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ObjectiveTo determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology.MethodsThis randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group).ResultsThe demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating hormone units required was 2,350.43±150.76 IU in group I and 2,366.25±140.34 IU in group II, which was not a significant difference (p=0.548). The duration of stimulation, number of retrieved oocytes, and number of developed embryos were not significantly different between the groups. The clinical and ongoing pregnancy rates likewise did not significantly differ. The cost of intracytoplasmic sperm injection per cycle was significantly lower in group I than in group II (US $494.66±4.079 vs. US $649.677±43.637).ConclusionReduction of the cetrorelix dose in the antagonist protocol was not associated with any significant difference either in the number of oocytes retrieved or in the pregnancy rate. Moreover, it was more economically feasible for patients in a low-resource country.

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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 118showed 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.

Objective: To compare the effect of prophylactic cervical cerclage with vaginal progesterone in triplet (with normal cervical measurements) to evaluate its efficacy in improving pregnancy outcome and prolonging gestation. Design: A randomized prospective comparative study. Setting: At Tanta university hospitals and outpatient clinics. Patients: 51 selected cases of triplet pregnancy were recruited and classified into 2 groups randomly, progesterone group (n = 28 cases) and cerclage group (n = 23 cases). Interventions: Transvaginal ultrasound was done for number of fetuses, viability, cervical measurements, vaginal progesterone for progesterone starting at 20 weeks, and applying McDonald cerclage at 14 -16 weeks for cerclage group. Main Outcome Measures: Time of occurrence of preterm labor, premature rupture of membranes (PROM), stitch removal, gestational age at delivery, mode of delivery, and neonatal complications. Results: Preterm labor occurred in 9, 8 cases and PROM in 4, and 3 cases in progesterone and cerclage groups respectively. The mean gestational age was 33.57 ± 2.97 and 31.74 ± 3.21 weeks in progesterone and cerclage groups; mean birth weight was 2049 ± 591 gm, and 1686 ± 512 gm in progesterone and cerclage groups respectively; Apgar score 7 or more was found in 52 (60.8%), and 39 (56.3%) newborn in progesterone and cerclage group respectively. Perinatal mortality was lower in progesterone group 26.1% (3 IUFD+19 neonatal) than in cerclage group 30.4% (2 IUFD + 19 neonatal). Respiratory distress syndrome (RDS) occurred in 43.9%, 49.76%, while need of mechanical ventilation occurred in 12.2%, 16.41% of progesterone and cerclage groups respectively and neonatal jaundice was found in 49.38%, 53.7% of progesterone and cerclage groups respectively. Conclusion: Vaginal progesterone seems to be more effective than prophylactic cerclage in reducing preterm delivery in triplet pregnancies with normal cervical measurements even in those with prior history of preterm labour and minimizing neonatal morbidity and mortality.

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 enrolled and randomly distributed into 3 groups. Each group included 20 patients. 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 im-

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