIALS AND METHODS: In this prospective double-blind randomized control trial, 320 eligible patients were enrolled, who were referred to the referral infertility clinic of Shiraz University of Medical Sciences from February 2018 till the end of 2019. They were divided into two groups randomly. After collecting the demographic data, all patients received clomiphene citrate from the 5th day of the menstruation cycle for 5 days. 50-150 units of recombinant purified follicle-stimulating factor (FSH) were started from the 8th day of the cycle. Follicle monitoring was done by transvaginal sonography till a mature follicle of 18 mm or more was developed. Human chorionic gonadotropin (HCG) injection was done in both groups with intrauterine administration of 300 µg GCSF in the case group and normal saline in the control group simultaneously. After 36 hours, IUI was performed. The clinical pregnancy, miscarriage, and ongoing pregnancy rates of both groups were calculated by SPSS software. RESULTS: The results showed improvement of clinical pregnancy rate [15.38% vs. 13.81% OR=1.17 (0.62-2.21)], miscarriage rate [3.84% vs. 5.26% OR=0.74 (0.25-2.20)] and ongoing pregnancy rate [11.53% vs. 8.55% OR=1.37 (0.65-2.92)] in the GCSF group compared to the control. However, the results revealed no statistically significance (P>0.05). CONCLUSION: Although it was not statistically significant, 300 µg Intrauterine GCSF administration simultaneously with hCG injection in standard IUI procedure might increase the pregnancy outcomes. Further studies are warranted (registration number: IRCT201212079281N2).

Assisted reproductive technique outcomes in patients with endometrioma undergoing sclerotherapy vs laparoscopic cystectomy: Prospective cross-sectional study.

PURPOSE: The authors compared assisted reproductive technique (ART) outcomes and the recurrence rate of endometrioma in the infertile patients undergoing sclerotherapy vs laparoscopic ovarian cystectomy. METHODS: In this prospective cross-sectional study, a total of 101 infertile patients, with unilateral endometriomas, were divided into two groups. The first group (n = 57) underwent ART after 1 year of unsuccessful spontaneous pregnancy after laparoscopic ovarian cystectomy; the second group (n = 44) had ethanol sclerotherapy (EST) at the time of oocyte retrieval. The authors measured the number of oocytes, clinical pregnancy rate (CPR), live birth rate (LBR), complication, and recurrence of endometriomas as the primary and secondary outcomes. RESULTS: The two groups had no significant differences in baseline characteristics and ovarian stimulation markers and also total number of oocytes. 42.1% and 34.1% of the patients (n = 24 and 15) had clinical pregnancy, and 38.6% and 29.5% (n = 22 and 13) had live birth following ART cycles in the surgery group and sclerotherapy group (P = .41, 0.34). The recurrence rates were 14.0% and 34.1% in the surgery and sclerotherapy groups (P = .017, X 2 = 5.67). CONCLUSIONS: Ethanol sclerotherapy can be a good alternative to surgery concerning the treatment of endometrioma; however, the recurrence of the disease in this group is significantly higher.

Pregnancy-Associated Osteoporosis Presented with Femoral Neck Fracture: A Case Report and Literature Review.

BACKGROUND: Pregnancy-associated osteoporosis (PAO) is a rare condition characterized by reduced bone mineral density during the third trimester or lactation. Multiple risk factors, such as genetic, sedentariness, and 25-hydroxy vitamin D deficiency, are associated with PAO. In the majority of cases, PAO is presented with a compression fracture in vertebras, but in our case, it presented with a fracture of the femoral neck. Case Presentation: A 29-year-old, gravida one woman, developed right hip joint pain during the gestational age 34 weeks who referred to our clinic. Despite conservative management, the pain intensified. The patient delivered a healthy neonate in the 38th week of gestation and afterward underwent magnetic resonance imaging of the pelvic, revealing a bruised bone in the femoral neck. Since she had developed a femoral neck fracture during the postpartum period, she underwent open reduction and fixation of the femoral neck. Dual-energy X-ray absorptiometry (DEXA) revealed osteoporosis of the vertebras and femoral neck. She received calcium supplements and alendronate, and the pain was relieved. On 2-year and 4-year follow-up, she was found to be osteopenic with significant improvement in DEXA indices. CONCLUSION: PAO is a rare condition among young women. This condition should be kept in mind when hip joint or back pain is encountered during pregnancy.

Spin transfer torque and exchange coupling in Josephson junctions with ferromagnetic superconductor reservoirs.

