Effect of low-dose aspirin on the development of ovarian hyperstimulation syndrome and outcomes of assisted reproductive techniques in the women with PCOS, a randomized double-blinded clinical trial.

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART. MATERIALS AND METHODS: This double-blinded placebo controlled RCT was performed on 232 PCOS infertile women in their first ART cycles during 2010-2016. LDA and placebo capsules were prepared, packed and specified by code numbers in similar shapes. One package was given to every woman and asked to take one capsule/day since the 21st day of her cycle prior to the gonadotropin stimulation. Gonadotropin releasing hormone agonist long protocol and triggering by human chorionic gonadotropin were used. Development of moderate to severe OHSS and their ART outcomes were documented then the codes were broken and data analyzed. Chi-square and Mann-Whitney U tests were used for the statistical analyses. RESULTS: Eighteen cases that did not follow the study design were excluded. 214 cycles remained for the final analyses with 109 cases in LDA and 105 in the placebo group. Rate of the moderate to severe OHSS in LDA group was 34.9% compared to 30.5% in placebo group (P = 0.494). Fertilization rate was 71.8% vs 65.1% (P = <0.001) and the mean number of grade III embryos were 3.28 ± 3.53 vs 1.46 ± 1.42 (P = 0.014) in LDA and placebo groups, respectively. The mean number of the oocytes in different grades, total and frozen embryos also implantation and clinical pregnancy rates were not different between the groups. CONCLUSION: Moderate to Severe OHSS was not decreased but fertilization rate and the mean number of poor quality embryos were increased in LDA arm. REGISTRATION NUMBER: IRCT 201105216541N1.

Angiotensin Type 2 Receptor Gene Polymorphisms and Susceptibility to Preeclampsia.

BACKGROUND: The purpose of the study was to determine the relationship between angiotensin II type 1 receptor at position+1166 (AT1R+1166A/C; rs5186) and angiotensin II type 2 receptor at position+1675 (AT2R+1675A/G; rs5194) gene polymorphisms with preeclampsia in an Iranian women population. METHODS: 430 women were recruited in this study including 212 preeclamptics and 218 healthy women. PCR-RFLP method was used for genotyping the polymorphisms. Chi square and Fisher exact test were used for comparing case and control groups. The p<0.05 was considered statistically significant. RESULTS: The frequency of genotypes of the AT1R gene and AT2R gene was similar in preeclampsia and normal pregnancy. There were no significant differences in genotype and also allele frequencies between preeclamptics and healthy women regarding the two studied polymorphisms. AT1R/AT2R genotypes combination study indicated that there was a statistically significant difference between preeclamptics and healthy women. AC/AG combination was significantly decreased, while CC/AA combination showed significant increase in patients compared with the healthy women (p<0.01). CONCLUSION: The present study showed that the genetic polymorphisms within AT1R and AT2R genes may be associated with susceptibility to preeclampsia in Iranian women.

Antisperm protein targets in azoospermia men.

BACKGROUND: The number of couples that meet the definition of infertility at reproductive ages is increasing worldwide. One of the most known conditions of infertility in males is azoospermia, defined as complete absence of spermatozoa in the semen. Azoospermia manifests in two forms, namely obstructive and non-obstructive azoospermia. Although the presence of antisperm antibody (ASA) has been reported in 88% of the patients with obstructive azoospermia (OA), interestingly, there is no data regarding ASA targets in OA individuals. AIM: The present study aimed to identify sperm antibody targets in a group of OA men. SETTINGS AND DESIGN: The present study was carried out on 27 OA infertile men and 27 healthy fertile age-matched males as cases and controls, respectively. SUBJECTS AND METHODS: The sperm proteome was separated using two-dimensional gel electrophoresis technique, transferred onto the polyvinylidene fluoride membrane, and blotted with the sera of a group of OA men. Then, it was compared with the membranes blotted with the sera of a group of healthy fertile men. Matrix-assisted laser desorption/ionization time-of-flight/time-of-flight (MALDI TOF/TOF) mass spectrometry was used to identify the different blotted spots and finally the results of the mass analysis were confirmed using reverse transcriptase polymerase chain reaction method. RESULTS: The results indicated that OA patients might produce antibody against two sperm proteins, Tektin-2 and triose phosphate isomerase. Moreover, the expressions of the two targeted proteins were confirmed at RNA level. CONCLUSIONS: The findings of the present study revealed two functionally important sperm proteins as antibody targets in azoospermic men.

