Effect of curcumin on painful symptoms of endometriosis: A triple-blind randomized controlled trial.

Endometriosis is one of the most common gynecological disorders. This study aimed to determine the effect of curcumin on painful symptoms of endometriosis and the quality of life in affected women. This randomized controlled trial was conducted on 68 women with endometriosis referred to Shahid Beheshti Infertility Center in Isfahan, Iran, 2022. The participants were allocated to intervention (n = 34) and control (n = 34) groups by the blocked randomization method. Curcumin capsules with a dose of 500 mg were given to the intervention group twice a day for 8 weeks, and the placebo with the same dose was given to the control group. The questionnaires of Endometriosis Health Profile, painful symptoms of endometriosis, and visual analogue scale were used to collect data. Independent t, ANCOVA, and Mann-Whitney U-tests were used to compare the outcomes between the study groups. After the intervention, based on the ANCOVA with the adjusting of the baseline values and Mann-Whitney U-test, there was no statistically significant difference in the amounts of usual pain (p = 0.496) and pain at its worst (p = 0.320), quality of life (p = 0.556), and visual pain (p = 0.845). The results showed that using curcumin does not affect the painful symptoms and quality of life of women with endometriosis. Future clinical trials are needed to investigate and highlight the role of curcumin in endometriosis.

Differential Gene Expressions of CALM1, PSMD6, and AK124742 Long Noncoding RNA in Cumulus Cells from Polycystic Ovary Syndrome Patients versus Normal Control Women.

Background: One of the well-known causes of subfertility is polycystic ovary syndrome (PCOS). Genetic components play a critical role in the etiology of PCOS. The recognition of differentially expressed genes in PCOS patients might provide a better understanding of the pathophysiology of this syndrome and paves the way for novel therapeutics. Gene expression profiles in cumulus cells (CCs) could be used as biological criteria for embryo competence and their analysis might lead to important molecular information about embryo quality. CALM1, PSMD6, and AK124742 are three well-known genes associated with embryo development. Therefore, the objective of this study was to compare the expression of CALM1, PSMD6, and AK124742 genes in the CCs of infertile PCOS patients with their expression in the CCs of the donor fertile group. Materials and Methods: CCs were collected from the follicular fluid of 33 patients with PCOS as the experimental group and 33 cumulus donor women who were referred to the infertility center for egg donation as the control group. CCs were frozen until genetic testing. The expression of CALM1, PSMD6, and AK124742 genes was detected by real-time polymerase chain reaction. Results: CALM1 and AK124742 gene expressions significantly increased (CALM1 P = 0.003) (AK124742 P = 0.000) and PSMD6 expression significantly decreased (P = 0.002) in the PCOS group compared to the cumulus donor (control) group. Conclusion: Therefore, our research findings suggest that the potential impact of Polycystic Ovary Syndrome (PCOS) on fertility could be attributed to modifications in the expression levels of genes that affect the reproductive.

The Effect of Garlic (Allium Sativum) on Polycystic Ovary Syndrome Related Hormones and Glycemic Parameters: A Randomized, Double-Blinded Clinical Trial.

Background: The purpose of the present study was to investigate the effect of garlic supplementation on androgen levels and glycemic-related markers in patients with PCOS. Methods: In these 8 weeks of randomized double-blinded control trial, 80 women were randomly assigned into two groups in which patients were asked to intake either 800 mg/day garlic or an identical placebo. A blood sample was obtained pre- and post-trial to assess androgens and glycemic-related parapets. A 3-days- food record and a short form of international physical activity questionnaires (IPAQ) were also evaluated at the beginning and end of the trial. Results: All participants completed the trial. Garlic supplementation resulted in significant reduction in fasting plasma glucose (-3.22 ± 7.41 vs. 0.72 ± 5.37; P = 0.008) and homeostatic model assessment for insulin resistance (HOMA-IR) (-0.29 ± 1.45 vs. 0.28 ± 1.20; P = 0.02). In addition, a trend to a significant improvement was detected in free androgen index (FAI) (P = 0.09), insulin levels (P = 0.07), and quantitative insulin sensitivity check index (QUICKI) (P = 0.06). However, no significant difference was found in testosterone and sex hormone-binding globulin (SHBG) (P > 0.05). Conclusions: Present study indicates that garlic supplementation could be beneficial for FPG and insulin resistance improvement. However, garlic supplementation does not show remarkable efficacy on androgens. Further studies are warranted to confirm the results.

