Objective: To evaluate the role HCG change in the 48 h prior to methotrexate treatment as a predictor for treatment success.Study design: Medical records of all women who were diagnosed with ectopic pregnancy between January 2001 and June 2013 were reviewed. Four hundred and nine patients received methotrexate due to ectopic pregnancy. The "single dose" methotrexate protocol with 50 mg/m(2) was administered to patients with progressing ectopic pregnancy. HCG levels in days 1, 4 and 7 were used to evaluate methotrexate treatment success. The percentage of HCG change in the 48 h prior to methotrexate treatment was compared between patients who were successfully treated and those who failed treatment with methotrexate.Results: Single dose methotrexate was successful in 309 patients (75.4%, success group). The medians of HCG change in the 48 h prior to methotrexate administration were significantly higher in the "failure group" (21% vs. 4%, p < 0.01). In a logistic regression analysis, the of HCG percent increment prior to methotrexate administration was shown to be an independent predictor for treatment outcome. Receiver operator characteristic curve for HCG percent change was 0.751, at a cutoff value of HCG increment <12% the positive predictive value for treatment success reached 86%.Conclusions: Percentage of HCG increment in the 48 h prior to methotrexate administration is an independent predictor for methotrexate treatment success. HCG increment <12% prior to methotrexate treatment is a good predictor for treatment success. (C) 2017 Elsevier B.V. All rights reserved.

OBJECTIVEThe purpose of this study was to determine the success rates of methotrexate in progressing ectopic pregnancies and to correlate them with beta-human chorionic gonadotropin (β-hCG) levels.STUDY DESIGNThis retrospective cohort study that was carried out in a tertiary university-affiliated medical center included women who had been diagnosed with ectopic pregnancies between January 2001 and June 2013. Daily β-hCG follow-up examinations were performed to determine the progression of the ectopic pregnancy. Women with hemodynamically stable progressing ectopic pregnancies received methotrexate (50 mg/m(2) of body surface). We measured the success and failure rates for methotrexate treatment in correlation to β-hCG level.RESULTSOne thousand eighty-three women were candidates for "watchful waiting" (β-hCG follow up). Spontaneous resolution and decline of β-hCG levels occurred in 674 patients (39.5%); 409 women (24.0%) had stable or increasing β-hCG levels and were treated with methotrexate. In 356 women (87.0%), the treatment was successful; 53 women (13.0%) required laparoscopic salpingectomy. Compared with prompt administration of methotrexate, our protocol resulted in lower overall success rates for all levels of β-hCG in women with progressing ectopic pregnancies: 75% in women with β-hCG levels of 2500-3500 mIU/mL, and 65% in women with β-hCG levels >4500 mIU/mL. A mathematic model was found describing the failure rates for methotrexate in correlation with β-hCG levels.CONCLUSIONThe success rates for methotrexate treatment in progressing ectopic pregnancies after daily follow-up evaluation of β-hCG levels are lower than previously reported. This reflects redundant administration of methotrexate in cases in which the ectopic pregnancy eventually will resolve spontaneously.

To assess the efficacy and safety of laparoscopic treatment of bladder endometriosis, especially in cases of full thickness endometriotic nodules.

