Intrauterine injection of HCG before embryo transfer: a parallel, double-blind randomized trial.

RESEARCH QUESTION: Does intrauterine administration of HCG before embryo transfer improve live birth rate during IVF cycles? DESIGN: A parallel, randomized controlled trial conducted between July 2018 and February 2020. Infertile women (n = 181) scheduled for fresh or vitrified-warmed embryo transfer after IVF carried out for any indication were randomized in a 1:1 ratio to receive either HCG (500 IU in 0.1 ml of tissue culture media) or culture media (0.1 ml of tissue culture media) via intrauterine injection 4 min before embryo transfer. In both groups, an intrauterine insemination catheter was used for administering the medication. Primary outcome was live birth, with ongoing pregnancy and clinical pregnancy as secondary outcomes. Analysis was based on intention-to-treat principle. RESULTS: Baseline and cycle characteristics were comparable between the two groups. In the control group, one woman with a confirmed clinical pregnancy was lost to follow-up. Live birth rates were 24% (22/90) in the HCG group versus 19% (17/90) in the control group (RR 1.29, 95% CI 0.74 to 2.27). Clinical pregnancy and ongoing pregnancy rates were 34% versus 26% (RR 1.31, 95% CI 0.84 to 2.04) and 24% versus 19% (RR 1.29, 95% CI 0.74 to 2.27) in the HCG and the control groups, respectively. CONCLUSION: Intrauterine injection of HCG before embryo transfer did not improve live birth rates in women undergoing IVF. As the study was designed to detect a 20% difference between groups, a smaller, clinically important difference could not be ruled out. Treatment outcomes were lower than expected in the control group.

Prediction of pelvic adhesions at repeat cesarean delivery through assessment of striae gravidarum score: A cross-sectional study.

OBJECTIVE: To investigate the predictive value of the Davey Score for striae gravidarum (SG) on the presence of pelvic adhesions at repeat cesarean delivery (CD). MATERIALS AND METHODS: The current study was a cross-sectional study conducted in a tertiary university hospital between November 2016 and March 2018. All women scheduled for elective CD were included if they had at least previous one CD with pregnancy in term fetus (37-40 weeks gestation. Preoperative evaluation of SG severity using Davey score, which is a validated scoring system, was done on the examination bed. Patients with no/mild striae (score 0-2) were classified as group (I) and women with severe striae (score 3-8) were classified as group (II). During surgery, pelvic adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the difference in the rate of pelvic adhesions between both groups. RESULTS: The study included 300 women; group I included 114 women and group II included 186 women. About 90% of women with severe striae versus 82.5% of women with no/mild striae were found to have adhesions (p = 0.035). Dense adhesions were significantly present in severe striae group (57.4%) versus (41.5%) in no/mild striae group (p = 0.022). The mean Davey score in women in group (II) was significantly higher than group (I) (4.25 ± 3.36 vs. 3.09 ± 2.95, p = 0.03). Nair's score had a significant positive moderate correlation with Davey score (r = 0.541, p = 0.016). According to the results of multivariate regression analysis, Davey score >2 was the only variable associated with increased risk of pelvic adhesions (p = 0.010). CONCLUSION: Assessment of SG score in women with previous CD using Davey score might help to predict pelvic adhesions status before planning a new surgery.

The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial.

Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS). Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30 IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures. Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p = .06 and 0.24 respectively) and hematocrit values (p = .12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7 ± 90.6 versus 588.9 ± 96.3 mL respectively, p = .001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p = .002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures. Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.

Repeated recovery of immature oocytes in a woman with a previous history of empty follicle syndrome.

The empty follicle syndrome (EFS) is defined as a failure to aspirate any oocyte (s) from the follicles after ovarian hyperstimulation in preparation for IVF/ICSI. It is a frustrating and vague syndrome; and a controversial one concerning its existence, causes and possible treatment. Recurrent EFS or the recovery of immature oocytes thereafter is a more challenging problem. Delayed injection after leaving the immature oocytes for in vitro-maturation (IVM) has been suggested to be a possible option if immature oocytes are retrieved. Here, we present a case of repeated retrieval of a few immature oocytes after a first incidence of EFS. IVM was tried twice for those immature oocytes. Unfortunately, in this case IVM was unsuccessful and the oocytes failed to mature in vitro. Assistance is required for future management of these unfortunate couples.

Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial.

OBJECTIVE: The current study aims to evaluate if vaginal misoprostol (400 mcg) administered prior to intrauterine device (IUD) insertion increases the ease and success of insertion among women who had delivered only by elective cesarean delivery (CD). STUDY DESIGN: The current study was a randomized, double-blind, placebo-controlled trial conducted in Assiut Women's Health Hospital, Egypt, between the 1st of April 2015 and the 31st of March 2016 and included women who delivered only by elective CD. One hundred forty women were randomized into two groups; misoprostol group received two misoprostol 400-mcg tablets vaginally, and placebo group received two placebo tablets 3 h before a copper T380A IUD insertion. The primary outcome measure was the difference in the ease of insertion score using a 10-cm visual analog scale between both groups with 0=very easy insertion, and 10=terribly difficult insertion. RESULTS: The ease of insertion score was lower in the misoprostol group (2.2±0.5 vs. 4.2±0.5, p=.0001) with higher number of successful IUD insertions than the placebo group (69 [98.6%] vs. 61 [87.1%], p=.009). The mean pain score reported by the women was lower in misoprostol group (2.7±0.6 vs. 4.3±0.8) with higher level of satisfaction from the whole procedure (8.9±0.4 vs. 7.9±0.2) with p=.001 for both. CONCLUSIONS: Misoprostol 400 mcg vaginally prior to IUD insertion eases and increase the success of insertion with reduction of pain among women who had delivered only by elective CD. IMPLICATIONS: The use of vaginal misoprostol before IUD insertion in women who had never delivered vaginally before may increase the ease and success of insertion. Moreover, it may reduce the pain felt by women during the procedure.