Proteome differences in the first- and third-trimester human placentas.

Placenta is a transient and unique pregnancy tissue that supports the fetus nutritionally and metabolically. Expression of the unique placental proteins in different stages may influence the development of the fetus as well as the pregnancy outcome. The present study aimed to compare the total placental proteome differences between the normal first- and third-trimester human placentas. In the current study, placental proteome was compared between normal first- and third-trimester placentas using 2-dimensional polyacrylamide gel electrophoresis method for separation and matrix-assisted laser desorption/ionization time-of flight mass spectrometry technique for identification of the proteins. Despite the overall similarities, comparison of the mean intensity of the protein spots between the first- and third-trimester placental proteomes revealed that 22 spots were differentially expressed (P < .05) among which 11 distinct spots were successfully identified. Of the 11 differentially expressed proteins, 4 were increased (protein disulfide isomerase, tropomyosin 4 isoform 2, enolase 1, and 78-kDa glucose-regulated protein), while the remaining 7 (actin γ1 propeptide, heat shock protein gp96, α1-antitrypsin, EF-hand domain family member D1, tubulin α1, glutathione S-transferase, and vitamin D binding protein) showed decreased expression in the placentas from the first-trimester compared to the full-term ones. In summary, the results of the present study as the first research on the comparison of the first- and third-trimester human placental proteomes introduced a group of 11 proteins with altered expression. Interestingly, some of these proteins are reported to be altered in pregnancy-related disorders.

Comparison of Elaeagnus angustifolia Extract and Sildenafil Citrate on Female Orgasmic Disorders: A Randomized Clinical Trial.

BACKGROUND: Orgasmic disorder can create a feeling of deprivation and failure and provide mental problems, incompatibility and marital discord. This study aimed to compare the effects of Elaeagnus angustifolia flower extract and sildenafil citrate on female orgasmic disorder in women in 2013. METHODS: In this randomized clinical trial, 125 women between 18-40 years old who suffered from orgasmic disorder were divided into three E. angustifolia, sildenafil citrate and control groups. The data were gathered using Female Sexual Function Index and through measurement of TSH and prolactin. The first intervention group had to consume 4.5 gr E. angustifolia extract in two divided doses for 35 days and the second one had to use 50 mg sildenafil citrate tablets for 4 weeks one hour before their sexual relationship. However, the control group had to consume the placebo. The data were analyzed using paired t-test, one-way ANOVA, and Bonferroni posthoc test and p<0.05 was considered significant. RESULTS: The frequency of orgasmic disorder before the intervention was 41.5%, 40.5%, and 57.1% in E. angustifolia, sildenafil citrate, and control groups, respectively (p=0.23). However, these measures were respectively 29.3%, 16.7%, and 50% after the intervention (p=0.004). A significant difference between the two groups regarding sexual satisfaction after the intervention (p=0.003) compared to the beginning of the study (p=0.356). Besides, the highest reduction of changes after the intervention (58.82%) was observed in the sildenafil citrate group. CONCLUSION: Both E. angustifolia extract and sildenafil citrate were effective in reduction of the frequency of orgasmic disorder in women.

Thalidomide affects experimental endometriosis: a randomized controlled study in the rat.

