Time-limited hydrotubation combined with clomiphene citrate treatment for unexplained infertility.

PURPOSE: To evaluate time-limited hydrotubation combined with clomiphene citrate as treatment for unexplained infertility. MATERIALS AND METHODS: In this unblinded, randomized controlled trial of patients who had unexplained infertility, 40 patients were treated with time-limited hydrotubation (saline, 20 ml; flushed within 20 to 30 seconds) and clomphene citrate (total, 70 cycles) and 40 patients were treated with clomiphene citrate alone (total, 74 cycles). All women underwent an ovulation induction protocol with clomiphene citrate (100 mg/d orally for five days, from day 3 to day 7 of the cycle). Hydrotubation was performed after detection of the dominant follicle. RESULTS: There were 15 pregnancies in the 80 patients (19%) (total, 144 stimulated cycles; 10% pregnancies per cycle). The frequency of clinical pregnancy per cycle was significantly greater in patients who were treated with hydrotubation and clomiphene citrate (nine pregnancies per cycle [13%]) than those treated with clomiphene citrate alone (two pregnancies per cycle [3%]; odds ratio, 5.3; 95% confidence interval, 1.1 to 25.5; p ≤ 0.05). The frequency of pregnancy per patient (total, clinical, or chemical) was similar for the two treatment groups. The frequency of live birth or abortion per cycle or patient was similar between the two treatment groups. CONCLUSION: Time-limited hydrotubation and clomiphene citrate may increase the frequency of clinical pregnancy per cycle in women who have unexplained infertility.

Albumin/creatinine ratio for prediction of 24-hour albumin excretion of > or =2 g in manifest preeclampsia.

PURPOSE OF INVESTIGATION: To compare whether albumin/creatinine ratios obtained from random or 8-hour urine collected in different periods of day differ in prediction of albumin excretion > or =2 g in 24-hour urine collection in preeclampsia. METHODS: From a total of 70 women, 24-hour urine collected by three consecutive periods of eight hours and three random urine samples were taken before each period. The variation of albumin-creatinine ratios in samples across the day was analyzed by the Friedman and inter-assay coefficient variation. For each sample, receiver operator characteristic (ROC) curves were constructed to determine an optimal albumin/creatinine ratio value in the prediction of albuminuria > or =2 g. RESULTS: The albumin/creatinine ratio did not vary significantly over time when all samples pooled. However, there was considerable intra-individual variation in both random and timed urine samples. On ROC analysis, the albumin/creatinine ratio in both random and timed urine samples predicted the 24-hour urine results and there was no difference between samples in prediction of albuminuria > or =2 g. A single optimal cut-off point was not available between samples. The positive and negative predictive values for optimal cut-offs ranged from 48%-88% and 94%-100%, respectively. CONCLUSIONS: The random urine albumin/creatinine ratio was a poor predictor for proteinuria a 2 g in patients with preeclampsia.

A rare case of ileal embedding by an intrauterine device.

Ileal penetration by a copper-bearing intrauterine device (IUD) is a rare but serious potential complication. This paper reports the case of a 30-year-old gravida 4 para 3 woman with ileal embedding by an IUD. Laparoscopy was performed on the patient 4 months after the insertion of the IUD. When the tail of the IUD was seen during laparoscopy protruding outside the small bowel, the device was removed through a 1-cm incision in the ileum by laparotomy. This report demonstrates a rare case of ileal embedding of an IUD.

Maternal carriage and neonatal colonisation of group B streptococcus in eastern Turkey: prevalence, risk factors and antimicrobial resistance.

Our object is to determine the prevalence of group B streptococcus (GBS) carriage among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility to formulate a policy for treatment and prevention regarding perinatal GBS diseases in eastern Turkey. A total of 150 pregnant women were screened for GBS colonisation. Samples were collected from the vagina and the rectum of pregnant women, and the ear canal, throat and umbilicus of the neonates of colonised mothers. Antimicrobial susceptibility of the isolates was also investigated. GBS was isolated in at least one specimen from the 150 women in 48 cases; it was estimated that, overall, about 32% of the pregnant women and 17.3% of overall newborns were colonised with GBS. The overall rate of GBS vertical transmission was 54.2% in this study. Maternal colonisation rate was significantly higher in younger ages (p < 0.01) when maternal age of 20 years was taken as a cut-off point. All isolates were found to be sensitive to penicillin, ampicillin, cefazolin and vancomycin. Resistance to erythromycin and clindamycin were found to be 13.5 and 2.7%, respectively.

Serum levels of insulin, IGF-1, and IGFBP-1 in pre-eclampsia and eclampsia.

