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Showing 26 results for Ectopic Pregnancy

Razieh Dehghani Firouzabady, Irandokht Mehri Mahani, Mehdi Dehghani Firouzabady,
Volume 2, Issue 2 (7-2004)

Background: Embryo transfer has received little clinical attention and has been the most inefficient step in in-vitro fertilization (IVF). Recent reports have suggested that an awareness of the position and length of the uterus during embryo transfer might be helpful in improving pregnancy rate. Objectives: The main objective of the present study was to determine the relation between the length and position of the uterus during embryo transfer and pregnancy rate. Materials and Methods: Patients were randomly allocated to two groups. In case group A (n=40) length of uterus was measured at the day of oocytes collection and the position of uterus was determined. In the control group, Group B, (n=40) the length and position of uterus were not investigated. The embryo transfer catheter was advanced to 5 mm from uterine fondues based on the previously determined cavity length in group A. The embryo transfer procedures ( IVF/ICSI) at 48 hours after oocytes collection was done. The outcome of the treatment cycle in two groups was investigated. Data analysis was performed by using chi-square, fisher-exact and ANOVA tests. The statistical significant was defined (P?0.05). Results: There were no significant differences in the mean age (28.5+4.4, 27.8+6.2), and duration of infertility (7+3.4, 8.7+5.4). The pregnancy rate was not significantly different with respect to position and length of uterus. The pregnancy rate in case groups was 25% and in control group was 22.5%, the difference was not significant (P= 0.792). In both groups, there were ectopic peregnancy and in fact he incidence of ectopic pregnancy, per reported clinical pregnancy, was highest in group A (14.9%) in comparison with group B (1.8%). Conclusion: The pregnancy rate was not significantly different in the two groups. Misdirecting the embryo transfer can not be avoided by an accurate knowledge of the position or length of uterine at the time of oocytes retrieval. Further studies are required to evaluate the role of length and position of uterus related to the pregnancy rate. Article
Parvin Gharabaghi, Seddighe Abdollahifard, Manizheh Gharabaghi, Mohammad Nouri,
Volume 5, Issue 5 (7-2007)

Background: The value of serial measurement of serum ß subunit of human chorionic gonadotropin (ßHCG) and ultrasonography in the early diagnosis of ectopic pregnancy has well established.
Objective: The objective of this study was to explore the diagnostic value of raising level of serum ßHCG, single measurement of progesterone (P) and estradiol (E2) in early diagnosis of ectopic pregnancy.
Materials and Methods: Serum levels of ßHCG and estradiol were measured by Radio Immuno Sorbent Assay (RIA) and progesterone level was measured by Enzyme Linked Immuno Sorbent Assay (ELISA) techniques in 43 symptomatic women with ectopic pregnancy and 42 women with normal intrauterine pregnancy in Alzahra Hospital, Tabriz, Iran. These values were compared by T-test. By determining cut-off levels of these parameters the efficiency and sensitivity of them in prediction of ectopic pregnancy was estimated.
Results: The mean serum levels of ßHCG, estradiol and progesterone in patients with ectopic pregnancies (940 ± 552 mlu/ml, 593 ± 237 pg/ml, 5.83 ± 3.41 ng/ml, respectively) were significantly lower than these levels in normal intrauterine pregnancies (4620 ± 2030 mlu/ml, 1627 ± 435 pg/ml, 24.8 ± 6.08 ng/ml, respectively). The average rate of ßHCG rising was 8.2% for 24 hours in patients with ectopic pregnancy (EP) and 32.8% in normal intrauterine pregnancies (NIUP).
Conclusions: In this study single measurement of serum progesterone level has the greatest sensitivity (100%) and specificity (98%) in the diagnosis of ectopic pregnancy.
Robabeh Taheripanah, Maryam Sadat Hosseini, Mohamad Hashemi,
Volume 6, Issue 2 (7-2008)