AIM: This study aimed to assess the efficacy of thalidomide for treatment of experimental endometriosis. METHODS: This study was a parallel-group, double-blind, stratified, randomized controlled animal trial with 1:1 allocation ratio. Endometriosis was induced experimentally in 23 mature, nulligravid, female Sprague-Dawley rats, weighing approximately 200 g and aged 2 months. A checkpoint surgery was performed 6 weeks later. Then, the rats were randomly allocated into the thalidomide (22 mg/day p.o.) and control (0.5 mL saline 0.9%/day p.o.) groups of nine. After 6 weeks, they were killed. Before each laparotomy, blood for leukocyte and lymphocyte counts and during them, implants for histopathology and peritoneal fluid for interleukin (IL)-6, tumor necrosis factor-α and vascular endothelial growth factor (VEGF)-A concentrations (by enzyme-linked immunoassay) were collected. Allocation and stratified randomization were done using a computer, based on the obtained histopathology scores of the implants of the checkpoint surgery. RESULTS: The histopathology scores (the main outcome measure) were 2.00 ± 1.55 versus 0.44 ± 1.01 (P = 0.035). The comparisons of after-treatment counts of leukocytes, lymphocytes, VEGF-A and IL-6 between the two groups were statistically significant. CONCLUSION: The results of this study are in favor of therapeutic implication of thalidomide in experimental endometriosis in rats. This is the first time thalidomide has been evaluated on endometriosis in an animal model.

Vagifem is superior to vaginal Premarin in induction of endometrial thickness in the frozen-thawed cycle patients with refractory endometria: A randomized clinical trial.

BACKGROUND: Embryo transfer to a developed endometrium is an important prognostic factor in frozen-thawed embryo transfer cycle outcome. Vaginal estrogen, such as Vagifem vaginal tablets and Premarin vaginal cream, is a regimen used for the patients with refractive endometria. OBJECTIVE: Our objective was to compare the effects of Vagifem and Premarin on the endometrial thickness of the patients with refractive endometria. MATERIALS AND METHODS: In this randomized clinical trial, 30 patients with refractive endometria in frozen-thawed embryo transfer cycles received Vagifem vaginal tablets and 30 women received Premarin vaginal cream. Endometrial thickness was measured on the 14th day of drug administration. RESULTS: Comparing the endometrial thicknesses of the two groups showed that the endometria of the Vagifem group was significantly thicker than that of the Premarin group (5.93±0.38 vs. 6.74±0.32; p<0.001). CONCLUSION: Vagifem is superior to Premarin in induction of endometrial thickness in frozen-thawed embryo transfer cycles in the patients with refractive endometria.

Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: A randomized clinical trial.

BACKGROUND: The direct effect of hCG on the human endometrium was studied several times. OBJECTIVE: The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin (rhCG) before embryo transfer (ET). MATERIALS AND METHODS: In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection (IVF-ICSI) cycles were randomly assigned to receive 250µg intrauterine rhCG (n=84) or placebo (n=98) before ET. The implantation and pregnancy rates were compared between groups. RESULTS: Patients who received intrauterine rhCG before ET had significantly higher implantation (36.9% vs. 22.4%; p=0.035), clinical pregnancy rates (34.5% vs. 20.4%; p=0.044) and ongoing pregnancy rate (32.1% vs. 18.4%; p=0.032) when compared to those who received placebo. The abortion (2.4% vs. 2.0%; p=0.929) and ectopic pregnancy rates (1.2% vs. 1.0%; p=0.976) were comparable between groups of rhCG and placebo, respectively. CONCLUSION: Intrauterine injection of 250µg of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles. REGISTRATION ID IN IRCT: IRCT2012121711790N1 This article extracted from fellowship course thesis. (Masoumeh Younesi).

Alteration in the expression of proteins in unexplained recurrent pregnancy loss compared with in the normal placenta.