A Comparison of Oral Dydrogesterone with Vaginal Progesterone for Luteal-Phase Support in In vitro Fertilization: A Randomized Controlled Trial.

Background: The quality of the luteal phase is the most important issue affecting pregnancy outcomes in assisted reproductive technology (ART). Luteal-phase support with the administration of gonadotropin-releasing hormone (GnRH) agonist or progesterone improves the likelihood of pregnancy in ART. Due to disagreements regarding the best pharmaceutical form of progesterone for success of in vitro fertilization (IVF) in ART methods, the present study aimed to compare the clinical efficacy of oral dydrogesterone with vaginal progesterone on the outcome of pregnancy in IVF. Materials and Methods: This unblinded randomized clinical trial was conducted at the Shahid Beheshti Hospital, Obstetrics and Gynecology Centre in Isfahan, Iran, between june 2021 and September 2021. In total, 126 couples were included in the study. All patients underwent controlled ovarian stimulation and IVF. Patients were randomly divided into two groups (n = 63 per group). After embryo transfer, group I was treated with Cyclogest 400 mg twice daily, and group II was treated with oral Duphaston 10 mg twice daily. Results: No significant differences were observed between the two groups in terms of the mean endometrial thickness (P = 0.613), the mean number of transferred embryos (P = 0.100), and the number of implanted embryos (P = 0.338). Additionally, no statistically significant differences in the pregnancy rate were detected between the two groups (P = 0.875). Conclusions: The evidence from this study indicates that Duphaston is as effective as Cyclogest for luteal-phase support.

Hormone Therapy with or without Platelet-Rich Plasma (PRP) for Treatment Asherman Syndrome; A Randomized Clinical Trial.

Background: Asherman syndrome is a controversial issue in obstetrics and gynecology without any consensus on its management and treatment. It is characterized by variable lesions inside the uterine cavity and also causes menstrual irregularities, infertility, and placental abnormalities. The study aimed to assess the platelet-rich plasma (PRP) effect in women with intrauterine adhesions by evaluating the improvement of the menstrual cycle and intrauterine adhesion (IUA) stage. Materials and Methods: This clinical trial study was performed on 60 women with Asherman syndrome in two groups of 30. For the first group, only hormone therapy was performed and for the second group, hormone therapy with platelet-rich plasma after hysteroscopy. Recovery of Asherman syndrome and IUA stage was assessed at 6 to 8 weeks after hysteroscopy and compared between the two groups. Results: Our results demonstrated that there was no significant difference between demographic data in the two groups as well as the menstrual pattern of both groups before or after treatment (P > 0.05). Frequency distribution of IUA after the intervention in the PRP + hormone therapy group in grade I, II, and III were equal to 73.3%, 20%, and 6.7% and in the hormone therapy group were 53.3%, 26.7%, and 20%, respectively (P = 0.22). In addition, hypo menorrhea was observed in 33.3% of PRP + hormone therapy group and 40% of the hormone therapy group with no significant difference between the two groups (P = 0.71). Conclusion: Hormone therapy with PRP compared to hormone therapy alone after routine surgical treatment had not a significant effect on the IUA stage, duration, and severity of menstruation.

The Therapeutic Impact of Garlic (Allium Sativum) on Oxidative Stress Markers among Polycystic Ovary Syndrome Patients: A Randomized, Double-Blinded Clinical Trial.

