The effects of peak and mid-luteal estradiol levels on in vitro fertilization outcome.

PURPOSES: To evaluate the role of peak E2 level and its ratio to mid-luteal E2 level on implantation and clinical pregnancy rates in patients undergoing IVF cycles. METHODS: A retrospective study was designed covering 106 patients who were admitted to IVF Unit between June and October 2008. The patients were divided into two groups with respect to peak E2 levels. Ovulation induction has been done via standard long agonist protocol. Blood samples were drawn on the day of (hCG) administration and 8 days after embryo transfer for serum E2, progesterone measurements. RESULTS: The mean peak E2 level was 2,697.4 ± 1,453 pg/ml (range 684-4,983 pg/ml. The number of retrieved oocytes, luteal E2 level, peak E2 level and E2 ratio were significantly higher in E2 >2,500 group, however, the implantation rate was significantly lower in this group. There were statistically significant differences in peak E2 levels, luteal E2 levels, retrieved oocytes, E2 ratios; of the women who got pregnant and did not get pregnant, all the above parameters were significantly higher in non-pregnant group. According to E2 ratios, the clinical pregnancy rate was highest in group 1 and significantly lowest in group 3. CONCLUSION: This study has shown that the high E2 level and mid-luteal decline of E2 which were defined as peak E2 level/mid-luteal E2 level were predictive for implantation rate in IVF cycles.

Circulating levels of copeptin, a novel biomarker in pre-eclampsia.

AIMS: Increasing evidence supports the participation of metabolic syndrome and insulin resistance in the pathogenesis of pre-eclampsia. Copeptin is co-synthesized with vasopressin and is a new and promising novel marker of metabolic syndrome and insulin resistance. Our aim was to investigate copeptin levels in normotensive pregnant, mild and severe pre-eclamptic women. MATERIALS AND METHODS: We included 96 pregnant women who received antenatal and obstetric care at the perinatology clinic of our hospital. They were divided into three groups: women with normal ongoing pregnancy (n=32), those with mild pre-eclampsia (n=32) and those with severe pre-eclampsia (n=32). Doppler velocimetry measurements of the uterine and umbilical arteries were performed for each patient. Plasma levels of copeptin were quantified with enzyme-linked immunosorbent assay. RESULTS: Plasma levels of copeptin were 0.31±0.09 ng/mL in the normotensive pregnant group, 0.62±0.16 ng/mL in the mild pre-eclamptic group and 0.85±0.18 ng/mL in the severe pre-eclamptic group (P<0.001). Copeptin levels in pre-eclamptic patients with abnormal Doppler velocimetry were significantly higher than in those with normal Doppler velocimetry. CONCLUSIONS: These results suggest that increased maternal levels of copeptin may be involved in the pathogenesis of pre-eclampsia and it may be useful in the assessment of the severity of the disease.

A comparison of the effects of three different luteal phase support protocols on in vitro fertilization outcomes: a randomized clinical trial.

OBJECTIVE: To evaluate the effects of three different luteal phase support protocols on pregnancy and implantation rates, as well as luteal phase hormone profile in intracytoplasmic sperm injection-ET cycles. DESIGN: A prospective, randomized study. SETTING: A tertiary teaching and research hospital. PATIENT(S): Two hundred eighty-eight patients who were undergoing intracytoplasmic sperm injection with a long protocol of controlled ovarian hyperstimulation. INTERVENTION(S): Group 1 (E(2) + P) received daily P plus 4 mg of E(2), group 2 (hCG + P) received P plus 1,500 IU of hCG, and group 3 (P only) received daily vaginal P gel. Blood samples were drawn on the day of hCG administration, as well as 7 and 10 days after the hCG for the E(2) and P measurements. MAIN OUTCOME MEASURE(S): The clinical pregnancy rate. RESULT(S): No difference existed between the E(2) + P and hCG + P groups with respect to pregnancy rate, but it was significantly lower in the P-only group.The implantation rate was significantly lower in the P-only group than in the other groups.The highest miscarriage rate was in the P-only group (38%). CONCLUSION(S): In assisted reproductive technology cycles including treatment with GnRH agonist, adding 4 mg of oral E(2) to P during the luteal phase significantly increased the pregnancy and implantation rates and decreased the miscarriage rate compared with the use of P only.

Effects of method of uterine repair on surgical outcome of cesarean delivery.

OBJECTIVE: To compare the rates of intraoperative and postoperative complications of uterine repair when performed in situ or extra-abdominally following cesarean delivery. METHODS: In this prospective randomized study 4925 women who underwent cesarean delivery were randomly assigned to in situ (n = 2462) or extra-abdominal (n = 2463) uterine repair (group 1 and group 2, respectively). The study compares drop in hemoglobin concentration (as a measure of intraoperative blood loss). It also compares operating time, time to return of bowel sound, and duration of hospitalization as well as rates of uterine atony, blood transfusion, intraoperative complications, additional use postoperative analgesics, endometritis, and wound infection. RESULTS: Uterine atony developed in 96 women (3.8%) in group 1 and 226 women (9.1%) in group 2 (P = 0.001). Moreover, the operating time and the time to return of bowel sound were shorter and the rates of both additional use of postoperative analgesics and wound infection were lower in group 1 (P = 0.001, P = 0.002, P = 0.001, and P = 0.003, respectively). CONCLUSION: Fewer cases of uterine atony, a shorter operating time, a faster return of bowel function, a lesser need for postoperative analgesics, and lower rates of additional use of postoperative analgesics and wound infections suggest that in-situ uterine repair ought to be preferred to extra-abdominal uterine repair following cesarean delivery.

Intrauterine device or estrogen treatment after hysteroscopic uterine septum resection.

OBJECTIVE: To investigate the effects on adhesion formation and pregnancy maintenance of an intrauterine device (IUD) and/or estrogen treatment after hysteroscopic septum resection. METHODS: After septum resection 100 women received either no treatment, or estrogens, or an IUD, or an IUD plus estrogens (n=25 per group). Most were later checked hysteroscopically for uterine cavity adhesions. All pregnancies occurring during the study period were recorded. RESULTS: Adhesions developed in 1 of 19 (5.3%) of the untreated women, 3 of 25 (12%) of the women treated with an IUD plus estrogens, 2 of 19 (10.5%) of the women treated with an IUD only, and none of the women treated with estrogens only. None of the differences, however, were significant. Regarding pregnancy, the differences between groups were also not significant. CONCLUSION: Neither IUD placement, nor estrogen treatment, nor both were found to prevent intrauterine adhesions or facilitate pregnancy after hysteroscopic uterine septum resection.

Laparoscopic conservative approach to ovarian pregnancies: two cases.

Primary ovarian ectopic pregnancy occurs quite rarely. Primary ovarian ectopic pregnancies usually occur in young, highly fertile, multiparous women using IUD. Two cases, we presented were middle aged, infertility and did not use IUD. The treatment of choice for ovarian pregnancy is usually ovarian wedge resection or oophorectomy, also there is a place for medical treatment of carefully selected patients. In this report, we aimed to present the laparoscopic conservative treatment of spontaneous ovarian ectopic pregnancy in two patients who had primary infertility.