In this paper, the spin transfer torque (STT) and the exchange coupling of the Josephson junctions containing the interesting cases of diffusive/ballistic-triplet/singlet ferromagnetic superconductor (FS) materials are investigated. First, the diffusive FS1/F c /FS2 structures with F c being a junction consisting of ferromagnetic and normal metal parts as well as insulating barriers are investigated. Secondly, the ballistic Josephson junction containing the triplet chiral p/wave FS reservoirs is studied. Using the Nazarov quantum circuit theory for the diffusive structures, it is found that the antiparallel/parallel or vice versa parallel/antiparallel transition of the favorable exchange coupling takes place due to the appearance of the only out-of-plane STT. Furthermore, the analyze of the phase difference interval in which an interlayer length-induced antiparallel/parallel transition can be occurred, is performed. Afterward, the mentioned ballistic structure is dealt with solving the 16 [Formula: see text] 16 Bogoliubov-de-Gennes equation. It is found that although the exchange fields of the FS are laid in the z and y  direction, the STT interestingly exists in all three directions of x, y  and z. This exciting finding suggests that the favorable equilibrium configuration concerning the least exchange coupling occurs in the relative exchange field direction different from 0 or [Formula: see text].

Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The existing knowledge about the pathophysiology, risk factors, and primary and secondary methods for the prevention of OHSS is reviewed in this manuscript. The clinical manifestations and characteristics of mild, moderate, severe, and critical forms of the syndrome are defined. The methods of handling affected cases as outpatient or in-hospital management methods as well as indications for hospitalization are summarized in this review. The clinical and biochemical routes of assessing and monitoring hospitalized patients with OHSS, various drugs and medical treatment strategies including indications for aspiration of the ascitic fluid and pleural effusion, and also rare indications for surgery are briefly explained in this article. Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. An OHSS-free clinic can be established nowadays by carefully considering the endocrinology of ovulation and using appropriate and dose-adjusted pharmaceutical agents, which are summarized and discussed in this review.

Diagnostic accuracy of magnetic resonance imaging, transvaginal, and transrectal ultrasonography in deep infiltrating endometriosis.

To determine the diagnostic accuracy of pelvic magnetic resonance imaging (MRI), transvaginal sonography (TVS), and transrectal sonography (TRS) in diagnosis of deep infiltrating endometriosis (DIE).This diagnostic accuracy study was conducted during a 2-year period including a total number of 317 patients with signs and symptoms of endometriosis. All the patients were evaluated by pelvic MRI, TVS, and TRS in the same center. The criterion standard was considered to be the laparoscopy and histopathologic examination.Of 317 patients being included in the present study, 252 tested positive for DIE. The sensitivity, specificity, positive predictive value, and negative predictive value of TVS was found to be 83.3%, 46.1%, 85.7%, and 41.6%, respectively. These variables were 80.5%, 18.6%, 79.3%, and 19.7% for TRS and 90.4%, 66.1%, 91.2%, and 64.1% for MRI, respectively. MRI had the highest accuracy (85.4%) when compared to TVS (75.7%) and TRS (67.8%). The sensitivity of TRS, TVS, and MRI in uterosacral ligament DIE was 82.8%, 70.9%, and 63.6%, respectively. On the contrary, specificity had a reverse trend, favoring MRI (93.9%, 92.8%, and 89.8% for TVS and TRS, respectively).The results of the present study demonstrated that TVS and TRS have appropriate diagnostic accuracy in diagnosis of DIE comparable to MRI.

Postpartum Spontaneous Rupture of Spleen in a Woman with Severe Preeclampsia: Case Report and Review of the Literature.

Splenic rupture during pregnancy is considered a catastrophic condition associated with high maternal and fetal mortality and morbidity. Herein, we report a case of severe preeclampsia that underwent cesarean delivery with subsequent spontaneous splenic rupture. A 21-year-old primigravid woman was transferred to our center due to severe preeclampsia that underwent cesarean delivery because of uncontrolled blood pressure and low platelet count. She developed coffee ground vomiting postoperatively and clinical evidence of free fluid was present. Emergency laparotomy was performed and revealed an approximately 2.5-3 cm defect in splenic capsule with active bleeding from the ruptured site. The site of splenic laceration was packed with gauze. Postoperative period was uneventful and she was discharged on day 15 after admission. As spontaneous splenic rupture is associated with severe complications, its differential diagnosis should be kept in mind in pregnant women with severe preeclampsia.

Spin-transfer and exchange torques in ferromagnetic superconductors.

We consider how superconducting correlations influence spin-transfer torques in ferromagnetic superconductors. It is demonstrated that there is a novel torque arising from particle-hole interference that depends on the U(1) phase associated with the superconducting order parameter. We also show that there is an equilibrium exchange torque between two ferromagnetic superconductors in contact via a normal metal mediated by Andreev states. The latter equilibrium magnetic torque is also sensitive to spin-resolved phase differences in the superconducting order parameters as well as to an externally applied phase difference.