Magnetite nanoparticles increase the hardness of aluminum by a factor of three. In the current work aluminum and magnetite powder were mixed via ball-milling followed by characterization of the prepared samples using Scanning Electron Microscope (SEM) and Energy Dispersive Spectroscopy (EDS) before sintering. The resultant Microstructure of the investigated samples showed a homogenous element distribution, which effects the physical and mechanical properties. The results of the composite material shows in SEM and EDS the presence of 2 phases homogeneously distributed with a decrease in particle size and rod-shaped.

Since first reports in the literatures by Mitwally and Casper, along the last two decades, the aromatase inhibitor letrozole has been found as a useful and safe agent for ovulation induction in anovulatory women, e.g., PCOS (Polycystic Ovarian Syndrome), ovarian superovulation in ovulatory women, e.g., unexplained infertility, and in conjunction with gonadotropins to achieve better ovarian response during assisted reproduction (1-5). This debate discusses if ultrasound is ‘not’ required during letrozole treatment ‘alone’ as an agent for ovarian stimulation. I am against not using ultrasound monitoring during letrozole treatment. I think ultrasound is required in patients undergoing letrozole treatment, at two points: a baseline ultrasound when starting administration and a follow-up ultrasound few days after finishing letrozole administration. Ultrasound during letrozole treatment may be highly recommended, advisable and least required in the following situations: Highly recommended for safety when ruling out possible underlying pregnancy and ovarian cysts; Advisable to determine stimulation protocol, and response to letrozole treatment, as well as timing HCG administration and fertility treatment including timing intercourse and IUI; Least required to determine the risk of multiple pregnancy which is pretty low with letrozole treatment.

Objective: To study the use of the aromatase inhibitor letrozole for treatment of ectopic pregnancy compared with methotrexate. Design: Nonrandomized prospective cohort study. Setting: University hospital. Patient(s): A series of 42 consecutive patients with undisturbed ectopic pregnancy. Intervention(s): Counseling on treatment options, including surgical treatment (control group) versus medical treatment with methotrexate (group 1) or letrozole (group 2). Main Outcome Measure(s): Primary outcome: complete resolution of ectopic pregnancy determined by serum human chorionic gonadotropin (b-hCG) levels below laboratory immunoassay detection. Secondary outcomes: changes in the biochemical parameter of ovarian reserve, antimullerian hormone (AMH), and hematologic changes associated with the two medical treatments compared with surgical treatment. Result(s): Each treatment group included 14 patients, and each patient made her own treatment choice. Complete resolution of ectopic pregnancy occurred in an equal number of patients: 12 out of 14 (86%) in each of the two medical treatment groups. Methotrexate treatment was associated with statistically significantly higher liver enzymes and lower blood platelets count. The decline in b-hCG levels was faster in the letrozole group when compared with the methotrexate group. Three months after treatment, AMH levels were lower in the methotrexate group when compared with the letrozole and the surgery groups. However, the decline in b-hCG and AMH levels was not statistically significant. Conclusion(s): To our knowledge, this is the first report in the literature on the success of letrozole for the medical treatment of ectopic pregnancy. The promisingly high resolution rate and better safety profile that letrozole has compared with a chemotherapeutic agent such as methotrexate should encourage further studies. (C) 2020 by American Society for Reproductive Medicine.