The placenta is a unique pregnancy-related tissue and plays a key role in occurrence of unexplained recurrent pregnancy loss (URPL). Abnormal placentation might play a key role in occurrence of URPL. Therefore, the purpose of this study was to compare the human placental proteome between URPL placentas and normal placental matched for gestational week. Total placental proteins were extracted, and the two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) technique was used for separation of the placental proteomes. Protein spots differentially expressed between URPL and normal placentas were selected and identified by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF/TOF) technique after being digested in the gel. Moreover, quantitative real-time PCR and Western blot techniques were used to confirm the differential expression mass results for some differentially expressed proteins. The results indicated that at least 19 protein spots were differentially expressed between URPL and normal placentas (P < 0.05), and twelve of them were successfully identified. While only two proteins were downregulated (calumenin and enolase 1), the remaining ten spots (actin gamma 1 propeptide, cathepsin D prepropeptide, heat shock protein gp96, tubulin beta, tubulin alpha 1, glutathione S-transferase, vitamin D binding protein, prohibitin, actin beta, apolipoprotein A-I) showed increased expression in URPL cases in comparison with normal placentas. Real-time PCR also confirmed the downregulation of calumenin and upregulation of prohibitin and apolipoprotein A-I at the mRNA levels. In conclusion, the results of the present study showed that alteration in the expression of proteins involved in proliferation and migration of endothelial cells as well as control of coagulation by these cells might play an important role in the pathogenesis of URPL.

Double versus single cervical cerclage for patients with recurrent pregnancy loss: a randomized clinical trial.

AIM: To compare the effectiveness of the double cervical cerclage method versus the single method in women with recurrent second-trimester delivery. METHOD: In this randomized clinical trial, we included 33 singleton pregnancies suffering from recurrent second-trimester pregnancy loss (≥2 consecutive fetal loss during second-trimester or with a history of unsuccessful procedures utilizing the McDonald method), due to cervical incompetence. Patients were randomly assigned to undergo either the classic McDonald method (n = 14) or the double cerclage method (n = 19). The successful pregnancy rate and gestational age at delivery was also compared between the two groups. RESULTS: The two study groups were comparable regarding their baseline characteristics. The successful pregnancy rate did not differ significantly between those who underwent the double cerclage method or the classic McDonald cerclage method (100% vs 85.7%; P = 0.172). In the same way, the preterm delivery rate (<34 weeks of gestation) was comparable between the two study groups (10.5% vs 35.7%; P = 0.106). Those undergoing the double cerclage method had longer gestational duration (37.2 ± 2.6 vs 34.3 ± 3.8 weeks; P = 0.016). CONCLUSION: The double cervical cerclage method seems to provide better cervical support, as compared with the classic McDonald cerclage method, in those suffering from recurrent pregnancy loss, due to cervical incompetence.

Differences in the expression of TLRs and inflammatory cytokines in pre-eclamptic compared with healthy pregnant women.

BACKGROUND: Preeclampsia (PE) is one of the most complex and life-threatening pregnancy disorders and is considered as a major cause of mortality among mothers and fetuses worldwide. Although the exact etiology of PE is not well known several lines of evidence support an immunological etiology for PE. OBJECTIVE: To investigate the differences in the expression of TLRs 2, 4, 5, and 6 and a group of inflammatory cytokines including IL-1, IL-6, TNF-α and IFN-γ in placentas from PE and healthy pregnant women in their third trimester of pregnancy. METHODS: This case-control study was performed on fifteen PE and fifteen age and gestational matched healthy pregnant women in the third trimester of pregnancy. Real time PCR (RT-PCR) technique was used to determine the expression of TLRs 2, 4, 5, and 6 in the maternal and fetal parts of the placenta. Moreover, the expressions of IL-1, IL-6, TNF-α and IFN-γ at RNA level in placental samples, peripheral, and cord blood were investigated. RESULTS: The results of the present study indicated that the expressions of TLRs 4, 5 and 6 were significantly increased in both maternal part (p<0.001 and p<0.003 for TLRs 4, 6 and TLR 5, respectively) and fetal part (p<0.001), while TLR2 showed significant increase only in the fetal part of PE placentas (p<0.002). The levels of all studied cytokines showed over-expression within peripheral and cord blood samples from PE patients (p<0.001 for IL-1, IL-6, and IFN-γ and p<0.004 for TNF-α in both cord and peripheral blood samples). CONCLUSION: The finding of the present study indicated that the expression of the studied TLRs and inflammatory cytokines are generally suppressed in normal pregnancy, but are up regulated in preeclamptic women. Moreover, it seems that the maternal and fetal parts of the placenta may play different roles in the induction of the inflammatory status within the placenta.