STUDY OBJECTIVE:To evaluate the accuracy of diagnostic office hysteroscopy in the detection of abnormal uterine findings in symptomatic and asymptomatic patients and compare it with the accuracy of operative hysteroscopy. DESIGN:A retrospective analysis of all women after operative hysteroscopy between 2010 and 2012 in our institution (Canadian Task Force classification II-2). SETTING:The department of gynecology in a tertiary referral medical center. PATIENTS:One hundred thirty-two patients with a mean age of 48 years after diagnostic office hysteroscopy and subsequent operative hysteroscopy. INTERVENTIONS:Operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS:We collected demographic and clinical data from patients' charts. The indications as well as findings of the previous diagnostic modality (transvaginal ultrasound [TVUS] and diagnostic hysteroscopy) were gathered and compared with the final tissue diagnosis obtained via operative hysteroscopy. Positive predictive values in diagnostic hysteroscopy were calculated for common pathological intrauterine findings. Forty-eight patients (37%) were menopausal, and 84 (63%) were premenopausal. The indications for hysteroscopy were abnormal uterine bleeding in 46% of patients and suspected uterine finding in 44%. A TVUS preceded the diagnostic hysteroscopy in 105 women (80%). Older female age, menopausal status, and abnormal intrauterine findings larger than 15 mm were associated with significantly greater true-positive rates on diagnostic hysteroscopy (i.e., the suspected findings on diagnostic hysteroscopy were verified by final pathology). Uterine bleeding during the interval between procedures was marginally significant and associated with greater false-positive results. Bleeding as opposed to routine evaluation of uterine cavity, interval between procedures, location of intrauterine finding, and hormone replacement therapy were not associated with greater true-positive values. CONCLUSION:Although diagnostic hysteroscopy is superior to TVUS in the assessment of polyps, it contributes little to TVUS when myomas and endometrial hyperplasia are suspected. Therefore, it should not be used routinely as an interface between TVUS and operative hysteroscopy when such findings such are suspected. Furthermore, in premenopausal patients with abnormal uterine bleeding between diagnostic and operative procedures and when small (<15 mm) polyps are suspected, it might be worthwhile to repeat a diagnostic procedure before operative hysteroscopy.

ObjectivePregnancy is a diabetogenic state that stems from enhanced insulin resistance. Metformin is an oral hypoglycemic agent that improves hyperglycemia by suppressing hepatic gluconeogenesis and improving insulin sensitivity. We sought to assess whether the addition of metformin to insulin treated pregnant women would improve glucose control and lower insulin requirements.Study DesignThis retrospective study included pregnant women with diabetes requiring >100 units of insulin to achieve euglycemia. Unbalanced glucose levels mandating further treatment (> 100 daily units of insulin) were divided into 2 groups: Group A treated with increasing doses of insulin solely. Group B addition of metformin 850mg bid along with insulin. The groups were compared for parameters of glucose control (number of daily hyperglycemia levels, time needed to achieve optimal control, maternal satisfaction on a scale from 1 to 5 and perinatal outcome (birthweight, macrosomia, shoulder dystocia, neonatal hypoglycemia).Results64 pregnant women meeting the inclusion crtieria were included. Metformin was added to the insulin treatment in 24 women (group B) while the other 40 were administered with increasing doses of insulin to achieve euglycemia (group A). The two groups were similar with regards to maternal age, body mass index, uterine scar and percentage of pre-gestational diabetes. Mean daily insulin requirements were significantly higher in group A (1352.3 vs 1053.6 units, p<0.05). Optimal glycemic control was achieved earlier with the combined treatment (8.31.2 days vs 10.11.2 days, p<0.05) and was better tolerated by the parturients (satisfaction score of 4.3 vs 3.6, p<0.05). Obstetrical performance was similar between the two groups with similar birthweights (3485212gr vs 3387138gr), NICU admission rates, neonatal hypoglycemia and macrosomia.ConclusionThe addition of metformin to pregnant women with diabetes requiring large amounts of insulin resulted in more rapid glucose control and higher maternal satisfaction and should be considered in these cases. ObjectivePregnancy is a diabetogenic state that stems from enhanced insulin resistance. Metformin is an oral hypoglycemic agent that improves hyperglycemia by suppressing hepatic gluconeogenesis and improving insulin sensitivity. We sought to assess whether the addition of metformin to insulin treated pregnant women would improve glucose control and lower insulin requirements. Pregnancy is a diabetogenic state that stems from enhanced insulin resistance. Metformin is an oral hypoglycemic agent that improves hyperglycemia by suppressing hepatic gluconeogenesis and improving insulin sensitivity. We sought to assess whether the addition of metformin to insulin treated pregnant women would improve glucose control and lower insulin requirements. Study DesignThis retrospective study included pregnant women with diabetes requiring >100 units of insulin to achieve euglycemia. Unbalanced glucose levels mandating further treatment (> 100 daily units of insulin) were divided into 2 groups: Group A treated with increasing doses of insulin solely. Group B addition of metformin 850mg bid along with insulin. The groups were compared for parameters of glucose control (number of daily hyperglycemia levels, time needed to achieve optimal control, maternal satisfaction on a scale from 1 to 5 and perinatal outcome (birthweight, macrosomia, shoulder dystocia, neonatal hypoglycemia). This retrospective study included pregnant women with diabetes requiring >100 units of insulin to achieve euglycemia. Unbalanced glucose levels mandating further treatment (> 100 daily units of insulin) were divided into 2 groups: Group A treated with increasing doses of insulin solely. Group B addition of metformin 850mg bid along with insulin. The groups were compared for parameters of glucose control (number of daily hyperglycemia levels, time needed to achieve optimal control, maternal satisfaction on a scale from 1 to 5 and perinatal outcome (birthweight, macrosomia, shoulder dystocia, neonatal hypoglycemia). Results64 pregnant women meeting the inclusion crtieria were included. Metformin was added to the insulin treatment in 24 women (group B) while the other 40 were administered with increasing doses of insulin to achieve euglycemia (group A). The two groups were similar with regards to maternal age, body mass index, uterine scar and percentage of pre-gestational diabetes. Mean daily insulin requirements were significantly higher in group A (1352.3 vs 1053.6 units, p<0.05). Optimal glycemic control was achieved earlier with the combined treatment (8.31.2 days vs 10.11.2 days, p<0.05) and was better tolerated by the parturients (satisfaction score of 4.3 vs 3.6, p<0.05). Obstetrical performance was similar between the two groups with similar birthweights (3485212gr vs 3387138gr), NICU admission rates, neonatal hypoglycemia and macrosomia. 64 pregnant women meeting the inclusion crtieria were included. Metformin was added to the insulin treatment in 24 women (group B) while the other 40 were administered with increasing doses of insulin to achieve euglycemia (group A). The two groups were similar with regards to maternal age, body mass index, uterine scar and percentage of pre-gestational diabetes. Mean daily insulin requirements were significantly higher in group A (1352.3 vs 1053.6 units, p<0.05). Optimal glycemic control was achieved earlier with the combined treatment (8.31.2 days vs 10.11.2 days, p<0.05) and was better tolerated by the parturients (satisfaction score of 4.3 vs 3.6, p<0.05). Obstetrical performance was similar between the two groups with similar birthweights (3485212gr vs 3387138gr), NICU admission rates, neonatal hypoglycemia and macrosomia. ConclusionThe addition of metformin to pregnant women with diabetes requiring large amounts of insulin resulted in more rapid glucose control and higher maternal satisfaction and should be considered in these cases. The addition of metformin to pregnant women with diabetes requiring large amounts of insulin resulted in more rapid glucose control and higher maternal satisfaction and should be considered in these cases.

