REPRODUCTIVE OUTCOMES AFTER ABDOMINAL MYOMECTOMY

Objective: To determine the frequency of reproductive outcomes after abdominal myomectomy in infertile women. Study Design: Case series. Place and Duration of Study: at Combined Military Hospital, Multan Pakistan, from Sep 2015 to Feb 2017. Methodology: This study included 60 women who underwent myomectomy to retain their capabilities of reproduction. Inclusion criteria were infertile women with uterine fibroids. Routine investigation was done to all patients like ultrasound and hysterosalpingogram before and after the procedure. The procedure of abdominal myomectomy was done under general anesthesia. All fibroids were enucleated and large blood vessels were tied. Vicryl no.1 was used to close the uterine defect. All patients were followed up for 3, 6 and 12 months interval and data was collected for conception, spontaneous conception, and conception with assisted reproductive technique, live birth and miscarriage. Results: In this study mean age was 27.33 ± 4.03 years, mean number of fibroid was 1.366 ± 0.48 and mean size of fibroid was 7.06 ± 1.64 cm. Twenty eight (46.7%) women had conceived after myomectomy, in which 92.9% had spontaneous conception and 7.1% by assisted reproductive technique. Conclusion: Abdominal myomectomy should be the standard treatment of infertile women with uterine fibroids if no other underline cause of infertility. Moreover, this study results also showed that younger patients might be benefited more in term of reproductive outcomes after abdominal myomectomy.

Dietary Fatty Acid Intakes and the Outcomes of Assisted Reproductive Technique in Infertile Women

Background: The purpose of this study was evaluating the relationship between fatty acid (FA) intakes and the Assisted Reproductive Technique (ART) out-comes in infertile women. Methods: In this descriptive longitudinal study, a validated food frequency questionnaire (FFQ) was used to measure dietary intakes among 217 women with primary infertility seeking ART treatments at Isfahan Fertility and Infertili-ty Center, Isfahan, Iran. The average number of total and metaphase II (MII) oocytes, the fertilization rate, the ratio of good and bad quality embryo and bio-chemical and clinical pregnancy were assessed. Analyses were performed using mean, standard deviation, Chi-square test, ANOVA, ANCOVA, logistic regres-sion. Results: A total of 140 women were finally included in the study. There was a positive relationship between the average number of total and MII oocytes and the amount of total fatty acids (TFAs), saturated fatty acids (SFAs), monoun-saturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), linoleic ac-ids, linolenic acids, and oleic acids intakes, while eicosapentaenoic acids (EPAs) and docosahexaenoic acids (DHAs) intakes had an inverse relationship. Consuming more amounts of TFAs, SFAs, PUFAs, MUFAs, linoleic acids, and oleic acids was associated with the lower fertilization rate, whereas the con-sumption of linolenic acids and EPAs increased the fertilization rate. The ratio of good quality embryo was directly affected by the amount of PUFAs intakes. Additionally, there was a negative correlation between the amount of SFAs in-takes and the number of pregnant women. Conclusion: TFAs, SFA, PUFA, and MUFA intakes could have both beneficial and adverse impacts on ART outcomes.

A rare case of heterotopic pregnancy: case report

Heterotopic pregnancy is defined as the coexistence of intrauterine and extrauterine gestation. The incidence is low and estimated to be 1 in 30,000 of spontaneous pregnancies though it is becoming commoner with assisted reproductive technique. It can be a life-threatening condition and can be easily missed with the diagnosis being overlooked. We present a rare case of spontaneous heterotopic pregnancy with intrauterine gestation without cardiac activity and unruptured tubal ectopic.

The effect of Myo-inositol on fertility rates in poor ovarian responder in women undergoing assisted reproductive technique: a randomized clinical trial

Background Poor ovarian response to gonadotropin is a significant challenge in assisted reproductive technique (ART) and affect 9–24% of ART cycles. This study aimed to evaluate the effect of Myo-inositol on fertility rates in poor ovarian responder women undergoing assisted reproductive technique. Methods This study is a double-blinded randomized controlled study that involved 60 poor ovarian responders included in an ICSI program and divided into two groups; intervention group: 30 patients who have been assuming Inofolic (4 g myo-inositol + 400 μg folic acid) for the before the enrollment day; control group: 30 patients assuming folic acid (400 μg) for the same period. Controlled ovarian stimulation was performed in the same manner in the two groups. The main outcomeswere the assessment of oocytes retrievednumber and quality, ovarian sensitivity index,required dose of Gonadotropinsunits × 1000), fertilization rate, biochemical, and clinical pregnancy rate. Result There is no significant difference in clinical characteristics between study groups. The number of oocytes retrieved, number of MII oocytes, number of embryos transferred, chemical, and clinical pregnancy were higher in the intervention group. However, they are not statistically significant in comparison to the control group. The ovarian sensitivity index and fertilization rate were significantly higher in the intervention group than the control group (P > 0.05). The required dose of gonadotropin significantly lower in the intervention group than the control group. Conclusion Our results suggest that the supplementation myo-inositol in poor ovarian responders significantly improved the ART outcomes such as fertilization rate gonadotropin, ovarian sensitivity index (OSI) and significantly reduced the required unities of gonadotropin. Additionally, more extensive randomized controlled studies are needed. Trial registration Iranian Registry of Clinical Trials, IRCT20180515039668N1, retrospectively registered since 2020-03-16.