Objective To assess the efficacy of misoprostol as an adjunct for easy cervical dilatation before operative office hysteroscopy under local anaesthesia. Design Randomized, placebo‐controlled clinical trial. Setting Tertiary centre for treatment of infertility. Subjects Patients undergoing hysteroscopy, for simultaneous diagnostic and operative indications such as uterine septae, synechiae, submucous myomas, endometrial polyps and lost intrauterine devices, were included into the study Intervention 43 cases were randomized to misoprostol (n=22) and placebo (n=21) groups. The drug was administered vaginally 4 h before hysteroscopy. Hysteroscopy was performed under local anaesthesia in an examination room as an office procedure. Main outcome measures Rapid and easy dilatation, decreased pain, decreased incidence of cervical haemorrhage, laceration and uterine perforation. Results In the misoprostol group, a 7‐mm hysteroscopic sheath passed easily without dilatation in 20 (91%) cases while it passed easily without dilatation in six (28%) of the placebo group (P<0.001). The average dilatation time for groups was 1.6 and 2.8 minutes respectively (P<0.05). Mean dilatation pain scores for the misoprostol and placebo groups were 5.1 and 9.3, respectively (P<0.05). Cervical bleeding was noted in two cases in the misoprostol group and laceration of the cervix was noted in three cases. In the placebo group there were eight cases each of both bleeding and laceration. Conclusion Application of misoprostol does provide a safe, painless and effective means of cervical dilatation by chemical, rather than mechanical forces, and reduces complications such as cervical bleeding, laceration and uterine perforation.

T he aim of this study was to make a conclusion about aplicability of two differnet gonadothropins in COS (rFSH versus HP-hMG). The primary conclusion for the success as a result of COS are the mean number of retrived oocytes, mature oocytes, fertilization rate, mean number of quality embrios, and criopreverzed embrios. The secondary conclusions were clinical pregnancy rate and delivery rates. Methods: The study was a retrospective case-control study,. A total of 1238 fresh, non donor, IVF cycles with COS were analyzed, but to minimize the bias, only the first cycle for each patient below 40 yaears old, in that period was analyzed. This selection composed the group of respondents that was analyzed which in total amounted to 760 patients.(rFSH = 422, HP-hMG = 338). The patients underwent COS by long luteal protocol using two differnt inducers of COS (rFSH and HP-hMG). Results: The average starting dose of rFSH used was significantely lower (152.7±41.1IU), whereas with HMG it was (228.8±68.7 IU, p=000000). The average number of IU gonadothropin used in therapy, statistically highly is significantly lower when r-FSH is used as an inducer. (1639.2 ± 476.9 IU, rFSH vs 2356.4 ± 955.1IU, HP-hMG, p <0.001). We received significantly higher average number of oocytes and mature oocytes in the group of r-FSH (oocytes; rFSH v HP-hMG-11.8 ± 7.1 v 10.7 ± 6.5, p = 0.028 ; mature oocytes: rFSH v HP-hMG 9.9 ± 6.2 v8.7 ± 5.5 p = 0.009). However, we did not find a significant difference in the use of the COS inductors regarding the clinical pregnancy rate (rFSH v HP-hMG 49.5% vs 48.9% p=0.92) and delivery rate (rFSH vs HP-hMG 42.9% vs 43.4% p=0.96). Conclusions: Our study showed that rFSH is more powerful and more applicable in individualized dosing then HP-hMG and brings better results from COS (more oocytes, more matured oocytes). Key words: Controled ovarian stimulation (KOS), rekominant folikulostimulative hormon (rFSH), high purity human menopausal gonadothropin (HP-hMG), intracitoplasmic sperm injection (ICSI), retrived oocytes.

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Objective To determine the incidence of recurrent ectopic pregnancies in four groups of patients with different conservative or radical operative techniques via laparoscopy or laparotomy. Design Retrospective analysis. Setting Tertiary centre for reproductive medicine Subjects 56 patients who were operated upon and followed up for at least 2 years were included in the study. Interventions The operations performed included linear salpingotomy (n = 21) and salpingectomy (n = 9) via laparoscopy, and linear salpingotomy with tubal reconstruction (n = 9) and salpingectomy with segmental resection (n = 23) at laparotomy. Results Recurrent ectopic pregnancy was found in 19% (4/21) of the laparoscopic salpingotomy group (P < 0.05). No recurrence was seen in the laparoscopic salpingectomy group. Recurrence was found in one case (11%) (p < 0.05) after salpingotomy with tubal reconstruction, and in one case (4.3%) of salpingectomy at laparotomy. Conclusion Conservative surgery for unruptured tubal pregnancy either via laparoscopy or laparotomy carries increased risk for repeated ectopic pregnancy.

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