s Regional Meeting (in alphabetical order) For personal use only. Not to be reproduced without permission of Krause & Pachernegg GmbH. 414 J Reproduktionsmed Endokrinol 2010; 7 (5) IFFS 2010 – Abstracts Regional Meeting IF FS – A b st ra ct s 3 generation AIs have been used in infertility treatment to induce ovulation. Clinical trials showed that transient inhibition of aromatase activity in the early follicular phase results in moderate ovarian hyperstimulation similar to that seen with clomiphene citrate [13, 14]. Additionally, letrozole reduces the gonadotropin dose required to induce follicular maturation especially in poor responders, and adjunctive use of letrozole may form an effective means of low-cost IVF protocol in these patients [15–17]. Approximately half of the patients with chronic pain associated with endometriosis are refractory to currently available treatments that create a hypoestrogenic state including OC, Depo-Provera, oral progestins and GnRH analogs [18–20]. The majority of these patients refuse to be treated with danazol because of its potential androgenic side effects [21]. Conservative surgical removal of endometriosis provides some pain relief. Response to surgical treatment varies extensively and heavily depends on many factors including the experience of the surgeon, previous attempts of treatment, use of adjuvant medical treatment and the definition of the therapeutic endpoint [22–25]. Following conservative surgery, endometriosis often recurs at some point after surgery; and pain is usually more refractory to repeated surgical attempts. The immediate overall response of chronic pain to conservative surgery in an unselected population of women is approximately 50 % [25]. The value of uterosacral nerve ablation or presacral nerve resection has not yet been clearly demonstrated, and the benefits of these adjunctive surgical approaches for endometriosis-associated pain remain controversial [22, 23]. Currently, when no other medical options remain and minimally invasive surgery has failed, women resort to a total hysterectomy with or without bilateral salpingo-oopherectomy. Even after this invasive procedure, their pain may not be relieved [1, 26, 27]. The results of the 5 studies on the effect of hysterectomy on chronic pelvic pain of presumed uterine origin consistently demonstrated that 3–17 % of operated women reported recurrence of pain one year after surgery [28]. Failure of current medical and surgical treatments to relieve pain prompted us and others to target the aromatase molecule in endometriosis using AIs. The rationale was that continued local estrogen production in endometriotic implants during other medical treatments (e. g., GnRH analogs) was, in part, responsible for resistance to these treatments. Anastrozole and letrozole have been successfully used to treat endometriosis [29–35]. The number of clinical trials employing AIs in the treatment of endometriosis strikingly increased after 2004. AIs appear to be the first breakthrough in the medical treatment of endometriosis since the introduction of GnRH agonists in the 80’s. Patients with endometriosis that do not respond to existing treatments appear to obtain significant painrelief from AIs. Most of the AI regimens are fairly simple consisting of taking 1 or 2 tablets a day. Finally, the side effect profiles of the AI regimens (including a progestin or OC add-back) are more favorable compared with treatments using GnRH agonists or danazol. Thus, some of these regimens may potentially be administered over prolonged periods of time. AIs administered in combination with an ovarian suppressant represent promising and novel treatments of premenopausal endometriosis. The requirement for calcium, vitamin D or bisphosphonate supplementation in premenopausal women needs further evaluation. The regimens including combinations of an AI with a progestin or OC will probably gain more popularity over the combination of an AI with a GnRH analog because the former are simpler, cheaper, associated with fewer side effects and may be administered for longer. Randomized clinical trials are needed to establish the efficacy and side effects of these regimens. Lower doses of AIs may also be used potentially in the treatment of pain or infertility associated with endometriosis. We anticipate that many more clinical trials performed over the next decade will provide answers to these questions.

Background: This retrospective study compares the safety and efficacy of temporary ovarian suspension (TOS) to the anterior abdominal wall using absorbable versus non-absorbable suture after operative laparoscopy to elevate the ovaries away from the ovarian fossa to reduce postoperative adhesion development. Methods: Patients (n=152) underwent TOS to the anterior abdominal wall at the conclusion of surgery between 1998 and 2017. One hundred forty-two patients underwent operative laparoscopy for advanced stages of endometriosis (93.4%) and 10 patients for other indications (6.6%). In 78 patients the ovaries were suspended to the fascia using absorbable 3-0 plain catgut sutures (Group 1). In 74 earlier patients non-absorbable 3-0 mono-filamentous nylon was used to suspend the ovaries to the anterior abdominal (Group 2). Results: In both groups there was no reported incidence of any major intra-operative complications such as bleeding, or late complications such as infection, hematoma or bowel herniation through the suture loop and its sequalae (bowel obstruction or strangulation). In all patients in both groups the ovaries were present in its anatomical location on transvaginal ultrasound scan, one week after surgery following absorption or removal of the TOS suture. There was no significant difference in clinical pregnancy (34.3% vs 44.2%) and delivery (31.3% vs 36.5%) rates in patients who conceived with non-IVF methods between Group 1 and Group 2 respectively. Conclusions: TOS to the anterior abdominal wall, using absorbable or non-absorbable sutures, in an attempt to reduce postoperative adhesion development between the ovary and ovarian fossa, is simple, safe, easy to learn, and has potential effectiveness.