To evaluate the effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation (COH), 36 women who underwent controlled ovarian stimulation cycles for IVF before and after salpingectomy were studied. The overall number of dominant follicles and the number of oocytes aspirated before and after salpingectomy were comparable (7.2 ± 3.8 vs. 7.3 ± 3.7 and 10.2 ± 6.6 vs. 10.3 ± 7.4, respectively) as well as maximal E(2) levels, daily doses of gonadotropins, and the number of dominant follicles before and after surgery on the operated side, demonstrating that salpingectomy does not influence ovarian response in COH.

Men diagnosed as having azoospermia occasionally have a few mature sperm cells in other ejaculates. Other men may have constant, yet very low quality and quantity of sperm cells in their ejaculates, resulting in poor intracytoplasmic sperm injection (ICSI) outcome. It has not been conclusively established which source of sperm cells is preferable for ICSI when both ejaculate and testicular (fresh or frozen) sperm cells are available. It is also unclear whether there is any advantage of fresh over frozen sperm if testicular sperm is to be used. We used ejaculate, testicular (fresh or frozen) sperm cells, or both for ICSI in 13 couples. Five of these couples initially underwent ICSI by testicular sperm extraction, because the males had total azoospermia, and in later cycles with ejaculate sperm cells. Ejaculate sperm cells were initially used for ICSI in the other 8 patients, and later with testicular sperm cells. The fertilization rate was significantly higher when fresh or frozen-thawed testicular sperm cells were used than when ejaculated sperm cells were used. Likewise, the quality of the embryos from testicular (fresh and frozen) sperm was higher than from ejaculated sperm (65.3% vs 53.2%, respectively, P < .05). The use of fresh testicular sperm yielded better implantation rates than both frozen testicular sperm and ejaculate. Therefore, fresh testicular sperm should be considered first for ICSI in patients with virtual azoospermia or cryptozoospermia because of their superior fertility.

