BackgroundUterine receptivity and implantation are complex processes requiring coordinated expression of molecules by zygote and uterus. Our objective was to evaluate the role of the endometrial expression of leukemia inhibitory factor (LIF) and its glycoprotein 130 (gp130) receptor molecules and their secretion in uterine flushing during the window of implantation in cases of primary unexplained infertilityCase presentationThe study was conducted on 25 infertile women with unexplained infertility for at least two years and 10 normal fertile women as a control group . Endometrial tissue and uterine flushing were obtained. Each tissue specimen was divided into two pieces; one piece was used for histological dating of the endometrium and for immunostaining of progesterone receptors, and the second was used for RNA extraction and PCR assay of LIF and gp130 mRNA expression. Serum estrogen and progesterone were measured for all subjects. LIF mRNA was expressed in the endometrium of all normal fertile women but significantly decreased in infertile women. LIF was not detectable in 88% of infertile women while it was fairly detectable in 12% of them. Gp130 mRNA was hardly detectable in both fertile and infertile women with no difference between them. Infertile women secreted significantly less LIF and gp130 molecules in the uterine flushing compared with normal fertile women.ConclusionsExpression of LIF mRNA in endometrium could be used as a molecular marker of unexplained infertility. Assessment of secreted LIF and gp130 molecules in uterine flushing could be another useful and safe method for predicting successful implantation as well as for diagnosing and eventually treating women with impaired fertility using recombinant human LIF.

Background:Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia.Methods:One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded.Results:There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group.Conclusion:Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

Background: In the current study, it was hypothesized that adding low dose atracurium to Local Anesthetic (LA) mixture would provide an early onset of akinesia and favorable surgical condition in percaruncular peribulbar anesthesia for high myopes undergoing phacoemulsification.Methods: 91 ASA-PS I-III high myopes scheduled for phacoemulsification were enrolled in this randomized controlled trial. The enrolled patients were randomly allocated to one of two groups. Group C (n=46) received 2.5ml of lidocaine 2%, 2.5ml of bupivacaine 0.5% with hyaluronidase 15IU/ml and 1ml normal saline, while patients in Group A (n=45) received the same mixture with 5mg atracurium. The onset of globe and eyelid akinesia and duration of akinesia were recorded. The need for supplementation, total LA volume and surgeons' satisfaction were recorded.Results: Eighty-two patients were analyzed with 41 patient in each group. The onset of globe akinesia was earlier in Group A than Group C [4 (2-9), 4 (4-15) min. respectively, p<0.001]. Furthermore, fewer patients in Group A required supplementation compared to Group C, 27% versus 62% respectively, p=0.002. The onset of eyelid akinesia, duration of akinesia and the total volume of LA were comparative between the 2 groups. Conclusion:Adding 5mg atracurium to LA solution reduced the time to onset of globe akinesia and the need for supplementation in the percaruncular block in myopic patients with no effect on duration of akinesia or quality of analgesia.