Placenta abruption in a woman with Wilson’s disease: a case report

Wilson’s disease is a rare genetic disorder of copper metabolism that causes primary hepatic cirrhosis, secondary menstrual abnormalities and infertility. Following the appropriate therapy patients are asymptomatic and pregnancy may be achieved. We present a case of placental abruption in a pregnant woman with Wilson’s disease and we review the management dilemmas and treatment options of pregnant women with Wilson’s disease

Laparoscopic management of mesenteric cyst: a case report

Mesenteric cysts are rare intra-abdominal lesions with variable clinical symptoms and signs that make pre-operative diagnosis difficult. Optimal treatment is surgical excision of the cyst with laparotomy or laparoscopy. We present a case of mesenteric cyst that was misdiagnosed as para-ovarian cyst and managed laparoscopically by gynaecologists

DEBATE - Ovarian hyperstimulation syndrome: are preventive measures effective?

Infertility treatment has been changed dramatically over the last decades with the introduction of the new assisted reproduction techniques (ART). Ovarian stimulation, either to induce ovulation in the management of anovulatory infertility or for controlled ovarian hyperstimulation in the course of in vitro-fertilization, is a main part of the various ART. Nevertheless, ovarian stimulation entails the risk for the development of ovarian hyperstimulation syndrome (OHSS), the commonest complication as such. Hence, it is of great importance not only to know how to effectively induce ovulation but also how to prevent this severe potential risk. Ovarian hyperstimulation syndrome is a well-known and important complication of ovulatory drugs. Its development has been described following ovulation induction with almost every drug used for ovarian stimulation, either in the management of anovulatory infertility or during controlled ovarian hyperstimulation for in-vitro fertilization, having an incidence of 0,5-2% (1). The employment of gonadotropin releasing hormone-agonists (GnRH-a) seems to be associated with an increased incidence of OHSS (2-4)

The role of endometrial scratching prior to in vitro fertilization: an updated systematic review and meta-analysis

Abstract Research question To evaluate the role of endometrial scratching performed prior to an embryo transfer cycle on the probability of pregnancy compared to placebo/sham or no intervention. Design A computerized literature (using a specific search strategy) search was performed across the databases MEDLINE, EMBASE, COCHRANE CENTRAL, SCOPUS and WEB OF SCIENCE up to June 2023 in order to identify randomized controlled trials (RCTs) evaluating the effect of endometrial scratching prior to an embryo transfer cycle on the probability of pregnancy, expressed either as live birth, ongoing pregnancy or clinical pregnancy (in order of significance) compared to placebo/sham or no intervention. Data were pooled using random-effects or fixed-effects model, depending on the presence or not of heterogeneity. Heterogeneity was assessed using the I 2 statistic. Subgroup analyses were performed based on the population studied in each RCT, as well as on the timing and method of endometrial biopsy. Certainty of evidence was assessed using the GRADEPro tool. Results The probability of live birth was significantly higher in embryo transfer cycles after endometrial scratching as compared to placebo/sham or no intervention (relative risk-RR: 1.12, 95% CI: 1.05–1.20; heterogeneity: I2=46.30%, p<0.001, 28 studies; low certainty). The probability of ongoing pregnancy was not significantly difference between the two groups (RR: 1.07, 95% CI: 0.98–1.18; heterogeneity: I2=27.44%, p=0.15, 11 studies; low certainty). The probability of clinical pregnancy was significantly higher in embryo transfer cycles after endometrial scratching as compared to placebo/sham or no intervention (RR: 1.12, 95% CI: 1.06–1.18; heterogeneity: I2=47.48%, p<0.001, 37 studies; low certainty). A subgroup analysis was performed based on the time that endometrial scratching was carried out. When endometrial scratching was performed during the menstrual cycle prior to the embryo transfer cycle a significantly higher probability of live birth was present (RR: 1.18, 95% CI:1.09-1.27; heterogeneity: I2=39.72%, p<0.001, 21 studies; moderate certainty). On the contrary, no effect on the probability of live birth was present when endometrial injury was performed during the embryo transfer cycle (RR: 0.87, 95% CI: 0.67-1.15; heterogeneity: I2=65.18%, p=0.33, 5 studies; low certainty). In addition, a higher probability of live birth was only present in women with previous IVF failures (RR: 1.35, 95% CI: 1.20-1.53; heterogeneity: I2=0%, p<0.001, 13 studies; moderate certainty) with evidence suggesting that the more IVF failures the more likely endometrial scratching to be beneficial (p=0.004). The number of times endometrial scratching was performed, as well as the type of instrument used did not appear to affect the probability of live birth. Conclusions Endometrial scratching during the menstrual cycle prior to an embryo transfer cycle can lead to a higher probability of live birth in patients with previous IVF failures. PROSPERO registration PROSPERO CRD42023433538 (18 Jun 2023