Objective: To assess ovarian response among carriers of FMR1 premutation who undergo preimplantation genetic diagnosis (PGD).Design: Retrospective study.Setting: Academic IVF unit.Patient(s): Of 18 carriers of FMR1 premutation referred to PGD, eight had <100 CGG repeats and ten had >= 100 CGG repeats.Intervention(s): Controlled ovarian stimulation (COH) and PGD.Main Outcome Measure(s): Correlation between the number of CGG repeats and the level of E-2 at day of hCG administration, number of retrieved oocytes, number of two-pronuclear (2PN) zygotes, and dose of recombinant FSH.Result(s): There was a positive correlation between CGG repeats and the level of E-2 at day of hCG administration, number of retrieved oocytes, and number of 2PN zygotes. There was a negative correlation between number of CGG repeats and the total dose of gonadotropins. The E-2 level and the number of retrieved oocytes and 2PN zygotes were significantly higher and the dose of gonadotropins significantly lower for premutation patients with >= 100 CGG repeats compared with <100 CGG repeats.Conclusion(s): There is a positive correlation between E-2 level, retrieved oocytes, 2PN zygotes, and number of CGG repeats. Premutation carriers with <100 CGG repeats suffer from impaired ovarian response and decreased fertilization rate. (Fertil Steril (R) 2010; 94: 869-74. (c) 2010 by American Society for Reproductive Medicine.)

Objective: To compare selected umbilical cord parameters, especially cord coiling, between breech and vertex presentations.Methods: We prospectively collected umbilical cords from uncomplicated breech and vertex obtained during elective term cesarean deliveries. We compared various cord parameters between the two groups as well as data regarding obstetric history and pregnancy outcome.Results: We evaluated 55 umbilical cords from breech and 55 from vertex deliveries. Umbilical cord length (56.93 cm vs. 63.95 cm, P = 0.05), number of coils (5.1 +/- 0.4 vs. 11.7 +/- 0.6, P < 0.0001) and umbilical cord index (UCI) (0.09 coils/cm vs. 0.18 coils/cm, P < 0.0001) were all significantly lower for breech presentations and remained significant following multivariate analysis.Conclusion: We document significant differences in umbilical coiling and the UCI between breech and vertex presentation. The precise reason for these differences is still unclear.

The umbilical cord is a helical structure. Its length is influenced by fetal activity. However, the origin of its coiling is still obscured. One theory claims that fetal movements play a role in coiling development. Breech presentation is tought to be associated with lower motor activity compared to vertex.Thus it is expected to find differences in cord length and coiling between presentations. Our objective was to compare various cord indices betwen presentations. We prospectively collected umbilical cords from breech and vertex uncomplicated term elective cesarean deliveries. The following cord indices were compared between the two groups: length, number of coils and coiling index (number of coils/length, UCI). Obstetric history and pregnancy outcome parameters were collected including maternal age, parity, gestational age, fetal gender, birth weight, Apgar scores and arterial blood pH. We used t-test, and multi variant analysis for statistics. A total of 110 umbilical cords were collected, 55 from breech and 55 from vertex deliveries. No differences were existed in obstetric history parameters and pregnancy outcome between breech and vertex, except for mean maternal age (30.4±4.5 vs. 34.2±4.1, p = 0.001) and fetal weight (3200±332g vs. 3425±410g, p = 0.02). However, umbilical cord length, number of coils and UCI, were statistically higher among fetuses in vertex presentation. Those differences remained significant even after correction for age and weight by multi variant analysis. We are the first to report a difference in umbilical cord coiling index between fetuses in vertex and breech presentation. Our findings may support the association between fetal movements and umbilical coiling.Tabled 1Outcome Characteristics of the Study populationBreech Mean ±SEVertex Mean ±SEP –value ANOVA modelMean Length (cm)56.93±1.4663.95±1.630.05No.of coils5.1±0.411.7±0.6<0.0001Umbilical coiling index (UCI)0.09±0.010.18±0.01<0.0001 Open table in a new tab