Importance of anti-GRP78 antibody in pre-eclampsia.

BACKGROUND: Preeclampsia (PE) is a pregnancy specific syndrome that is associated with high maternal and fetal morbidity and mortality. Glucose regulated protein78 (GRP78) is an Endoplasmic Reticulum (ER) protein which is expressed on the cell surfaces of trophoblast cells under stress or hypoxic condition. GRP78 has a role in aggressive behavior of invasive cells and may play a role in normal placentation. OBJECTIVES: To investigate the autoantibody against GRP78 in the sera of patients with PE and to assess the correlation between antibody and severity of the disease. METHODS: We evaluated the anti-GRP78 antibody within the sera of fifty pre-eclamptic (12 severe and 38 mild PE) and fifty healthy pregnant women using a home-made ELISA assay. Furthermore, western blot technique was used to assess the expression of GRP78 in placenta of healthy and pre-eclamptic women in their third trimester. The presence of anti-GRP78 antibody in the serum samples from pre-eclamptic and healthy women was also assessed. RESULTS: GRP78 was expressed by placenta, and both healthy and pre-eclamptic women produced anti-GRP78 antibody. Although no significant difference was found between the pre-eclamptic and healthy women regarding the level of anti-GRP78 antibody, the difference between severe pre-eclamptic and healthy control women was statistically significant (p<0.003). CONCLUSION: The findings of the present study indicated that measurement of anti-GRP78 antibody may provide a new marker for severe pre-eclampsia. Yet, future studies are required to confirm this notion.

Soluble CD30 (sCD30) and effectiveness of leukocyte therapy in recurrent pregnancy loss patients.

While there is still controversy regarding its effectiveness, leukocyte therapy is considered a useful method of treatment for a subgroup of patients with recurrent pregnancy loss (RPL). To date, there is no reliable test for evaluating the effectiveness of leukocyte therapy. Deviation in the cytokine balance toward a Th2 response is suggested to be the major mechanism underlying the benefit of leukocyte therapy. sCD30 is an index of activity of the Th2 arm of the immune system. The aim of this study was to determine the effect of leukocyte therapy on serum sCD30 and also to investigate the relationship between the sCD30 level after therapy and pregnancy outcome. The sCD30 titer in a group of RPL patients treated with paternal leukocytes was measured before and after therapy and compared with two control groups (normal non-pregnant and first trimester pregnant women). The mean level of sCD30 was found to be significantly increased after treatment. A significant increase in the mean level of sCD30 was observed in patients after leukocyte therapy irrespective of later successful or unsuccessful pregnancy outcome. No correlation between the increase in sCD30 level and pregnancy outcome was observed. In conclusion, the results of the present study show that leukocyte therapy increases the sCD30 level; however, the rise in the sCD30 level is not correlated with a successful outcome.

Presence of autoantibody against two placental proteins, peroxiredoxin 3 and peroxiredoxin 4, in sera of recurrent pregnancy loss patients.

