Comparison of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women.

OBJECTIVE: To compare the effectiveness of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women. DESIGN: Placebo-controlled, double blind, randomized trial. SETTING: Teaching and research hospital. PATIENT(S): Ninety women of reproductive age eligible for diagnostic hysteroscopy. INTERVENTION(S): Randomly assignment to receive 400 µg of misoprostol (n = 30) or 10 mg of dinoprostone (n = 30) vaginally before diagnostic hysteroscopy, with a control group (n = 30) not receiving any cervical priming agent. PRIMARY OUTCOME: the number of women requiring cervical dilatation; secondary outcomes: cervical width before surgery, duration of dilatation time, ease of dilatation, complications during surgical procedure, and side effects of the drugs. RESULT(S): In the placebo group, 23 patients required cervical dilatation compared with 17 in the misoprostol group and 9 in the dinoprostone group. The mean (± standard deviation) cervical widths for the placebo, misoprostol, and dinoprostone groups were 4.23 ± 0.43 mm, 5.43 ± 0.5 mm, and 5.83 ± 0.64 mm, respectively. These widths were statistically significantly different. The duration of dilatation was also statistically significantly longer in the control group. CONCLUSION(S): Vaginally administered dinoprostone before diagnostic hysteroscopy is more effective than misoprostol for inducing cervical priming. Further studies are required to elucidate the most efficient option with the least side effects for cervical ripening. CLINICAL TRIAL REGISTRATION NUMBER: NCT01620814.

Associations between adipocyte fatty acid-binding protein and clinical parameters in polycystic ovary syndrome.

PURPOSE: We evaluated a possible association between serum adipocyte fatty acid-binding protein (A-FABP) levels and clinical parameters in women with polycystic ovary syndrome (PCOS). METHODS: Our study included 86 women: 49 with PCOS (study group), 37 with non-PCOS (control group). We recorded and analyzed age, body mass index [BMI = weight (kg)/height (m)(2)], waist circumference, and blood pressure and follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, free testosterone (fT), dehydroepiandrosterone sulfate, 17-OH progesterone, insulin, glucose, triglyceride, high-density lipoprotein, low-density lipoprotein, very low density lipoprotein, HOMA-IR, and A-FABP levels. RESULTS: The mean BMI, waist circumference, and levels of serum LH, fT, LH/FSH, fasting insulin, and HOMA-IR were significantly higher in PCOS patients (p < 0.05). Pearson correlation analysis showed positive correlations of A-FABP levels with BMI and HOMA-IR levels and a negative correlation between A-FABP and fT levels. A ROC curve analysis found that BMI, waist circumference, and levels of fT, A-FABP, and HOMA-IR were discriminative parameters. CONCLUSION: Serum A-FABP levels may be a good prognostic marker in predicting metabolic syndrome and cardiovascular diseases in PCOS patients.

Knowledge about HPV, relation between HPV and cervix cancer and acceptance of HPV vaccine in women in eastern region of Turkey.

OBJECTIVE: The aim of this study is to determine the knowledge of the women living in the eastern region of Turkey about human papillomavirus (HPV) and cervix cancer and their approaches to HPV vaccine. METHODS: The questionnaire forms were distributed to 1,052 patients who applied to the Gynecology Department of Elazig Training and Research Hospital. The subjects were recruited from the general gynecology outpatient clinic of the hospital. The patients from sexually transmitted disease and oncology outpatient clinics were not included in the study. The information about 945 women who completely filled in the questionnaire form was included into the study. The questions set forth in the questionnaire form consisting of 20 questions were prepared by taking the studies previously performed as model. RESULTS: Ninety-five percent of the women were married and 83.5% were housewives (unemployed). Thirteen percent of the women were illiterate, only 12% were graduated from university. Seventy-four percent of the women did not hear about HPV, 78.4% did not know about HPV vaccine, 63% did not know about the fact that some viruses cause cancer, and 83% did not know about the relation between HPV and cervix cancer. According to the multivariate analysis, free-of-charge vaccination, vaccinated relatives or friends, graduation from university and being under the age of 25 predict to accept the vaccine for themselves. CONCLUSION: The young population and the women who graduated from university seem to be more well-informed about HPV and more sensitive about being vaccinated. In addition, free vaccination will ensure the expansion of the vaccine.

The effects of peak and mid-luteal estradiol levels on in vitro fertilization outcome.