OBJECTIVES: To investigate whether the serum concentrations of insulin, insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-1 (IGFBP-1) were altered in women with mild pre-eclampsia, severe pre-eclampsia, and eclampsia. METHODS: In this prospective study, we investigated 20 mild pre-eclamptic, 20 severe pre-eclamptic, and 20 eclamptic patients in the third trimester. The control group consisted of 20 healthy pregnant women. Serum levels of insulin, IGF-1, and IGFBP-1 were measured. RESULTS: In patients with eclampsia, serum levels of IGF-1 were lower, and IGFBP-1 were higher, respectively, than control and other study groups (P<0.001) The values of IGF-1 in mild pre-eclampsia and severe pre-eclampsia were lower compared with control groups (both P<0.01), but there were no differences between mild and severe pre-eclampsia. The serum levels of IGFBP-1 in severe pre-eclampsia were higher compared with control groups (P<0.01), but there was no statistical difference between mild pre-eclampsia and other groups. CONCLUSIONS: IGF-1 was lower, and IGFBP-1 was higher in pre-eclamptic and eclamptic patients than controls, these alterations were related to the severity of pre-eclampsia.

Evaluation of active and passive transport mechanisms in genital tracts of IUD-bearing women with radionuclide hysterosalpingoscintigraphy.

The objective of this study was to evaluate the active and passive transport mechanisms in the genital tracts of copper T-200 intrauterine device (IUD)-bearing women. (Tc-99m)HMPAO-labeled spermatozoa and (Tc-99m)-labeled albumin macrospheres were placed into the vagina at midcycle. Serial scintigraphic images were obtained over a period of 2 h. Migration of spermatozoa and particles in the genital tract and the direction of transport related to dominant follicle were evaluated. While active sperm migration was greatly inhibited, the passive transport of the particles was not affected in IUD-bearing women. The direction of radiolabeled particles and spermatozoa was toward the dominant follicle side. Passive transport was not affected, whereas active transport of spermatozoa was strongly inhibited in the genital tract by the presence of the IUD. However, the direction of active and passive transport related to dominant follicle side was unchanged in IUD-bearing women and was preferentially toward the tube ipsilateral to the dominant follicle.

Changes in leukocyte, granulocyte and lymphocyte counts following antenatal betamethasone administration to pregnant women.

OBJECTIVE: Preterm labor and premature rupture of membranes are associated with a mild leukocytosis. However, we have observed a higher maternal leukocyte count after antenatal betamethasone therapy. We planned this study to evaluate the effects of antenatal betamethasone treatment on maternal leukocyte, granulocyte and lymphocyte count. METHODS: Forty-six pregnant women with the diagnosis of preterm labor between 28 and 33 weeks of gestation age received 12 mg betamethasone at a 12-h interval. The control group consisted of 50 pregnant women between 28 and 33 weeks of gestational age with no medical or obstetrics problems. After a baseline venous sampling, serial leukocyte, granulocyte and lymphocyte counts were obtained every 6 h until it returned to baseline value. RESULTS: There were no statistically significant differences in the control group with respect to the total leukocyte, lymphocyte, and neutrophil count. Total leukocyte and granulocyte counts were increased by 29.8% and 17.8% within 24 and 12 h after betamethasone injection, respectively (P < 0.01). A significant reduction in lymphocyte count was observed within 12 h (45.4%) after betamethasone injection (P < 0.01). All changes in leukocyte, granulocyte and lymphocyte counts returned to baseline values within 3 days. CONCLUSION: Antenatal betamethasone therapy leads to an increase in maternal leukocyte count and a decrease in lymphocyte count. This effect is transient and any leukocytosis persisting for more than 3 days is not due to betamethasone administration.

Comparison of labor induction with misoprostol vs. oxytocin/prostaglandin E2 in term pregnancy.

OBJECTIVE: To compare the efficacy and safety of intravaginal and oral misoprostol vs. oxytocin/prostaglandin E2 (PGE2) gel for third trimester labor induction. METHODS: Two hundred twenty-four pregnant women were randomized to induction of labor either with misoprostol or oxytocin and PGE2 gel. Patients in the misoprostol group (n = 112) received 100 micrograms intravaginal misoprostol followed by 100 micrograms p.o. every 2 h. The oxytocin/PGE2 group consisted of 112 patients who underwent PGE2 cervical instillation 6 h before continuous oxytocin infusion. The perinatal, intrapartum and neonatal characteristics of both groups were determined. RESULTS: Induction to active phase of labor was successfully achieved in 96 women (85.7%) in the misoprostol group vs. 86 women (76.8%) in the oxytocin/PGE2 group, but the drug initiation-delivery interval was significantly shorter in the misoprostol group (9.2 +/- 2.4 h) than in the oxytocin/PGE2 group (15.2 +/- 3.2 h, P < 0.001). The incidence of adverse intrapartum outcomes was similar for both methods. Intravaginal misoprostol 100 micrograms followed by a single oral dose of 100 micrograms misoprostol safely produced labor and a vaginal delivery in 70% of patients. More than three tablets were required in only 10% of patients. There was a higher prevalence of cesarean section for failed induction in the oxytocin/PGE2 group than in the misoprostol group (13.4 vs. 6.3%, P < 0.001). The neonatal outcomes of both groups were also similar. CONCLUSION: Misoprostol is significantly more effective for labor induction than oxytocin/PGE2 gel. The maternal intrapartum and neonatal outcomes were the same for both induction regimens. From a clinical and perinatal perspective, misoprostol is an acceptable choice for labor induction.

Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation.

The effects of pelvic and periaortic peritoneal closure or (non-closure) on morbidity and adhesion formation were prospectively compared in 102 patients with ovarian cancer who had undergone a pelvic and periaortic lymphadenectomy. Hysterectomy with bilateral salpingoophorectomy, bilateral pelvic and periaortic lymphadenectomy, omentectomy, appendectomy and lysis of pelvic adhesions for the standardization of initial adhesion scores was performed on all patients. The pelvic and periaortic peritoneum were re-approximated in group I (n = 50) patients, and left open in group II (n = 52) patients. The groups were similar for mean age, previous surgery, tumour histology and disease stage. Morbidity characteristics such as blood loss, transfusion rate, post-operative infectious and non-infectious complications, and total hospital stay were also similar. After six courses of PAC (cisplatin 50 mg/m(2), Adriamycin 50 mg/m(2), cyclophosphamide 500 Mg/M(2)) chemotherapy, all patients underwent a second-look laparotomy. Persistent cancer was detected in 49 of 102 (48.03%) patients. Adhesion scores were detected at the time of second-look laparotomy. Adhesion scores for group I (8.9 +/- 2.9) were significantly higher than the group II (peritoneum non-closure) (5.8 +/- 2.3) (P<0.01). Closing the pelvic and periaortic peritoneum did not effect morbidity, but leaving the pelvic and periaortic peritoneum open significantly decreased the adhesion formation.

Diminished growth hormone responses to L-dopa in polycystic ovarian disease.

OBJECTIVE: To investigate the GH secretion capacity in polycystic ovarian syndrome (PCOS). DESIGN: Prospective. SETTING: Reproductive endocrinology unit. PATIENTS: Nineteen women with clinical and endocrinologic signs of PCOS were compared with 10 healthy weight-matched volunteers with normal menstrual rhythm and no history of endocrine or reproductive abnormality. INTERVENTIONS: Standard GH reserve estimates were affected in all subjects using oral L-Dopa. The test was carried out after an overnight fast on cycle days 5 to 8 in menstruating subjects; the test was done randomly in patients with amenorrhea. RESULTS: Both PCOS and control groups responded to L-Dopa over a 3-hour period with significant elevations in GH concentrations. The control group showed significantly higher values than the PCOS group at 90, 120, and 180 minutes. CONCLUSION: The findings indicate that PCOS patients demonstrate a relative deficiency in GH reserve.

Reproductive failure and antisperm-antibody production among prostitutes.

Reproductive failure and anti-sperm antibody (ASA) production among prostitutes were investigated. A questionnaire including the subject's age, years of prostitution, date of most recent birth, number of children and contraceptive method used at the beginning of prostitution were asked of 109 prostitutes, but only 53 agreed to complete the questionnaire. ASA was detected by ELISA in the prostitutes (n = 109) and in the control group (n = 40) sera. The tests revealed a high ASA rate (43.1%) among the prostitutes. The difference in the incidence of ASA between controls (5%) and the prostitutes (43.1%) was highly significant (p less than 0.01). It was found that ASA positivity incidence in 27 prostitutes who had never use any contraception method and who became infertile within 9.3 years (average) was 61.3%. These results may be explained by repeatedly inoculations with multiple sperm antigens and/or microorganisms.

PIP: Health workers at the National Health Centre Laboratories in Izmir, Turkey took blood samples from 109 prostitutes to test for antisperm antibodies (ASA) and for Treponema pallidum (the causative agent for syphilis). Researchers analyzed the results to determine the role of ASA incidence in reproductive failure. 40 fertile women who were not prostitutes comprised the control group. Significantly more prostitutes (43.1%) tested positive for ASA than did the controls (5%) (p.01). 53 prostitutes tested positive for T. pallidum. T. pallidum positive women were slightly more likely to also be ASA positive women were slightly more likely to also be ASA positive than T. pallidum negative women (49.1% vs. 37.5%) (p.05). 27 (51%) prostitutes did not use any contraception. ASA incidence for these women stood at 61.31% compared to only 28.3% for the control group (p.01). 23 of these women had had children, but the last birth occurred on average 9.3 years prior to the study. It was significant that these 23 women had not used any contraception since the last birth. Mean length of prostitution stood at 9.6 years. Of the prostitutes who did use contraception, most (24.5% of all prostitutes) used oral contraceptives. The researchers could not determine if the prostitutes who used contraception would have also become infertile if they did not use contraception. In conclusion, repeated exposure to multiple sperm antigens and/or microorganisms may explain the high incidence of ASA and reproductive failure among prostitutes.