Background: The present study aimed to investigate the effect of garlic supplementation on oxidative stress markers in patients with polycystic ovary syndrome (PCOS). Methods: Eighty patients with PCOS were randomized and instructed to consume either garlic supplementation (800 mg/day) or a placebo (starch) for 8 weeks. They were also asked to avoid intake of any other supplement during the study. Oxidative stress-related markers including total antioxidant capacity, catalase, glutathione, malondialdehyde concentrations, and anthropometric measures were assessed at baseline and end of the trial. Results: Garlic supplementation resulted in significant improvement in catalase concentration (1.82 ± 9.28 vs. -1.55 ± 8.66; P value: 0.03), glutathione levels (29.15 ± 57.53 vs. 2.42 ± 77.51; P value: 0.048) as well as weight (-0.64 ± 1.94 vs. 0.11 ± 0.82; P value: 0.04), body mass index (BMI; -0.25 ± 0.75 vs. 0.05 ± 0.61; P value: 0.04), and waist circumference (-0.21 ± 0.77 vs. 0.02 ± 0.65; P value: 0.01). However, we failed to detect any significant change in hip circumference, waist to hip circumference ratio, total antioxidant capacity, and malondialdehyde levels between the two groups. Conclusions: The present study indicates that garlic supplementation could be beneficial in improving oxidative stress and weight loss among PCOS women.

Intrauterine Instillation of Human Chorionic Gonadotropin with Intrauterine Insemination Catheter Around the Golden Time of Embryo Transfer Does Not Improve In Vitro Fertilization /Intracytoplasmic Sperm Injection Outcomes in Infertile Women: A Randomized Controlled Trial.

Background: We set out to explore the effect of intrauterine human chorionic gonadotropin (hCG) instillation by intrauterine insemination (IUI) catheter before embryo transfer (ET) on assisted reproductive technologies (ART) outcomes of infertile women. Methods: One hundred women with infertility who were scheduled for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were included in the study. They were randomly devoted to two groups: experimental (n= 50) and control (n= 50). In the experimental group, 500 IU hCG passed into the internal cervical orifice via IUI catheter within 15 minutes before the transfer of fresh or vitrified cleavage-stage embryos. The control group underwent the same ET procedure without prior injection of hCG. Results: None of the outcomes showed a statistically significant difference between the two groups. In the intervention and control groups, respectively, biochemical pregnancies rates were 26% and 18%, implantation rates were 13.5% and 8.6%, clinical pregnancies rates were 22% and 14%, ongoing pregnancies rates were 18% and 14%, and live birth rates were 14% and 12%. Conclusion: Intrauterine injection of hCG via IUI catheter is not recommended in a clinical routine setting at this stage. Future efforts are warranted to further refine the applicability of this modality.

Correction to "Effect of granulocyte colony stimulating factor (G-CSF) on IVF outcomes in infertile women: An RCT" [Int J Reprod BioMed 2016; 14: 341-346].

[This corrects the article on p. 341 in vol. 14 PMCPMC4910038.].

Evaluation of The Effect of Letrozole in the Ovarian Hyperstimulation Syndrome Prevention in Participants at Risk of Treatment with Ovulation-Stimulating Drugs:A Randomized Controlled Trial.

Background: This study aims to evaluate the effect of Letrozole (LE) in reducing ovarian hyperstimulation syndrome (OHSS) in high-risk participants with polycystic ovary syndrome (PCOS) treated with In vitro fertilization (IVF). Methods: This study was a randomized clinical trial in which participants were randomly divided into two groups (n= 25 per group). Based on GnRH-antagonist protocol, recombinant follicle-stimulating hormone 150 units/day subcutaneously and human menopausal gonadotropin 75 units/ day intramuscularly used from day 2 of the menstrual cycle. In the study group, Letrozole 5 mg daily was added simultaneously with gonadotropin during the first five days of the IVF cycle and in the control group placebo was added. Results: There were statistically significant differences among the groups in terms of Estradiol level on Trigger Day (p= 0.04). The total days of stimulation and cumulative Gonadotropin dose were significantly lower in the Letrozole group (p= 0.00). There were no significant differences between the groups in terms of the number of oocytes retrieved, numbers of implanted embryos, and clinical pregnancy rates (p-value> 0.05). There was only one moderate case in the intervention group and 9 moderate symptoms in the control group (p= 0.04). Discussion: Administration of Letrozole with GnRH antagonist protocol, conventional protocol in PCOS cases in IVF cycle, had a significant effect on reducing the incidence of OHSS. So, if the future studies prove LE co-administration may lessen the incidence of OHSS, LE will be a highly potent drug for preventing OHSS in PCOS cases.