PURPOSES: To evaluate the role of peak E2 level and its ratio to mid-luteal E2 level on implantation and clinical pregnancy rates in patients undergoing IVF cycles. METHODS: A retrospective study was designed covering 106 patients who were admitted to IVF Unit between June and October 2008. The patients were divided into two groups with respect to peak E2 levels. Ovulation induction has been done via standard long agonist protocol. Blood samples were drawn on the day of (hCG) administration and 8 days after embryo transfer for serum E2, progesterone measurements. RESULTS: The mean peak E2 level was 2,697.4 ± 1,453 pg/ml (range 684-4,983 pg/ml. The number of retrieved oocytes, luteal E2 level, peak E2 level and E2 ratio were significantly higher in E2 >2,500 group, however, the implantation rate was significantly lower in this group. There were statistically significant differences in peak E2 levels, luteal E2 levels, retrieved oocytes, E2 ratios; of the women who got pregnant and did not get pregnant, all the above parameters were significantly higher in non-pregnant group. According to E2 ratios, the clinical pregnancy rate was highest in group 1 and significantly lowest in group 3. CONCLUSION: This study has shown that the high E2 level and mid-luteal decline of E2 which were defined as peak E2 level/mid-luteal E2 level were predictive for implantation rate in IVF cycles.

The effect of resveratrol on blood pressure in a rat model of preeclampsia.

OBJECTIVE: To examine the hypothesis that resveratrol administration could result in blood pressure and blood flow decrease in a rat preeclampsia model. MATERIALS AND METHODS: Desoxycorticosterone acetate (DOCA) was used to produce hypertension. The Wistar albino rats were divided randomly into three groups: control (n = 12), DOCA injected (n = 11), and DOCA injected and resveratrol treated (n = 13). Rats were sacrificed on gestational day 16-20. The systolic blood pressure was measured by the tail-cuff method. Urine protein was expressed as protein/creatinine. Laser Doppler measurements of the blood flow were made in one placenta, the left kidney and both parietal lobes of brain. Placentas were examined by light microscopy. RESULTS: DOCA injected group exhibited significant differences in blood pressure and protein/creatinine. Mean blood pressure in DOCA-treated rats was 130.1 ± 12.9 mmHg at baseline and 148.4 ± 20.1 mmHg at the time of euthanization (p = 0.044). Resveratrol did not significantly affect blood pressure, placental and renal blood flows. There were also no significant differences in placental pathology parameters among the three groups. CONCLUSION: The present study demonstrated that resveratrol did not decrease blood pressure, and did not result in a significant response in blood flows and placental pathology parameters.

The conservative treatment of postoperative chylous ascites in gynecologic cancers: four case reports.

INTRODUCTION: Chylous ascites is a rare complication following radical surgery in gynecologic cancers. Its treatment is difficult due to nutritional and immunological problems caused by protein and lymphocyte loss. Its conservative treatment includes the use of a low-fat diet, medium chain triglyceride intake, paracentesis, total parenteral nutrition, and somatostatins. Other treatment options for resistant cases include surgical exploration and peritoneovenous shunt. CASE REPORT: We present four gynecologic cancer cases with development of chylous ascites following pelvic-para-aortic lymph dissection. Two of these cases were endometrial cancer, one was cervical cancer, and the last one was ovarian cancer. In three of these cases, chylous ascites developed immediately after surgery. In the cervical cancer case, it developed following surgery and radiotherapy. All subjects responded to conservative treatment. CONCLUSION: Chylous ascites should be considered in the differential diagnosis of abdominal distension following retroperitoneal surgery. Cases generally respond well to conservative treatment. However, treatment options should be personalized, and the right treatment should be chosen for each patient. The best measure is to pay utmost attention to the ligation of large lymph vessels during lymph dissection.

Circulating levels of copeptin, a novel biomarker in pre-eclampsia.