Background: Ectopic pregnancy is one of the pathologic entities that it destroys the fallopian tube and impairs the future pregnancy. There are different medical and surgical therapies in order the treatment and reserve of fertility. The aim of this report is discuss a case of successful intrauterine after management of ectopic pregnancy with local injection of KCL in an infertile PCOD patient.
Case: The patient was a PCOD woman with gestational age of 8.5 weeks. One gestational sac and alive fetus with normal heart beat was seen in the right adnexa. Hemodynamic situation was stable. 0.5cc KCL 10% was injected to the fetal heart and the extracted tissue sent for pathology. We evaluated the effects of this treatment by measuring serial human chorionic gonadotropin (hCG) titers. Moreover, we used hysterosalpingogrphy to diagnose and to evaluate the patency of the tubes. Induction ovulation and intrauterine insemination was done and pregnancy occurred. Patient passed the pregnancy very good and she delivered by cesarean section due to breech presentation at 39 weeks of gestational age. There was no sign of pathologic finding in the tubes or adhesion or sequel of ectopic pregnancy.
Conclusion: The beneficial outcomes of this kind of treatment suggest that local injection of KCL as a low invasive treatment can be the choice treatment for alive and progressed ectopic pregnancy or heterotopic pregnancy. Because of rarity of this management and successful intrauterine we reported the usefulness of local KCL injection for the successful conservative treatment of alive ectopic pregnancy in Iran.
Ferdous Mehrabian, Behnaz Khani Robati,
Volume 8, Issue 1 (7-2010)

Background: Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges.
Case: A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy (IUP). Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra- or post-procedural complications but the IUP was aborted spontaneously on the second postoperative day.
Conclusion: Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively if they are clinically stable and the abdominal pregnancy is recognized early in gestation.
Tahere Ashrafganjooei, Iraj Harirchi, Giti Iravanlo,
Volume 9, Issue 3 (7-2011)

Background: Tubo-ovarian abscess as a serious complication of pelvic inflammatory disease is very uncommon in sexually inactive girls.
Case: We report a case of tubo-ovarian abscess in a 24-year-old sexually inactive girl with transverse vaginal septum who was presented with abdominal pain and a pelvic mass and without prior surgical history and no evidences of appendicitis, inflammatory bowel disease, or cancer. A huge unilateral tubo-ovarian abscess was recognized at laparotomy. Unilateral salpingoophorectomy, hysterectomy and postoperative antibiotic therapy cured the patient. Conclusion: Early diagnosis and treatment are essential to prevent further sequel including infertility, ectopic pregnancy, and chronic pelvic pain which cause morbidity.
Maryam Asgharnia, Roya Faraji, Fariba Mirblouk, Zahra Atrkar Roshan , Ayda Parvizi,
Volume 10, Issue 4 (8-2012)

Background: Vaginal sonograghy and serial -hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase (CPK) in blood.
Objective: assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy.
Materials and Methods: In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and βhCG divided into 3 groups (N=37): tubal pregnancy (1), threatened abortion (2) and normal pregnancy (3). Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. Results: Mean total CPK level were 96.27±63.9 u/lit (group 1), 55.37±14.1 u/lit (group 2) and 48.94±19.2 u/lit (group 3) and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62±5.2 u/lit, 17.32±6.9 u/lit, and 15.1±4.7 u/lit, respectively which was not significant.
Conclusion: It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy.
Reihaneh Hosseini, Zahra Asgari, Ashraf Moini,
Volume 11, Issue 12 (1-2013)

Background: Ectopic pregnancy is one of the main problems in women in reproductive age that needs special attention and appropriate strategy should be managed. In some cases expectant management seems good strategy without any medicine or surgery and their possible side effects. But are the outcomes always the same? Which outcomes should we expect?
Case: We have reported 2 patients whose ectopic pregnancy had been managed conservatively and they had sustained pain for several months which needed surgery to resolve.
Conclusion: In the case of ectopic pregnancy, it is important for the clinician to select the patient meticulously and be aware of common and rare consequences of her treatment.
Afsoon Zarei, Mohammad Ebrahim Parsanezhad, Masoumeh Younesi, Saeed Alborzi, Jaleh Zolghadri, Alamtaj Samsami, Sedigheh Amooee, Shahintaj Aramesh,
Volume 12, Issue 1 (2-2014)

Background: The direct effect of hCG on the human endometrium was studied several times.
Objective: The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin (rhCG) before embryo transfer (ET).
Materials and Methods: In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection (IVF-ICSI) cycles were randomly assigned to receive 250μg intrauterine rhCG (n=84) or placebo (n=98) before ET. The implantation and pregnancy rates were compared between groups.
Results: Patients who received intrauterine rhCG before ET had significantly higher implantation (36.9% vs. 22.4%; p=0.035), clinical pregnancy rates (34.5% vs. 20.4%; p=0.044) and ongoing pregnancy rate (32.1% vs. 18.4%; p=0.032) when compared to those who received placebo. The abortion (2.4% vs. 2.0%; p=0.929) and ectopic pregnancy rates (1.2% vs. 1.0%; p=0.976) were comparable between groups of rhCG and placebo, respectively. Conclusion: Intrauterine injection of 250μg of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles
Leyla Fath Bayati, Marefat Ghaffari Novin, Fatemeh Fadaei Fathabadi, Abbas Piryaei, Mohammad Hasan Heidari, Mozhgan Bandehpour, Mohsen Norouzian, Mahdi Alizadeh Parhizgar, Mahmood Shakooriyan Fard,
Volume 12, Issue 1 (2-2014)