The effect of garlic (Allium sativum) supplementation on the lipid parameters and blood pressure levels in women with polycystic ovary syndrome: A randomized controlled trial.

Polycystic ovary syndrome (PCOS) is the most prevalent female endocrine-related disorder in reproductive ages. The aim of the study was to investigate the effect of garlic on the lipid parameters and blood pressure levels in women with PCOS. The present study was a randomized, double-blinded control trial, conducted on 80 PCOS patients. Participants were taught to intake either a total 800 mg/day garlic supplement or an identical placebo (starch) after lunch for 8 weeks. Physical activity, diet intake, anthropometric measures, and blood pressure were evaluated at baseline and end of the study. The blood sample was also taken to assess the change in outcomes of interest at the pre- and post-intervention. Garlic supplementation significantly reduced serum total cholesterol (change mean difference: -8.05, 95% CI: -15.47, -0.62) and LDL-C (change mean difference: -7.67, 95%CI: -14.64, -0.70) levels in comparison to the control group. In addition, a trend to a significant decrease was found in serum triglyceride levels and Systolic blood pressure; however, no significant difference was observed between two groups in HDL-C and diastolic blood pressure levels. The present study suggested that garlic supplementation might be effective on lipid markers improvement. Further studies are needed to confirm our findings.

Environmental extreme temperature and daily preterm birth in Sabzevar, Iran: a time-series analysis.

OBJECTIVES: Most of the studies on the effect of heat stress on preterm birth (PTB) are conducted in temperate climates. Evidence on this effect in hot and arid countries with low and middle income is limited. This paper describes the short-term effect of exposure to the hot and cold environment on a daily number of PTB in Iran. METHODS: The daily number of PTB was obtained from all hospitals of the city. Meteorological and air pollution data from 2011 to 2017 were obtained from a metrological station in the city. A semi-parametric generalized additive model following a quasi-Poisson distribution with the distributed lag non-linear model was selected as a modeling framework for time-series analysis to simultaneously model the short-term and lagged effect of heat stress on PTB in the Sabzevar city. RESULTS: The minimum and maximum daily temperature were - 11.2 and 45.4 °C respectively. The highest risk estimate at extreme cold temperature was found for apparent temperature (relative risk (RR) 1.83; 95% CI 1.61: 2.09). This pattern was seen for both models. For extreme hot temperatures, the model with mean temperature showed the highest risk increase for both the main model and air pollution adjusted model (RR 1.36; 95% CI 1.25: 1.49). The lowest risk estimate in extremely cold conditions was found in the model with mean temperature. However, for extremely hot temperature conditions, the lowest risk estimate was found for both maximum and apparent temperature. CONCLUSION: Obstetricians working in semi-arid areas should be aware of the influence of environmental extreme temperature on the incidence of PTB.

Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial.

OBJECTIVE: One of the important aspects involved in achieving optimal outcomes after assisted reproductive treatment (ART) is the endometrium. Some cycles are cancelled due to inadequate endometrial growth in ART. In this clinical trial, we evaluated the effectiveness of platelet-rich plasma (PRP) in the treatment of thin endometrium. MATERIALS AND METHODS: In this randomized clinical trial, 83 women with poor endometrial response to standard hormone replacement therapy (HRT) (endometrium thickness < 7 mm) in the 13th day of the cycle in a frozen-thawed embryo transfer (FET) were entered in two groups. In the PRP group (n = 40), in addition to HRT, 0.5-1 cc of PRP was infused into the uterine cavity on the 13th day of HRT cycle. The control group (n = 43) was only received HRT. If endometrial thickness failed to increase after 48 h, PRP infusion was repeated in the same cycle. When the endometrium thickness reached ≥7 mm, embryo transfer was done. Finally, endometrial thickness, chemical, clinical, and ongoing pregnancy rates were compared between two groups. RESULTS: Endometrial thickness increased significantly to 8.67 ± 0.64 in PRP group than in controls (p = 0.001). This increase was higher in women who conceived in PRP group (p value: 0.031). The implantation rate and per-cycle clinical pregnancy rate were significantly higher in PRP group (p = 0.002 and 0.044, respectively (p = 0.002). CONCLUSION: PRP may be effective in improving the endometrial growth, and possibly pregnancy outcomes in women with a thin endometrium.