AIMS: Increasing evidence supports the participation of metabolic syndrome and insulin resistance in the pathogenesis of pre-eclampsia. Copeptin is co-synthesized with vasopressin and is a new and promising novel marker of metabolic syndrome and insulin resistance. Our aim was to investigate copeptin levels in normotensive pregnant, mild and severe pre-eclamptic women. MATERIALS AND METHODS: We included 96 pregnant women who received antenatal and obstetric care at the perinatology clinic of our hospital. They were divided into three groups: women with normal ongoing pregnancy (n=32), those with mild pre-eclampsia (n=32) and those with severe pre-eclampsia (n=32). Doppler velocimetry measurements of the uterine and umbilical arteries were performed for each patient. Plasma levels of copeptin were quantified with enzyme-linked immunosorbent assay. RESULTS: Plasma levels of copeptin were 0.31±0.09 ng/mL in the normotensive pregnant group, 0.62±0.16 ng/mL in the mild pre-eclamptic group and 0.85±0.18 ng/mL in the severe pre-eclamptic group (P<0.001). Copeptin levels in pre-eclamptic patients with abnormal Doppler velocimetry were significantly higher than in those with normal Doppler velocimetry. CONCLUSIONS: These results suggest that increased maternal levels of copeptin may be involved in the pathogenesis of pre-eclampsia and it may be useful in the assessment of the severity of the disease.

The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study.

OBJECTIVE: To evaluate the effect of two different laparoscopic methods on ovarian reserve as determined by antral follicle count (AFC) and ovarian volume in patients with bilateral endometriomas. DESIGN: Randomized prospective study. SETTING: Tertiary education and research hospital. PATIENT(S): Forty-eight patients with bilateral endometriomas. INTERVENTION(S): AFC and ovarian volumes determined before and after surgery; coagulation and cystectomy performed on one randomly selected side of each patient for their endometriomas; in vitro fertilization and embryo transfer. MAIN OUTCOME MEASURE(S): Ovarian reserve damage as determined by AFC and ovarian volume, and number of dominant follicles and retrieved oocytes after controlled ovarian hyperstimulation. RESULT(S): In vitro fertilization and embryo transfer were performed for 37 of 48 patients. The number of dominant follicles and the retrieved oocytes were assessed after controlled ovarian hyperstimulation. The postprocedural AFC was 3.67±1.26 and 4.75±0.60 after cystectomy and coagulation, respectively. A statistically significantly greater decrease in AFC was found after cystectomy as compared with coagulation. Postprocedural ovarian volumes were 6.27±1.95 and 9.87±2.01 after cystectomy and coagulation, respectively. A decrease in ovarian volume was found after cystectomy when compared with coagulation. CONCLUSION(S): The decreases in AFC and ovarian volume were found for both coagulation and cystectomy, but the decrease was statistically significantly more frequent in cystectomized ovaries than in coagulated ovaries. Also, in the in vitro fertilization cycles, the ovarian response to ovulation induction was statistically significantly reduced in cystectomized ovaries as compared with coagulated ovaries.

Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility.

OBJECTIVE: To evaluate the reproductive outcomes of patients with a uterine septum and otherwise unexplained infertility who underwent hysteroscopic metroplasty, and to compare them with those of patients with the same diagnosis who did not have hysteroscopic metroplasty. METHODS: The present retrospective study included 127 patients with diagnosis of a uterine septum and otherwise unexplained infertility. The reproductive outcomes of 102 patients who underwent hysteroscopic metroplasty (group 1) and 25 patients who rejected the operation (group 2) were compared. RESULTS: Of the 102 patients who underwent hysteroscopic metroplasty, 44 (43.1%) were able to achieve pregnancy, as compared with 5 (20%) of the 25 patients who did not undergo the operation (P=0.03). The abortion rate was 11.4% (5/44) in group 1, compared with 60% (3/5) in group 2 (P=0.02). The live birth rate was 35.3% (36/102) in group 1, as compared with 8% (2/25) in group 2 (P=0.008). CONCLUSIONS: The results indicate that hysteroscopic metroplasty improves reproductive outcome for patients with a uterine septum and otherwise unexplained infertility.

Treatment of recurrent vulvar Paget disease with imiquimod cream: a case report and review of the literature.

INTRODUCTION: Extra-mammary Paget disease is one of the rare neoplastic conditions of the skin. The most common site of involvement is the vulva and presents itself with erythematous plaques. Surgery is the most important treatment option. In the recent years, there are publications of the topical use of imiquimod cream in extra-mammary cutaneous Paget disease. We report the case of a woman with recurrent vulvar Paget disease, who underwent successful treatment with imiquimod cream. We also review the reports of other patients with vulvar Paget disease who were treated with topical imiquimod cream. CASE REPORT: A 65-year-old woman presented to the Oncology Outpatient Clinic with an itchy lesion in her vulva for 2 years. In the gynecologic examination, a hyperkeratotic erythematous lesion was found starting from the right labium to involve clitoris, with a size of 4 × 3 cm. Pathology result was reported as Paget disease. She was operated and wide vulvar excision was performed with a safety margin of 2 cm. Then recurrence two times occurred. Because she refused surgery, imiquimod cream 5% was applied for treatment. CONCLUSION: Imiquimod cream is an effective and safe therapeutic agent for both primary and recurring vulvar Paget disease.