PROBLEM: Recurrent pregnancy loss (RPL) is defined as two or more consecutive abortion before the 20th week of gestation. Autoimmune diseases increase the risk and accounts for at least 20% of RPL. Placenta is a pregnancy unique tissue, and proper formation of placenta is key phenomenal for success of a pregnancy. The aim of this study was to investigate the placental proteins that may act as antibody targets in RPL patients. METHOD OF STUDY: Total placental proteins were extracted and separated using 2D-PAGE technique. Separated protein spots were transferred on PVDF membrane and blotted with sera from 20 RPL patients and compared with the protein spots that membrane blotted with sera from 20 normal women. Differentially blotted spots were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry mass spectrometry technique. The results of the mass analysis also were confirmed by western blot using mAb and reverse transcriptase polymerase chain reaction technique. RESULTS: The results indicated that RPL women may produce antibody against Peroxiredoxin 3 (Prx3) and Peroxiredoxin 4 (Prx4). CONCLUSION: Our results indicate that two placental proteins, Prx3 and Prx4, may act as new placental immune targets. Considering the role of antioxidant defense in the protection of placenta from oxidative stress, production of antibodies against peroxiredoxins 3 and 4 may introduce a new autoimmune hypothesis in RPL, which is needed to be tested in the future works.

Soluble CD30 in normal pregnancy, pre-eclampsia and recurrent pregnancy loss.

BACKGROUND: Normal pregnancy is thought to be dependent on Th2 deviation, while Recurrent Pregnancy Loss (RPL) and Pre-eclampsia (PE) appear to be biased toward the Th1 immune response. It is believed that the soluble form of CD30 (sCD30) is an index of Th2 immune response or modulator of Th1/Th2 responses. OBJECTIVE: The aim of this study was determination of the sCD30 level in RPL and PE patients. METHODS: The sCD30 level was measured in sera of a group of normal non-pregnant women (N=43) and compared with normal pregnancy at the first (N=42) and third (N=42) trimester. Furthermore, the level of sCD30 in the normal first and third trimester pregnancies were compared with that of RPL (N=38) and severe pre-eclamptic (N=41) patients, respectively. sCD30 levels were measured by ELISA method and student t-test was used for statistical analysis. RESULTS: The mean level of sCD30 at the first trimester in normal pregnancy was significantly elevated as compared with normal non-pregnant women (21.4 vs. 15.2 ng/ml, p<0.0001). A significant difference between sCD30 concentration at the first and third trimester of normal pregnancies was also observed (21.4 vs. 14.3 ng/ml, p<0.0001). Interestingly, the sCD30 concentration did not show any significant changes at the first trimester of normal pregnancy as compared with RPL (21.4 vs. 20.9 ng/ml) and third trimester of normal pregnancy as compared with PE (14.3 vs. 13.1 ng/ml). CONCLUSION: The data of this study indicated that the concentration of sCD30 in serum during pregnancy period is not associated with RPL or PE and serum sCD30 is not a good correlate of Th2 immune responses in pregnancy.

Correlation of first-trimester fetal crown-rump length with outcome of pregnancy and birth weight.

OBJECTIVE: To examine the association of crown-rump length (CRL) in the first trimester with low birth weight and adverse pregnancy outcome. METHODS: In a prospective cross-sectional study, CRL was measured in 876 healthy pregnant women undergoing ultrasound evaluation between 9 and 14 weeks of gestation. Birth weight and pregnancy outcomes were analyzed for the 544 participants who met the study criteria. RESULTS: Low (<2500 g) and high (>4000 g) birth weights were correlated with the difference between actual and expected CRL expressed in days of gestation, but no correlation was found between the difference between actual and expected CRL and premature delivery. Low birth weight (P=0.005) and abortion (P=0.03) were also correlated with the difference between actual and expected CRL. CONCLUSION: Routinely measuring CRL during the first trimester to detect CRLs shorter than expected for gestational age could be useful to obstetricians. Anticipating a low birth weight and being warned about the possibility of abortion would enable them to manage prenatal care and delivery more appropriately.

The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion.