Background: Tubal ectopic pregnancy (tEP) is the most common type of extra-uterine pregnancy and the most common cause of maternal mortality. Nitric oxide (NO) is a molecule that incorporates in many physiological processes of female reproductive system. Recent studies have demonstrated the possible role of endothelial isoform of nitric oxide synthase (eNOS) enzyme in the regulation of many reproductive events that occur in the fallopian tube (FT).
Objective: The aim of this study was to evaluate the expression of eNOS in the FTs of women with tEP.
Materials and Methods: In this case-control study, a total number of 30FTs samples were obtained from three groups including: 10 FTs of women that bearing an EP, 10 FTs from the non-pregnant women at luteal phase of the menstrual cycle, and 10 FTs of healthy pregnant women (n=10). Samples were fixed in 10% buffered formalin and then were evaluated by immunohistochemistry.
Results: Localization of eNOS was seen in secretory and ciliated luminal epithelium and vascular endothelium of all groups. However, we did not observed the expression of eNOS in smooth muscle cells of all groups. Expression of eNOS in luminal epithelium of women with EP compared to non-pregnant women at luteal phase of menstrual cycle and healthy pregnant group showed statistically significant increase (p=0.00). Significant difference in expression of eNOS was not observed in luminal epithelium of FTs of women at luteal phase compared to healthy pregnant groups (p=0.78).
Conclusion: This study indicates that changes in expression of eNOS in luminal epithelium of FT may lead to development of EP.

Mehri Jamilian,
Volume 12, Issue 2 (2-2014)

Background: The incidence of ectopic pregnancy varies between 1.5-2% of all pregnancies. Bilateral tubal ectopic pregnancy is rare. It may occur in 1 per 200 000 pregnancies.
Case: This is a case report of 25 year-old woman who underwent intra uterine insemination (IUI), because of tubal factor infertility (unilateral). On the 30th day after the IUI she complained from pelvic pain and vaginal bleeding. Pelvic ultrasound showed bilateral tubal ectopic pregnancy with fluid in Douglas Pouch and empty uterine cavity. Exploratory laparotomy, left salpingectomy, and right salpingostomy were performed on the same day of admission.
Conclusion: The above case suggests that cases presenting with infertility and ectopic pregnancy should be followed very closely with β-hCG and or Trans Vaginal Sonography (TVS) to exclude double ectopic. So, as in this case, early diagnosis is essential for prevention of maternal morbidity and mortality.

Julio Elito Júnior, Leandro Gustavo Oliveira, Marcelo Octávio Fernandes Silva, Edward Araujo Júnior, Luiz Camano,
Volume 12, Issue 3 (4-2014)