The value of urocortin and Ca-125 in the diagnosis of endometrioma.

PURPOSES: In this study, we sought to establish the value of a new molecule, urocortin (Ucn), in the diagnosis of endometrioma and compare with Ca-125 to identify superiority of urocortin. METHODS: Of the patients operated on at our hospital with the initial diagnosis of adnexal mass, 88 patients whose pathology results were endometrioma and benign ovarian cyst were included in the study. As a result of the pathological examination, the patients were assessed in two groups. Group 1 consisted of 42 cases of endometrioma and Group 2 included 46 cases of benign ovarian cyst (control group). The serum Ucn and CA 125 levels of patients were measured from the blood samples drawn prior to the operation. RESULTS: While the serum Ucn level was 4.8 ± 1.00 ng/ml in the endometrioma group, it was 4.5 ± 1.03 ng/ml in the control group (P = 0.21). The difference was statistically not meaningful. On the other hand, mean serum Ca-125 level was 43.8 U/l (11.7-251) in the endometrioma group, it was 16.5 U/l (4.3-121.1) in the control group. The difference was statistically meaningful (P = 0.001). When the cut-off point for Serum Ca-125 level was taken as 21.38, sensitivity and specificity levels were found to be 88.1 and 63%. When the cut-off point for Ucn was taken as 4.16, sensitivity was 76.2%, and specificity 45.7%. CONCLUSION: Ucn was not found to be efficient in distinguishing endometrioma from other benign ovarian cysts or to be superior to CA125 in the diagnosis of endometrioma.

Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity.

PURPOSE: The aim of our retrospective study was to assess and to compare the surgical complications of hysterectomy regarding the choice of procedure [abdominal (AH), vaginal (VH), and total laparoscopic hysterectomy (TLH)]. METHODS: A total of 6,480 patient charts undergone hysterectomy were retrospectively analyzed. Data including transfusion, bladder, ureteral and bowel injury, cuff dehiscence, pulmoner embolus, febrile morbidity, hematoma, reoperation, pelvic wall problems were gathered. The Chi-square test and Student's t test were used in the statistical analysis. RESULTS: The most common perioperative complication was blood transfusion which occurred in 114 patients (2.6%). VH patients required significantly less blood transfusion than AH (2.1, 2.6%, respectively). AH had significantly more bladder injury than VH (0.7, 0.4%, respectively). AH had significantly more ureteral injury than VH (0.2, 0.1%, respectively). AH had the same bowel injury as VH (0.1%). AH and VH necessitated significantly more reoperation than TLH (0.4, 0.2, 0.0%, respectively). CONCLUSION: To our study, VH ensures less complication rates than AH. In experienced centers, VH can be a reliable alternative to AH. Controlled prospective studies with large patient volumes are required to compare TLH and VH according to complication rates.

A comparison of the effects of three different luteal phase support protocols on in vitro fertilization outcomes: a randomized clinical trial.

OBJECTIVE: To evaluate the effects of three different luteal phase support protocols on pregnancy and implantation rates, as well as luteal phase hormone profile in intracytoplasmic sperm injection-ET cycles. DESIGN: A prospective, randomized study. SETTING: A tertiary teaching and research hospital. PATIENT(S): Two hundred eighty-eight patients who were undergoing intracytoplasmic sperm injection with a long protocol of controlled ovarian hyperstimulation. INTERVENTION(S): Group 1 (E(2) + P) received daily P plus 4 mg of E(2), group 2 (hCG + P) received P plus 1,500 IU of hCG, and group 3 (P only) received daily vaginal P gel. Blood samples were drawn on the day of hCG administration, as well as 7 and 10 days after the hCG for the E(2) and P measurements. MAIN OUTCOME MEASURE(S): The clinical pregnancy rate. RESULT(S): No difference existed between the E(2) + P and hCG + P groups with respect to pregnancy rate, but it was significantly lower in the P-only group.The implantation rate was significantly lower in the P-only group than in the other groups.The highest miscarriage rate was in the P-only group (38%). CONCLUSION(S): In assisted reproductive technology cycles including treatment with GnRH agonist, adding 4 mg of oral E(2) to P during the luteal phase significantly increased the pregnancy and implantation rates and decreased the miscarriage rate compared with the use of P only.