Pregnancy outcome in delayed start antagonist versus microdose flare GnRH agonist protocol in poor responders undergoing IVF/ICSI: An RCT.

BACKGROUND: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet. OBJECTIVE: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone (GnRH) antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders. MATERIALS AND METHODS: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol (with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation) and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate. RESULTS: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes (5.10±3.41 vs. 3.08±2.51) with p=0.002, mature oocytes (4.32±2.69 vs. 2.34±1.80) with p=0.003, number of 2PN (3.94±1.80 vs. 2.20±1.01) with p=0.001 and implantation rate (19.40% vs. 10.30%) with p=0.022 were significantly higher in delayed antagonist group. CONCLUSION: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development.

Role of granulocyte colony-stimulating factor in human reproduction.

As new research reveals, granulocyte colony-stimulating factor (G-CSF) plays an effective role in pregnancy success, considering that it not only affects the embryo implantation and ovarian function but also it promotes endometrial thickening and improves the pathophysiology of endometriosis, which all fundamentally lead to reducing pregnancy loss. In this review, we focus on the role of G-CSF in human reproduction. We summarized its role in ovulation, luteinized unruptured follicle syndrome, poor responders, improving repeated in vitro fertilization failure, endometrial receptivity and treatment of thin endometrium, and recurrent spontaneous abortion.

Shift Work Effects and Pregnancy Outcome: A Historical Cohort Study.

Objective: Employed mothers face considerable amount of hazards. Especially shift work can impact pregnant women by affecting some hormones. This study was conducted to assess the adverse effects of shift work on pregnancy outcomes. Materials and methods: This historical cohort study was conducted in 2017 in order to assess the effect of shift work on pregnancy outcomes. The subjects were consecutively selected from pregnant women, which referred to Al Zahra and Shahid Beheshti hospitals, Isfahan, Iran for their pregnancy care. The effect of shift work on pregnancy and labor complications (low birth weight, small for gestational age, pre-eclampsia and eclampsia, intra-uterine growth retardation, spontaneous abortion, preterm delivery, excessive bleeding during labor, and type of labor) was assessed. The effect was adjusted for occupation and number of children as well. Data were analyzed by SPSS (ver. 17) usingT-test, chi-Square test and logistic regression analysis. Results: Totally, 429 pregnant women entered the study. There was not a statistically significant difference between morning and shift workers regarding age. It was found that shift work probably increases the incidence of small for gestational age, pre-eclampsia and eclampsia, intra-uterine growth retardation, spontaneous abortion, and preterm delivery, but after adjustment for job and number of children the effect was observed only on preterm delivery. Conclusion: Working in a rapid cycling schedule of shift work may cause an increase in the incidence of preterm delivery in pregnant mothers.

The effect of 24 hours delay in oocyte maturation triggering in IVF/ICSI cycles with antagonist protocol and not-elevated progesterone: A randomized control trial.

BACKGROUND: The best time of final oocyte maturation triggering in assisted reproduction technology protocols is unknown. This time always estimated by combined follicular size and blood progesterone level. OBJECTIVE: The aim of this study was evaluation of the effect of delaying oocyte maturation triggering by 24 hr on the number of mature oocytes (MII) and other in vitro fertilization cycle characteristics in antagonist protocols with not-elevated progesterone (p ≤1 ng/ml). MATERIALS AND METHODS: All patients' candidate for assisted reproduction technology underwent controlled ovarian hyperstimulation by antagonist protocol. When at least 3 follicles with ≥18 mm diameters were seen by vaginal ultrasonography; blood progesterone level was measured. The patients who had progesterone level ≤1 ng/dl entered the study. The participants' randomizations were done and patients were divided into two groups. In the first group, final oocyte maturation was done by human chorionic gonadotropin at the same day, but in the second group, this was performed 24 hr later. Oocytes retrieval was done 36 hr after human chorionic gonadotropin trigger by transvaginal ultrasound guide. RESULTS: Number of retrieved oocytes, mature oocytes (MII), fertilized oocytes (2PN), embryos formation, number of transferred embryos and embryos quality has not significant differences between two groups. Also, fertilization and implantation rate, chemical and clinical pregnancy did not differ between groups. CONCLUSION: Delaying of triggering oocyte maturation by 24 hr in antagonist protocol with not-elevated progesterone (progesterone ≤1 ng/ml) have not beneficial nor harmful effect on the number of mature oocytes (MII) and other in vitro fertilization cycle characteristics.