Ectopic pregnancy (EP) is the most important cause of maternal death in the first trimester accounting for 9 - 13% of all pregnancy-related deaths (1). Despite the use of transvaginal sonography and high sensitive quantitative beta-hCG assays for diagnosis, nearly 40-50% of all EPs may be initially misdiagnosed (2). Therefore, several biomarkers have been investigated for early diagnosis of EP. Activin A, a dimeric glycoprotein belonging to the TGF-β superfamily, has been highlighted among these “new biomarkers” (3). Florio et al reported that serum activin A levels can be markedly lower in women with tubal EP than those levels found either during normal intrauterine pregnancy or spontaneous miscarriage (4). The authors showed that a cut-off value of 0.37 ng/mL have 100% and 99.6% of sensitivity and specificity, respectively for predicting EP. Conversely, Kirk et al demonstrated in another elegant study that activin A has much lower sensitivity and specificity when used as a single biomarker for the diagnosis of EP (5). Bearing on these considerations, it is clear that this subject still needs to be carefully evaluated and it prompted us to develop this project where we compared serum activin A levels in women at first trimester of normal pregnancy to women with tubal EP. The study group was comprised of 5 women with EP. The diagnosis criteria was based on visualization of an adnexial mass by transvaginal scan associated with positive test for β-hCG in women with a suspected EP (amenorrhea, bleeding and pain). For this study were included only those cases in which the gestational age was established between 5-6 weeks gestational age. In all patients the mass was confirmed to be a tubal EP without signs of rupture by pathologist analysis. The control group was comprised of 10 women with normal intrauterine pregnancy at 5-6 weeks gestational age confirmed by transvaginal scan (evaluated by gestational sac measurements and/or crown-rump length). This work has been approved by the Ethics Committee of The Federal University of São Paulo (UNIFESP). Informed consent was obtained from all participants before the blood samples were collected. All blood samples of patients with EP were collected before surgery by peripheral venous puncture and immediately centrifuged at 1000g for 10 minutes; the supernants were stored at -80oC until processing. For the determination of serum activin A levels a commercially available assay for ELISA was used (activin A- Catalog number: Dy338; R&D systems, Inc. Minneapolis, USA). All activin A measurements and analysis were performed in duplicate at the same time. The limit of detection of the kit was less than 0.133 ng/mL. Data were presented as mean and standard deviation. The statistical analysis was performed using Prism software (version 4.02, Graph Pad Software Inc., San Diego, CA). The two groups were compared using Mann-Whitney U test and results were considered significant when p<0.05. The mean gestational age was 5.2±0.14 for the EP group and 5.2±0.19 for the normal intrauterine pregnancy group. The mean of activin A serum levels was 0.26±0.714 ng/mL and 0.37±161.4 ng/mL for women with EP and for women with normal pregnancy, respectively (p=0.206). The Figure 1 depicts all cases studied.
Hatav Ghasemi Tehrani, Zaynab Hamoush, Mojdeh Ghasemi, Leila Hashemi,
Volume 12, Issue 4 (5-2014)

Background: Ovarian pregnancy is a rare form of the non-tubal ectopic pregnancy. It ends with rupture before the end of the first trimester. One of the important risk factors for ovarian pregnancy is in the use of Intra uterine devices (IUD).
Case:  We report here one such uncommon case of ovarian ectopic pregnancy. Our patient is a 30 years old multiparous woman with two previous cesarean sections with severe hypogastric abdominal pain. During laparotomy, ruptured ovarian ectopic pregnancy was diagnosed, and wedge resection of the ovary was only done. Histopathological examination confirmed it to be an ovarian ectopic pregnancy.
Conclusion:  IUD is one of contraceptive methods which prevents intra-uterine implantation in 99.5%, if implant occurs with IUD, it is tubal implantation in 95% of cases, and it is very rare in other places such as ovary. The most important risk factor of ovarian ectopic pregnancy is IUD as in this study it was showed
Siniša Šijanović, Domagoj Vidosavljević, Zlatko Topolovec, Andrea Milostić-Srb, Milanka Mrčela,
Volume 12, Issue 4 (5-2014)

Background: Cervical pregnancy is rare and dangerous form of ectopic pregnancy which can be treated surgically or conservatively. Methotrexate is reasonable conservative option with high efficiency and acceptable level of side effects. Aim of this paper is to present possible treatment option in case of methotrexate failure, still keeping the postulates of minimal invasive surgery.
Case:  We describe a case of cervical ectopic pregnancy in nulliparous female that was unsuccessfully treated with single dose, local, ultrasound guided intraamniotic methotrexate. Due to vaginal bleeding caused by remaining products of conception a hysteroscopic resection was performed.
Conclusion:  Despite the problems that can occur in methotrexate treatment, it is still by far, cheapest and most effective treatment of cervical pregnancies. If necessary, procedure can be combined with other minimal invasive surgical procedures leading to satisfactory results. Hysteroscopic resection has enabled us to remove the product of conception from cervix making the minimal damage to the local tissue, thus preserving fertility.
Chunjuan Shen, Defeng Shu, Xiaojie Zhao, Ying Gao,
Volume 12, Issue 6 (8-2014)