Estradiol supplementation during the luteal phase of in vitro fertilization cycles: a prospective randomised study.

OBJECTIVE: To find the optimal dosage of estradiol (E2) for luteal phase support through the addition of different doses of E2 to progeserone (P) luteal phase support in patients undergoing long GnRH agonist in vitro fertilization (IVF) treatments. STUDY DESIGN: Two hundred and eighty-five women undergoing IVF treatment with a long GnRH agonist protocol were prospectively randomized into three groups. Group 1 (n = 95) received P and 2mg E2, group 2 (n = 95) received P and 4 mg E2 and group 3 (n = 95) received P and 6 mg E2 as luteal phase support. The primary outcome was the clinical pregnancy rate (PR). The secondary variables of interest were the implantation rate (IR), miscarriage rate and multiple PR. RESULTS: The clinical PR was 31.6%, 40% and 32% respectively in groups 1, 2 and 3 and the differences between groups were not statistically significant. However, the miscarriage rate was significantly lower in group 2 (2.6%) than in group 1 (20%) but was not significantly lower than in group 3 (9.6%). CONCLUSION: For luteal phase support, adding 2, 4 or 6 mg of oral E2 to P creates no statistical difference in terms of pregnancy rates. However, a significantly higher miscarriage rate was found when 2mg E2 was used. Therefore, in the luteal phase support, 4 mg of oral estradiol in addition to progesterone can be considered to reduce the miscarriage rate. CONDENSATION: For luteal phase support, adding 2, 4 or 6 mg of oral estradiol to progesterone showed no statistical difference in terms of pregnancy and implantation rates, but a significantly higher miscarriage rate was found when 2mg estradiol was used.

Relationship between the oestradiol/oocyte ratio and the outcome of assisted reproductive technology cycles with gonadotropin releasing hormone agonist.

The aim of this study was to evaluate the relationship of oestradiol level on the day of hCG (peak E2)/oocyte ratio and the outcome of ART cycles. Of the patients who underwent IVF-ET, 600 normal and high responders to the first cycle of COH with gonadotropin releasing hormone (GnRH)-agonist were included in the study. Patients were designated into three groups based on peak E2/oocyte ratio (Group A: <100 pg/ml per oocyte, Group B: 100-200 pg/ml per oocyte, Group C: >200 pg/ml per oocyte). A comparison among groups was made regarding ovarian stimulation characteristics, fertilisation, implantation and pregnancy rates. After the division based on E2/oocyte ratio, in Group C, the number of oocytes retrieved, 2PN and M2 oocyte were statistically lower than both of the other two groups (p = 0.001, 0.001, 0.001, 0.045). HCG day E2 level was significantly different in all groups (p = 0.001), and fertilisation rate was meaningfully highest in Group C and lowest in Group A (p = 0.001). No difference existed among the three groups with respect to the number of embryos transferred and implantation rates. However, clinical pregnancy rate was significantly lower in Group A than others (p = 0.04). In ART cycles suppressed by GnRH-agonist, IVF outcomes are lower in patients with an E2/oocyte proportion of <100 pg/ml per oocyte.

Continuous versus interrupted episiotomy repair with monofilament or multifilament absorbed suture materials: a randomised controlled trial.

PURPOSE: To compare different repair techniques and different suture materials for episiotomy. METHODS: 160 women having vertex delivery with right-mediolateral episiotomy were randomly allocated to four groups. In the groups where continuos technique was performed, vaginal mucosa, perineal muscles and the skin were sutured continuously. In the groups of interrupted technique, vaginal mucosa was sutured with continuous sutures, then muscle layers and skin were closed by interrupted sutures. Two different types of synthetic absorbed suture material were used: monofilament type is in form of polyglycolide-co-caprolactone and multifilament one is polyglactin 910-Rapide. Perineal pain during different activities on the first and tenth day postpartum and also during sexual intercourse 6 weeks after the delivery was questioned by visual analogous scale (VAS). Furthermore, repair time, amount of suture and episiotomy complications were investigated in each groups. RESULTS: On the first day after delivery, the perineal pain scores, the repair time, the amount of suture were statistically less in the continuous technique groups. The differences between the pain at tenth day and during sexual intercourse 6 weeks after the delivery were statistically same. CONCLUSIONS: The continuous suturing techniques for episiotomy closure, compared to interrupted methods, are associated with less short-term pain, are quicker and also need less suture material.

