Outcome of using vaginal misoprostol for treatment of retained products of conception after first trimester miscarriage: a retrospective cohort study.

PURPOSE: Standard treatment for retained products of conception (RPOC) is dilation and curettage (D&C), however, this brings a risk of intrauterine synechiae and subsequent fertility issues. A treatment strategy to avoid D&C is medical management with misoprostol. The justification for misoprostol in this setting is extrapolated from miscarriage and termination literature, however, no studies have looked specifically in the setting of RPOC. The purpose of this study is to determine the efficacy of misoprostol as definitive management of RPOC. MATERIALS AND METHODS: A retrospective cohort study was conducted from January 2016 to March 2017 at an Early Pregnancy Assessment Clinic. Patients diagnosed with RPOC with clinical symptoms and ultrasound findings of endometrial mass and/or doppler flow treated expectantly, medically with vaginal misoprostol or with a suction D&C underwent a chart review. Primary outcome was resolution of RPOC without surgical intervention. RESULTS AND CONCLUSIONS: Of 1743 unique pregnancies, 189 women were diagnosed with RPOC. 34% (65/178) chose misoprostol for management of RPOC. Baseline demographics between the three treatment modalities (expectant, medical, surgical) were comparable. 65% (42/65) of patients who took misoprostol avoided D&C. Misoprostol is most effective (76%) in the setting of RPOC if the primary treatment for miscarriage was expectant management, with less success with primary medical management (44%) and primary surgical management (40%).

The effect of unilateral tubal block diagnosed by hysterosalpingogram on clinical pregnancy rate in intrauterine insemination cycles: systematic review and meta-analysis.

BACKGROUND: Fallopian tube occlusion is a common cause of infertility, but the effect of unilateral tubal block (UTB) on pregnancy rates (PR) after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) remains controversial. OBJECTIVE: To evaluate PR after COH-IUI among infertile women with proximal and distal UTB diagnosed by hysterosalpingogram (HSG), compared against women with bilateral patent tubes experiencing unexplained infertility. SEARCH STRATEGY: We searched EMBASE, MEDLINE, Google Scholar, Cochrane Library, and PUBMED from inception to 14 January 2018. SELECTION CRITERIA: Studies that report PR/cycle or cumulative PR among women with UTB and controls were included. DATA COLLECTION AND ANALYSIS: Two authors independently selected and extracted study characteristics and data. Methodological quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. MAIN RESULTS: Among 2965 patients and 5749 IUI cycles across ten studies, no significant difference in PR/cycle (odds ratio, OR = 0.88; 95% confidence interval, 95% CI = 0.69-1.12) and cumulative PR (OR = 0.80, 95% CI = 0.62-1.04) was observed. Patients with proximal UTB demonstrated similar PR/cycle (OR = 1.06, 95% CI = 0.68-1.66) and cumulative PR (OR = 1.10, 95% CI = 0.75-1.62), compared with controls, whereas patients with distal UTB had significantly lower cumulative PR (OR = 0.49, 95% CI = 0.25-0.97, P = 0.04). Patients with proximal block also demonstrated significantly improved cumulative PR, compared with patients with distal block (OR=2.41, 95% CI = 1.37-4.25, P = 0.002). CONCLUSION: Infertile patients with proximal UTB diagnosed by HSG can expect similar pregnancy rates after COH-IUI, compared with those with bilateral tubal patency and unexplained infertility, whereas patients with distal UTB have lower odds of pregnancy. These differences may reflect inherent diagnostic limitations of HSG or differences in underlying pathologies. TWEETABLE ABSTRACT: Meta-analysis evaluates pregnancy outcomes after COH-IUI in women with unilateral tubal block diagnosed by HSG.

Reproductive character displacement of male stickleback mate preference: reinforcement or direct selection?

Reproductive isolation can evolve between species as a byproduct of adaptation to different niches, through reinforcement, and by direct selection on mating preferences. We investigated the potential role of direct selection in the reproductive isolation between sympatric species of threespine sticklebacks. Each sympatric pair consists of a small-bodied limnetic species and large-bodied benthic species. We compared the mate preferences and courtship behavior of males from one sympatric limnetic population and two allopatric populations. We used limnetic-like allopatric populations to control for the effects of ecological character displacement and adaptation to different niches on mate preferences. The sympatric limnetic males preferred the small limnetic females, whereas the allopatric limnetic-like males preferred the large benthic females, suggesting that adaptation to the limnetic niche does not automatically confer a preference for small limnetic females. This reproductive character displacement of male preference is consistent with the predictions of both reinforcement and direct selection on mate preferences. To test for direct selection, we assessed a prediction of one proposed mechanism: predation by benthic females on eggs guarded by limnetic males. The allopatric males come from populations in which there is no egg predation. Sympatric limnetic males were more aggressive toward benthic females than toward limnetic females, whereas the allopatric limnetic-like males did not treat the two types of females differently. The contrast in male behavior suggests that egg predation has shaped male preferences. Direct selection is potentially more effective than indirect selection via reinforcement, and it is likely that it has been important in building up reproductive isolation between limnetic and benthic sticklebacks.