Background: Advances in embryo culture technology and cryopreservation have led to a shift in in vitro fertilization (IVF) from early fresh or frozen-thawed cleavage embryo transfer to fresh or frozen-thawed blastocyst stage transfer.
Objective: To compare the clinical outcomes of fresh embryo transfers and frozen-thawed embryo transfers.
Materials and Methods: In this retrospective case control study, patients undergoing IVF cycles from January 2012 to December 2012 were enrolled in Assisted Reproduction of Wuhan :union: Hospital were enrolled. A total of 1891 cycle contains 1150 fresh embryo transfers and 741 frozen-thawed embryo transfers were studied. All data were transferred directly to SPSS 18 and analyzed.
Results: Clinical pregnancy rates of fresh cleavage-stage embryo transfers compared with fresh blastocyst transfers, frozen-thawed cleavage-stage embryo transfers, post thaw cleavage-stage extended blastocyst culture transfers and frozen-thawed blastocyst transfers were 52.7%, 35.88%, 35.29%, 47.75%, 59.8% in patients under 35 years of ages and 41.24%, 26.92%, 11.32%, 46.15%, 55.8% in patients older than 35 years old, respectively. The multiple pregnancy rates, abortion rates and ectopic pregnancy rates did not differ significantly among the five groups.
Conclusion: The clinical pregnancy rates were not different significantly between fresh cleavage-stage embryo transfers and fresh blastocyst transfers. But the clinical pregnancy rate of frozen-thawed blastocyst transfer was the highest among fresh/frozen-thawed embryo transfers.
Tahereh Ashrafganjoei, Behzad Nemati Honar, Sara Defaee,
Volume 12, Issue 11 (12-2014)

Background: Ovarian pregnancy constitutes 0.15-3% of all ectopic pregnancies. The incidence of ectopic pregnancy is on the rise owing to evolution in assisted reproductive techniques (ART). The incidence reported following In vitro fertilization (IVF) or embryo transfer (ET) is 0.27% per clinical pregnancy.
Case: We present a case of a 13-weeks ovarian pregnancy following IVF-ET and through a review of the literature, the specific symptomatology, diagnostic criteria, and treatment of this particular pathology will be described.
Conclusion: Ovarian pregnancy is a rare condition and its diagnosis is difficult and relies on criteria based on intraoperative and histopathological findings. The management is, in spite of medical improvement, based on surgery. But the trend has shifted towards conservative surgeries in majority of cases.
Lajya Devi Goyal, Rimpy Tondon, Poonam Goel, Alka Sehgal,
Volume 12, Issue 12 (12-2014)

Background: Primary ovarian pregnancy is one of the rarest forms of ectopic pregnancy having incidence of 1/7000-1/40,000 in live births and 0.5-3% of all ectopic gestations. Intrauterine contraceptive device (IUCD), salpingitis, infertility, and assisted reproductive techniques are the important risk factors. Approximately, 75% terminate in first trimester and are often misdiagnosed as corpus luteum haemorrhage. Preoperative diagnosis by ultrasonography (USG) in early pregnancy can help in conservative medical/ surgical management.
Objective: The aim of the present study was to find the incidence, risk factors, role of USG in pre-operative diagnosis, feasibility of conservative management with medical method or minimal invasive surgery in developing countries like India.
Materials and Methods: We did a retrospective cross-sectional study of ovarian pregnancies managed at Government Medical College and Hospital Chandigarh between July 2000 to July 2010. We analyzed the incidence, risk factors, clinical presentation, management of ovarian pregnancy, and reviewed the literature.
Results: Incidence of ovarian pregnancy was 4.9% of all ectopic pregnancies (14/523). Thirteen (93%) patients presented in first trimester with acute pain abdomen and of these ten patients had bleeding per vaginum. One (7%) patient referred from peripheral hospital at term gestation with ultrasonographic diagnosis of breech presention with plecenta previa. Pre-operative diagnosis was made only in two cases (11%). All cases were managed by laparotomy. Excision of the sac with conservation of the ovary was done in eleven cases (78%) and oophorectomy was done in two cases (14%).
Conclusion: Incidence of ovarian pregnancy is on the rise. Although ultrasonography can detect ovarian gestations in unruptured cases but cannot easily differentiate ovarian from other tubal gestation in ruptured state. Medical management is usually not feasible it most of the patients present in ruptured state. Conservative surgical approach is the management of choice.
Roya Faraji Darkhaneh, Maryam Asgharnia, Nastaran Farahmand Porkar, Ali Akbar Alipoor,
Volume 13, Issue 2 (2-2015)