Effects of method of uterine repair on surgical outcome of cesarean delivery.

OBJECTIVE: To compare the rates of intraoperative and postoperative complications of uterine repair when performed in situ or extra-abdominally following cesarean delivery. METHODS: In this prospective randomized study 4925 women who underwent cesarean delivery were randomly assigned to in situ (n = 2462) or extra-abdominal (n = 2463) uterine repair (group 1 and group 2, respectively). The study compares drop in hemoglobin concentration (as a measure of intraoperative blood loss). It also compares operating time, time to return of bowel sound, and duration of hospitalization as well as rates of uterine atony, blood transfusion, intraoperative complications, additional use postoperative analgesics, endometritis, and wound infection. RESULTS: Uterine atony developed in 96 women (3.8%) in group 1 and 226 women (9.1%) in group 2 (P = 0.001). Moreover, the operating time and the time to return of bowel sound were shorter and the rates of both additional use of postoperative analgesics and wound infection were lower in group 1 (P = 0.001, P = 0.002, P = 0.001, and P = 0.003, respectively). CONCLUSION: Fewer cases of uterine atony, a shorter operating time, a faster return of bowel function, a lesser need for postoperative analgesics, and lower rates of additional use of postoperative analgesics and wound infections suggest that in-situ uterine repair ought to be preferred to extra-abdominal uterine repair following cesarean delivery.

Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF.

This report aimed to examine the effects of atosiban on pregnancy outcome after IVF-embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5 mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P=0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P=0.01). These results have indicated that atosiban increases the IR and PR after IVF-embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF-embryo transfer.

Intrauterine device or estrogen treatment after hysteroscopic uterine septum resection.

OBJECTIVE: To investigate the effects on adhesion formation and pregnancy maintenance of an intrauterine device (IUD) and/or estrogen treatment after hysteroscopic septum resection. METHODS: After septum resection 100 women received either no treatment, or estrogens, or an IUD, or an IUD plus estrogens (n=25 per group). Most were later checked hysteroscopically for uterine cavity adhesions. All pregnancies occurring during the study period were recorded. RESULTS: Adhesions developed in 1 of 19 (5.3%) of the untreated women, 3 of 25 (12%) of the women treated with an IUD plus estrogens, 2 of 19 (10.5%) of the women treated with an IUD only, and none of the women treated with estrogens only. None of the differences, however, were significant. Regarding pregnancy, the differences between groups were also not significant. CONCLUSION: Neither IUD placement, nor estrogen treatment, nor both were found to prevent intrauterine adhesions or facilitate pregnancy after hysteroscopic uterine septum resection.

Comparison of the effectiveness of single versus double intrauterine insemination with three different timing regimens.

OBJECTIVE: To compare double insemination with two different single insemination regimens. DESIGN: Prospective study. SETTING: Tertiary education and research hospital. PATIENT(S): Four hundred and fifty patients with unexplained infertility, male factor, and ovulatory dysfunction underwent controlled ovarian hyperstimulation with gonadotropin. INTERVENTION(S): The patients were divided randomly into three groups: patients in group 1 underwent a single preovulatory intrauterine insemination (IUI) performed 24 hours after hCG administration. Patients in group 2 underwent two IUIs performed 12 and 36 hours after hCG administration. Patients in group 3 underwent a single periovulatory IUI performed 36 hours after hCG administration. MAIN OUTCOME MEASURE(S): Pregnancy rate. RESULT(S): The total pregnancy rate per patient was 14.2 % (64 pregnancies in 450 patients). Group 1 had 17 pregnancies (11.3%), while groups 2 and 3 had 21 (14.0%) and 26 (17.2%) pregnancies, respectively. The difference between the three groups in regard to pregnancy rates was statistically not significant. CONCLUSION(S): Despite the 36th hour being the preferred timing for IUI, there was no difference regarding pregnancy rates between single 24th hour and double 12th- and 36th-hour inseminations. This finding suggests that the 24th-hour IUI might be preferred in demanding situations.