Surrogacy as a good option for treatment of repeated implantation failure: a case series

Background: Repeated implantation failure (RIF) is defined as pregnancy failure after two to six times with at least ten high grade embryo transfer to uterus. A variety of causes have been anticipated for RIF, including anatomical, autoimmune, genetics, endocrine and thrombotic anomalies. Factors responsible for RIF have important implication regarding treatment however in many couples a perfect cause cannot be found. Cases: In these case series, we reported nine couples with RIF that after investigation no definitive etiology was found for RIF and empirical therapy by heparin, aspirin and or immunotherapy was not effective. In these cases we recommended transfer of embryos to surrogate uterus. Nine patients were studied and six of them developed a normal pregnancy (pregnancy rate=66.66%). Conclusion: This study showed that surrogacy is a good option for treatment of RIF

Comparison between Transvaginal Sonography and Cytological results for detection of ovarian cysts

Background: Ovarian functional cyst is one of the most common pelvic mass in reproductive age which mostly resolves spontaneously. Sonography is a valuable tool for diagnosis of benign cyst with high accuracy. The objective of this cross sectional study was to evaluate the accuracy of transvaginal sonography in detecting type of ovarian cyst and compare the results wieh cytological results. Materials and Methods: 82 women in reproductive age who have had simple ovarian cysts with benign criteria which unresolved after taking contraceptive pills for 3 months were considered for this clinical study. Transvaginal ultrasound-guided aspiration of cysts were done and were then sent to the pathological evaluation. Also, all data regarding the size of the cysts and aspirated fliud were recorded in charts for further statistical analysis. Results: The accuracy of transvaginal ultrasound comparing with cytology on diagnosis for functional cysts was 94.9%, for epithelial ovarian cyst was 97.5% and for endometrioma was 97.5% (P= 0.0001).The size of cysts with diameter of <10cm was not related to the quality of cysts. Conclusion: The results showed that sonography is a valuable and reliable tool for diagnosis of benign ovarian cyst. It seems that if a mass appears benign by ultrasound morphologic criteria, probability of it being malignant is near to zero, which can be aspirated by transvaginal route without any fear from missing of malignancy or complication

Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized Clinical Trial

Background: Endometriosis is a common hormone-dependent gynecologic disease with a high recurrence. Laparotomy or laparoscopy is the standard surgery for the large endometrioma. Also, sclerotherapy is basically used to treat different diseases one of which is endometrioma. Objective: The study was designed to assess the value of transvaginal ultrasound-guided ethanol sclerotherapy in patients with a recurrent endometrioma. Materials and Methods: In a randomized clinical trial, an interventional group of 20 patients underwent transvaginal ethanol sclerotherapy for recurrent ovarian endometrioma. The patients were followed up first after one and two weeks and then after one, two, and three months. If the patients had no endometrioma, they were treated with in vitro fertilization (IVF) (standard long protocol). A control group of 20 patients with endometrioma were enrolled for an IVF protocol. They had no treatment by ethanol sclerotherapy. IVF parameters, pregnancy rates, and implantation rates were compared in both groups. Results: The demographic data showed no difference between the two groups. The initial mean endometria size was 41.45±15.9 cm, the recurrence rate after 6 months was 4 (20%), FSH before and after sclerotherapy was 6.97±2.25 IU/L and 6.78±1.88 IU/L (p=0.343). The clinical pregnancy rate was 6 (33.3%) vs. 3 (15%), (p=0.616). The fertilization rate emerged 63.06% in study group vs. 60.38%, (p=0.57). The implantation rate turned out 12.9% in study group vs. 7.5%, (p=0.52). None of these results were significant. However, the data pointed to a better trend toward the ethanol sclerotherapy group. Conclusion: Ethanol sclerotherapy could be an effective strategy for the treatment of recurrent endometrioma especially before IVF

Visceral Leishmaniasis in Southeastern Iran: A Narrative Review

Background: Visceral leishmaniasis (VL) has strong links with poverty, substantial medical and veterinary impacts. This review aimed to focus in studies published during 1994-2016 on VL in southeastern Iran. Methods: The present review is based on expert knowledge and historical studies published during the past 23 yr (1994-2016) on VL in southeastern Iran. In addition, related literature found in PubMed by using the keywords such as visceral leishmaniasis, kala-azar, and Leishmania infantum are included. Results: Overall, 118 children aged 4.2 yr were detected as infected with human VL (HVL). The majority of the cases were from Orzoieh district (37.1%) in southwest of Kerman Province, followed by Sirjan (15.7%), Jiroft (14.8%), Kahnuj (9.3%) and to lesser extent from other areas. The male to female ratio was 1.7. The three most frequent clinical features were represented by fever (100.0%), anemia (95.0%) and splenomegaly (91.5%). Altogether, 42.0% of the VL cases developed secondary bacterial infections, the overall case-fatality rate was 3.4%, and majorities (88.0%) of the VL patients were undernourished. Overall, 733 dogs and wild canines were examined by different techniques with various seroprevalence ranges. Conclusion: In southeastern Iran, VL is endemic in Orzoieh district in Kerman Province. While the dogs are implicated as the main domestic reservoir of VL, wide range of wild canines can serve as a secondary potential reservoir host