OBJECTIVES: We performed this study in order to investigate the role of chronic endometritis (CE) in unexplained recurrent spontaneous abortion (RSA) and to determine the correlation between hysteroscopic and histologic findings of CE in patients with unexplained RSA. We also tried to find out the relation between CE and primary vs. secondary RSA. STUDY DESIGN: One hundred and forty-two consecutive patients with unexplained RSA and 154 fertile women were enrolled in this study. All the patients and controls underwent hysteroscopy and, at the same time, endometrial biopsy. CE was suspected when hysteroscopy revealed signs of focal or diffuse endometrial hyperemia or endometrial endopolyps (less than 1mm in size). Histopathologic diagnosis of CE was based on superficial stromal edema, increased stromal density, and pleomorphic stromal inflammatory infiltrate dominated by lymphocytes and plasma cells. Results were compared between cases and controls as well as those with primary (n=61) and secondary (n=81) RSA. RESULTS: Patients with RSA had a significantly higher incidence of CE both hysteroscopically (67.6% vs. 27.3%; p<0.0001) and pathologically (42.9% vs. 18.2%; p<0.0001). The sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy in the diagnosis of CE were found to be 98.4%, 56.23%, 63.5% and 97.82% respectively. Patients with secondary RSA had a higher prevalence of CE both pathologically (83.9% vs. 45.9%; p<0.0001) and hysteroscopically (58.1% vs. 24.6%; p<0.0001). CONCLUSION: CE is associated with unexplained RSA. Hysteroscopy, with high sensitivity and acceptable specificity, is suitable for the diagnosis of CE in those with unexplained RSA. CE should be taken into consideration in those with secondary unexplained RSA.

Laparoscopic metroplasty in bicornuate and didelphic uteri.

OBJECTIVE: To determine the feasibility of laparoscopic metroplasty in the treatment of bicornuate and didelphic uteri. DESIGN: Case report. SETTING: University and private hospitals. PATIENT(S): Four women with a diagnosis of double uterine cavity (two bicornuate and two didelphic uteri) with a history of two recurrent spontaneous abortions at less than 5 months of pregnancy. INTERVENTION(S): Laparoscopic metroplasty with diagnostic hysteroscopy was performed for the unification of the uterus. Second-look laparoscopy and hysteroscopy was performed about 3 months later. MAIN OUTCOME MEASURE(S): Evaluation of the uterine compliance to high intrauterine pressure and presence of adhesions in the pelvic and uterine cavities. RESULT(S): In all four patients, laparoscopic metroplasty resulted in a unified uterus with a good cavity and tolerance to high intrauterine pressure. Minimal pelvic adhesions were noted in the two patients at the second surgery. CONCLUSION(S): This new technique of laparoscopic metroplasty is an acceptable alternative for abdominal metroplasty, with minimal adhesion formation.

Effect of folic acid in women with and without insulin resistance who have hyperhomocysteinemic polycystic ovary syndrome.

OBJECTIVE: To study the effect of folic acid on homocysteine (Hcy) levels in women with insulin resistance and polycystic ovary syndrome (PCOS) in a prospective clinical trial. METHOD: Of 210 women with PCOS, 70 were hyperhomocysteinemic; and of these, 32 were insulin resistant and 38 were not. The 70 women were treated with folic acid for 3 months. Baseline and serum levels of Hcy and insulin were measured in both groups. RESULTS: In both groups Hcy concentrations were significantly decreased following folic acid supplementation. The mean+/-SD levels before and after treatment were 14.03+/-1.5 micromol/L and 12.53+/-1.72 micromol/L in group 1 (P<0.001), and they were 12.07+/-0.87 micromol/L and 8.83+/-0.78 micromol/L in group 2 (P<0.001). CONCLUSION: The Hcy levels of hyperhomocysteinemic women with PCOS were reduced after 3 months of folic acid supplementation, and the rate of reduction was higher among women without insulin resistance. No change was found in fasting insulin levels.