Study of the Relationship between Anti-Peroxidase Antibody and Miscarriage, Preterm Labor and IUGR in Egyptian Pregnant Women

Background: This research studied the relationship between anti-peroxidase anti-body in euthyroid pregnant female and miscarriage, preterm labor and IUGR in Egyptian patients. Patients and Methods: This prospective study was carried on patients who attended to the Obstetrics and Gynecology department of Tanta University Hospital for routine antenatal care from January 2016 to November 2016. 80 women enrolled in the study and were divided into four groups, 20 cases for each group, a control group, recurrent unexplained abortion group, preterm labor group and IUGR group. A Thyroperoxidase (TPO) antibody was measured in all cases. Results & Discussion: The eighty patients were randomly enrolled into 4 groups, 20 patients in each group. Their age ranged from 20 to 35 years and BMI ranged from 18 to 35. The percentage of +ve TPO Ab of the control group was 5% and of the recurrent abortion group was 20% and of the preterm labor group was 15% and of the IUGR group it was 5%. (P value 0.026) indicating statistically significant correlation between TPO Ab and recurrent unexplained abortion and preterm labor. Conclusion: The presence of (TPO) antibodies could be correlated to recurrent unexplained abortion and preterm labor. More studies are required to determine whether an intervention is needed to treat thyroid autoantibody positivity during pregnancy.

Endometrial Ice Application Prior to Embryo Transfer in Cases of Recurrent Unexplained <i>In-Vitro</i>Fertilization Failure: A Pilot Study

Introduction: This prospective pilot study was done to get preliminary data about a new technique of inflecting endometrial injury in order to improve implantation rate in IVF cases. Patients and methods: 60 patients were en-rolled and randomly distributed into 3 groups. Each group included 20 pa-tients. This study was conducted in the Egyptian consultants for infertility management and IVF center Tanta-Egypt, in the period from January 2015 to March 2016. In group A (study group 1), the 20 patients included in this group underwent endometrial scratching once at day 21 of menstrual cycle in the cycle prior to ET by a 4 mm disposable Karman’s cannula inserted through the cervical os. While in group B (study group 2), the 20 patients underwent the new technique of endometrial Ice bars application for 10 minutes at day 7 of the embryo transfer cycle to inflect the physical trauma required for the change in the endometrial receptivity. In Group C (control group), the 20 patients didn’t receive any extra action rather than the ordinary preparation for embryo transfer. The primary outcome measures of the study were the clinical pregnancy rate and the number of pregnancies that exceeded 14 weeks of gestation. The secondary outcome measures were multiple pregnancy and miscarriage ratios. Results: The results of this pilot study shows a (>14 weeks) pregnancy rate which is equal in the endometrial icing (30% n = 6/20) and endometrial scratching group (30% n = 6\20). The >14 weeks pregnancy rate in both groups is higher than the control group (25% n = 5/20). The small number of patients in the pilot study may explain the difference to be statistically non-significant. The abortion rate was 33.3% (n = 3/9) in the scratching group and 25% (n = 2/8) in the icing group and 16.6% (n = 1/5) in the control group. The multiple pregnancy rate was 16.6% (n = 1/6) in the scratching group and 33.3% (n = 2/6) in the icing group and 20% (n = 1/5) in the control group. Conclusion: Endometrial icing is a new technique of endometrial injury which deserves more studies to test its efficacy in improving embryo implantation and to test its safety.

Clinical and Biochemical Changes in Polycystic Ovarian Syndrome Patients in Response to 3 Different Oral Hypoglycemic Drugs: A Double Blind Randomized Controlled Study

Introduction: This study was done to evaluate other oral hypoglycemic medications;especially the new ones in the management of PCOS patients as alternatives to the standard medication used for this purpose Metformin. Patients and Methods: 105 patients were enrolled and randomly distributed into 3 groups according to sequence of computer-generated block-random numbers. Each group included 35 patients. This randomized double blind case controlled study was conducted at Tanta University Hospital from December 1, 2015 to October, 1, 2016. In group A (study group 1) the patients received Pioglitazobe 30 mg once a day for 6 months while in group B (study group 2) the patients received Vildagliptin 50 mg once daily. In Group C (control group) the patients received Metformin 500 mg tds. for 6 months. The clinical outcome measures of the study were the improvement in the regularity of the menstrual cycle, the BMI and the improvement in the modified Ferriman-Gallwey (F-G) score for hirsutism. The biochemical outcome measures will be the change in the Serum Free testosterone, dehydroepiandrosterone (DHEA), fasting insulin level, Glcosylated hemoglobin (Hb A1c) and fasting Low Density Lipoproteins (LDL) levels. Results: Pioglitazobe in the study group 1 patients showed a significant reduction of BMI (p = 0.016), Ferriman-Gallwey score (p = 0.003), free testosterone level (p = 0.003), DHEA level (p = 0.001), fasting insulin level (p = 0.036) and Hb a1c level (p = 0.000), and also significant reduction of menstrual irregularities (p = 0.035). When compared to Metformin in the control group 3, there were significant reduction of BMI (p = 0.010), Ferriman-Gallwey score (p = 0.002), free testosterone level (p = 0.034), Hb a1c (p = 0.000) level and significant reduction of menstrual irregularities (p = 0.004) only. This means that the clinical and metabolic effect of Pioglitazobe is better than Metformin in PCOS patients. On the contrary there were disappointing results of the new drug Vildagliptin in group 2;the patients in this group showed significant reduction of BMI (p = 0.001), Ferriman-Gallwey score (p = 0.046) and Hb a1c (p = 0.000) level only. Non significant effect on menstrual irregularities and non significant reduction of LDL level are noticed. But there is elevation of Ferriman-Gallwey score, free testosterone level, DHEA level and fasting insulin level. Conclusion: Pioglitazobe is an effective and safe alternative to Metformin in the management of PCOS patient although further studies including larger number of patients should be done while Vildagliptin should be omitted for use in PCOS patients.