Study ObjectiveTo determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology.DesignRetrospective case series (Canadian Task Force classification III).SettingUniversity-affiliated outpatient medical center.PatientsPatients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015.InterventionsIn all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation.Measurements and Main ResultsA total of 1010 patients who underwent operative hysteroscopy for uterine septum (n = 479), arcuate uterine anomaly (n = 483), or multiple submucosal myomas (n = 48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery.ConclusionIn 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed.

Single crystal silicon freestanding structures for tensile and fatigue testing were treated with KrF excimer laser to improve surface roughness and accordingly mechanical performance. Sample thickness was 5 μm. Localized laser treatment was successful in eliminating the scallops developed during Bosch process and in reducing surface roughness. Harsh irradiation at laser energies up to 4 J/cm2 was only possible due to localized treatment without significant vibrations occurring on the freestanding samples that led to fracture in preliminary experiments at energies as low as 0.16 J/cm2. Finite element analysis was used to investigate the temperature distribution on the irradiated structures. Atomic force microscopy (AFM) and Raman spectroscopy were also used to assess surface roughness, crystallinity changes and surface stresses developing on surfaces subjected to perpendicular laser irradiation. At a high energy (3.2 J/cm2) the top surface showed a decrease of roughness compared to fabricated samples. Raman spectroscopy showed the dominance of crystalline silicon after laser irradiation. The effects of laser energy, number of pulses

OBJECTIVE:To determine reproductive outcome after in-vitro fertilization/embryo transfer (IVF-ET) in women with primary infertility following hysteroscopic septoplasty of incomplete uterine septum or arcuate uterine anomaly.METHODS:This is a historical cohort study. The study group consisted of 156 consecutive patients who underwent a total of 221 cycles of IVF/ET following hysteroscopic septoplasty of an incomplete uterine septum or arcuate anomaly (Group 1). The control group included 196 consecutive patients with normal endometrial cavity on hysteroscopy who underwent a total of 369 cycles of IVF/ET (Group 2). The reproductive outcome after the first cycle of IVF-ET and the best reproductive outcome of all the cycles the patient underwent were calculated. In addition, we compared the reproductive outcome in the study group based on the type of the anomalies (septum versus arcuate).RESULTS:In the first fresh cycle, following septoplasty, there were significantly higher clinical pregnancy and delivery rates in Group 1 (60.3% and 51.3% respectively) compared to Group 2 (38.8% and 33.2% respectively). However, there was no significant difference between the two groups in the clinical pregnancy (74.4% vs. 67.3%) or in the delivery (65.4% vs. 60.2%) rates per patient, respectively. There was no significant difference in the reproductive outcome after IVF-ET between patients who previously had arcuate uterine anomaly versus incomplete uterine septum.CONCLUSION:Reproductive outcome of IVF-ET after hysteroscopic correction of incomplete uterine septum/arcuate uterine anomaly in women with primary infertility is no different from women with normal uterine cavity.

Background: This article describes a case of heterotopic pregnancy that included a normal twin intrauterine pregnancy and one cesarean section (CS) scar pregnancy diagnosed at 6 weeks of gestation. Ultrasound-guided aspiration of the ectopic gestational sac was performed, and the concurrent twin intrauterine pregnancy (IUP) was preserved successfully. The patient was a 50-year-old woman with secondary infertility. Case: The patient underwent in vitro fertilization and embryo transfer using a donor-egg program to achieve pregnancy with her current partner. At 6-weeks' gestation, she underwent a transvaginal ultrasound scan (US) examination showing a viable twin IUP with a third gestational sac with viable embryo located low within the anterior wall of the uterus. The appearance was consistent with a cesarean scar ectopic pregnancy. This was confirmed on a subsequent US 1 week later. She desired to continue the intrauterine pregnancy. US-guided aspiration of the cesarean scar ectopic pregnancy was attempted. The treatment was successful. Results: The twin pregnancy progressed without further complications. Conclusions: Heterotopic CS ectopic pregnancy can be successfully treated with transvaginal US-guided aspiration. (J GYNECOL SURG 29:317)

The concept of using aromatase inhibitors in place of clomiphene citrate (CC) for ovulation induction was introduced >10 years ago; a brief history of its development is presented. Its worldwide usage for ovulation induction, including as an adjunct for intrauterine insemination and in vitro fertilization has occurred despite the absence of definitive data of superiority to CC. The results of two ongoing potentially definitive multicenter trials of efficacy and safety of letrozole compared with CC are eagerly awaited.