Background: Measurement of serum β-hCG concentration commonly used to diagnose tubal ectopic pregnancy (EP) and follow up patients treated conservatively.
Objective: The aim of this study was to determine the predictive value of maternal serum β-hCG concentration in ruptured tubal ectopic pregnancy to help physicians identify those women who are at greatest risk.
Materials and Methods: This is a cross-sectional study conducted on all women with a diagnosis of tubal ectopic pregnancy who were treated in Alzahra Hospital, in Rasht, from March 2002 to February 2011. The data was collected for each woman from medical records and included age, parity, gravidia, gestational age, primary level of serum β-hCG, rupture status, past history of pelvic inflammation disease, EP, abortion, and intrauterine contraceptive device use. Women with tubal rupture were compared to those without rupture. Statistical analysis was conducted by SPSS 19 for Windows.
Results: A total of 247 cases of tubal ectopic pregnancy were recorded during the study period. One hundred and ninety seven (79.8%) were cases with unruptured EP and 50 patients (20.2 %) were cases with ruptured EP. The mean level of β-hCG was significantly higher in patients with ruptured EP compared to patients with unruptured EP (p=0.03). Logistic regression analysis revealed that >1750 IU/ml of β-hCG levels (OR: 1.41; 95% CI: 1.18-1.68) was the significant risk factors for tubal rupture.
Conclusion: Higher β-hCG levels seem to be significant risk factors for rupture of a tubal EP.
Fariba Mirbolouk, Azadeh Yousefnezhad, Atefeh Ghanbari,
Volume 13, Issue 6 (8-2015)

Background: Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment.
Objective: The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX.
Materials and Methods: In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or “success group” are the patients who were successfully treated with MTX. The second group or “failure group” consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and ß-hCG level were compared between groups.
Results: Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (ß-hCG) and fall in ß-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial ß-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.
Conclusion: The results showed that patients who have ß-hCG levels below 1375 and the number of cases with decreasing ß-hCG level on day 4 are the good candidates for medical treatment.
Reihaneh Pirjani, Leila Bayani, Mahboobeh Shirazi,
Volume 13, Issue 7 (9-2015)

Background: Treatment of cesarean scar pregnancy (CSP) is controversial. The objective of this study was to report our successful experience in the medical treatment of CSP with potassium chloride (KCl) and methotrexate.
Case: This is a case series of six patients between 6-12 gestational weeks with the diagnosis of CSP.  In five cases the fetus was alive and in one case, despite being at a gestational age of 12 weeks based on CRL, there was no fetal heart activity. In four of these cases, an ultrasound- guided KCl injection in the heart was performed on four living fetuses and then systemic methotrexate was administered. In two other cases, methotrexate was injected into the gestational sac and subsequently the systemic methotrexate was administered. During follow-up, the patients were stable and no complications occurred. Additionally, serum beta human chorionic gonadotropin (β-hCG) was negative between five to 11 weeks later. One of the patients became pregnant one year later. Her pregnancy continued without any complication and she was delivered by cesarean section at the gestational age of 38 weeks. During caesarean section, it was noticed that the appearance of previous cesarean scar was normal and there was no scar.
Conclusion: Based on our experience, the combination of systemic Methotrexate with local Methotrexate or KCl is feasible and can be performed as an outpatient procedure and is successful in the treatment of CSP.
Mahsomeh Hajishafiha, Zahra Shahbazi, Abdolghader Pakniyat, Sima Oshnouei, Nazila Kiarang,
Volume 13, Issue 7 (9-2015)

Background: Gonadotropin-releasing hormone agonists or antagonists are used in assisted reproductive technique cycles as premature luteinizing hormone secretion inhibition. Studies have been reported different and contradictory results on the serum progesterone effect on intra-cytoplasmic sperm injection.
Objective: The purpose of this study was to evaluate the effect of serum progesterone level on the day of Human chorionic gonadotropin (HCG) administration on the intra-cytoplasmic sperm injection (ICSI) outcome in infertile women.
Materials and Methods: 249 infertile couples candidated for ICSI were enrolled in the study. Their serum progesterone level on the day of HCG administration was measured and according to serum level, patients were divided into four groups of less than 0.9, 0.9-1.4, 1.5-1.9, and ≥2 ng/mL. The four groups were compared with each other regarding fertility outcomes.
Results: Pregnancy rate was not significantly different among the four groups (p>0.05). Also, there was no significant difference among the groups regarding frequency of abortion and ectopic pregnancy.
Conclusion: Serum progesterone level on the day of HCG administration does not have any significant effect on pregnancy outcomes, including abortion, ectopic pregnancy, and pregnancy rate in patients undergoing ICSI treatment.

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