Recurrent Vulvovaginal Candidiasis: Could It Be Related to Cell-Mediated Immunity Defect in Response to Candida Antigen?

BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to candida antigen in RVVC cases. MATERIALS AND METHODS: Our cross-sectional study was performed in 3 groups of RVVC patients (cases), healthy individuals (control I) and known cases of chronic mucocutaneous candidiasis (CMC) (control II). Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mononuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to candida antigen via flow cytometry. RESULTS: T lymphocyte proliferation in response to candida was significantly lower in RVVC cases (n=24) and CMC patients (n=7) compared to healthy individuals (n=20, <0.001), but no statistically significant difference was seen between cases and control II group (P>0.05). Family history of primary immunodeficiency diseases (PID) differed significantly among groups (P=0.01), RVVC patients has family history of PID more than control I (29.2 vs. 0%, P=0.008) but not statistically different from CMC patients (29.2 vs. 42.9%, P>0.05). Prevalence of atopy was greater in RVVC cases compared to healthy individuals (41.3 vs. 15%, P=0.054). Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy (P=0.01, P=0.02). CONCLUSION: Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components.

Effect of granulocyte colony stimulating factor (G-CSF) on IVF outcomes in infertile women: An RCT.

BACKGROUND: Despite major advances in assisted reproductive techniques, the implantation rates remain relatively low. Some studies have demonstrated that intrauterine infusion of granulocyte colony stimulating factor (G-CSF) improves implantation in infertile women. OBJECTIVE: To assess the G-CSF effects on IVF outcomes in women with normal endometrial thickness. MATERIALS AND METHODS: In this randomized controlled clinical trial, 100 infertile women with normal endometrial thickness who were candidate for IVF were evaluated in two groups. Exclusion criteria were positive history of repeated implantation failure (RIF), endocrine disorders, severe endometriosis, congenital or acquired uterine anomaly and contraindication for G-CSF (renal disease, sickle cell disease, or malignancy). In G-CSF group (n=50), 300 µg trans cervical intrauterine of G-CSF was administered at the oocyte retrieval day. Controls (n=50) were treated with standard protocol. Chemical, clinical and ongoing pregnancy rates, implantation rate, and miscarriage rate were compared between groups. RESULTS: Number of total and mature oocytes (MII), two pronuclei (2PN), total embryos, transferred embryos, quality of transferred embryos, and fertilization rate did not differ significantly between two groups. So there were no significant differences between groups in chemical, clinical and ongoing pregnancy rate, implantation rate, and miscarriage rate. CONCLUSION: our result showed in normal IVF patients with normal endometrial thickness, the intrauterine infusion of G-CSF did not improve pregnancy outcomes.

Pheochromocytoma after Cesarean Section.

Pheochromocytoma is a catecholamine-producing tumor. There are a very few reported cases of clinical pheochromocytoma. Here, we report a 27-year-old woman para 1 live 1 with chief complaint of headache, confusion, nausea, and vomiting 2 days after cesarean section. She was anxious and had palpitation. On physical examination, fever, tachycardia, tachypnea, high blood pressure, and right thyroid nodule were found. She was managed as pregnancy-induced hypertension at first. In laboratory data, epinephrine, norepinephrine, metanephrine, normetanephrine, and vanillylmandelic acid were increased in 24 h urine collection. An adrenal mass was detected in abdominal computed tomography. Regarding clinical and paraclinical findings, pheochromocytoma was diagnosed. The patient received medical treatment, but it was not effective; hence, she underwent adrenalectomy.