To compare the implantation rates in two groups of women with Polycystic Ovary Syndrome (PCOS) after embryo transfer based on the initiation time of GnRH antagonist. Secondary outcome measures included clinical pregnancy, delivery and miscarriage rates. This is a prospective, randomized trial in which 140 PCOS patients underwent ICSI, with 122 having ET performed. GnRH-antagonist was started on day 1 of stimulation in 69 patients (Group 1) or day 5 in 71 patients (Group 2). The overall implantation rate in Group 1 (46.2 %) was clinically higher than Group 2 (35.5 %), although not statistically significant (p = 0.075). For blastocysts transfer, the implantation rate in Group 1 was 55.1 %, compared to 40.4 % in Group 2 (p = 0.051). There was a clinically, but not statistically, higher clinical pregnancy rate (68.3 % vs. 56.5 %) and delivery rate (60.0 % vs. 53.2 %) per transfer in Group 1 compared to Group 2, respectively. There was a statistically significant lower biochemical pregnancy rate in Group 1 (2.4 %) compared to Group 2 (18.6 %) [p = 0.015]. There was no difference in miscarriage rates between the two groups. Our data suggest that early initiation of GnRH antagonist on day 1 of ovarian stimulation in PCOS patients undergoing ICSI-ET may improve implantation rates, especially after blastocyst transfer.

For almost half a century, the first-line treatment for ovulation induction in cases of anovulation, unexplained infertility, or mild male factor has been clomifene (clomiphene citrate). Clomifene is an effective and safely used oral agent, but is known to have relatively common antiestrogenic endometrial and cervical mucous adverse effects that could prevent pregnancy in the face of successful ovulation. In addition, there is a significant risk of multiple pregnancies with clomifene compared with natural cycles. These drawbacks are mainly a result of the extended antiestrogenic effect of clomifene as a result of its accumulation in the body (clomifene isomers have a half-life of several days up to few weeks). Because of these problems, we proposed the concept of aromatase inhibition as a new method of ovulation induction that could avoid many of the adverse effects of clomifene. Over the last few years several published studies, both controlled and noncontrolled, compared clomifene and treatment with aromatase inhibitors (AIs), either alone or in combination with gonadotropins, for ovulation induction or augmentation. These studies found AIs as effective as clomifene in inducing ovulation, with the major advantage of absence of any antiestrogenic adverse effects. Several other major advantages of AIs include the lower serum estrogen production per developing follicle resulting in more physiological estrogen levels around the time of ovulation and good pregnancy rates with a lower incidence of multiple pregnancy than with clomifene. When combined with gonadotropins for assisted reproductive technologies, AIs reduce the dose of gonadotropins required for optimal follicle recruitment and improve the response to gonadotropin stimulation in poor responders. Such preliminary evidence suggests that AIs may replace clomifene in the future because of similar efficacy with a reduced adverse-effect profile. However, we believe that definitive studies in the form of randomised controlled trials comparing clomifene with AIs are needed.

Infertility afflicts 15% of couples who wish to conceive. Despite intensive evaluation of both male and female partners, the etiology may remain unknown leading to a diagnosis of unexplained infertility. For such couples, treatment often entails ovulation induction (OI) with fertility medications coupled with intrauterine insemination. Complications of this therapy include ovarian hyperstimulation syndrome and creation of multiple gestation pregnancies, which can be complicated by preterm labor and delivery, and the associated neonatal morbidity and expense of care for preterm infants. The Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) study is designed to assess whether OI in couples with unexplained infertility with an aromatase inhibitor produces mono-follicular development in most cycles, thereby reducing multiple gestations while maintaining a comparable pregnancy success rate to that achieved by OI with either gonadotropins or clomiphene citrate. These results will provide future guidance of therapy for couples with unexplained infertility, and if comparable pregnancy rates are achieved with a substantial reduction in multiple gestations, the public health benefit will be considerable.