Objective: To determine the effect of fresh IVF/ICSI cycles on FET cycle embryo and pregnancy outcomes.Methods: This retrospective cohort study included data from the medical records of 104 FET cycles performed from January 2014 to December 2016. Embryos were previously vitrified and then thawed for embryo transfer. Statistical significance was established at p<0.05. The main endpoints were FET cycle survival and pregnancy rates.Results: A total of 104 FET cycles were analyzed for survival; 94 showed good progression and 84 achieved embryo transfers. Patients with secondary infertility achieved significantly higher pregnancy rates -6/38 (15.8%) vs. 18/46 (39.1%) (p<0.018). Stimulation with FSH/LH resulted in more significant embryo progression, 38/48 (79.2%) vs. 28/46 (60.9%) in the FSH group (p=0.01). Patients who got pregnant from fresh cycles had the highest pregnancy rates in FET cycles (p<0.0001). Lower numbers of frozen embryos correlated with higher pregnancy rates (p=0.048). Embryos frozen on day 2 or 3 had the most significant progression (p<0.0001). Freeze-thaw intervals >12 months yielded higher pregnancy rates, 13/30 (43%), vs. 11/54 (20.4%) (p=0.025). Conclusion:Patient pregnancy in fresh cycles is a good prognostic factor for FET cycle success. Delaying FET by more than 12 months might result in higher pregnancy rates.

The early diagnosis of ectopic pregnancy is essential in determining the appropriate therapeutic approach. This study demonstrates the important factors considered in the prediction of a successful medical treatment, which will, in turn, improve the quality of patient counseling and guidance prior to the initiation of the treatment. MethodsThis was a retrospective cohort study of 58 ectopic pregnancies that were treated medically with methotrexate in Bahrain Defense Force (BDF) Hospital from January 2016 to January 2021. All patients that were offered medical treatment of ectopic pregnancy and completed the follow-up were included in the study. StatsDirect software was used to analyze the baseline characteristics of the successful and failed medical treatment of ectopic groups. Simple linear regression was used to correlate initial beta-human chorionic gonadotropin (β-hCG) levels and the drop of β-hCG levels after one week of medical treatment. ResultsPatients were divided into two outcomes: the primary outcome represented in the successful treatment group, 68.9% (40/58), and the secondary outcome represented in the unsuccessful treatment group 31% (18/58). The mean β-hCG level in the successful group was significantly lower than that of the unsuccessful treatment group (1403.6±1421 IU/L versus 2845.1±1705 IU/L, p=0.001). There were no differences between the two groups with regards to the size of the adnexal mass, presence of gestational sac, or size of the gestational sac. The cut-off value of the initial β-hCG level for successful medical treatment was 2,141 IU/L, with 72% sensitivity, 75% specificity, and receiver operator curve (ROC) of 0.76 [95% confidence interval (CI) = 0.63 to 0.89)]. The cut-off value of β-hCG fell between day four and day seven and was 37.2%, with 78% sensitivity, 68% specificity, and a ROC curve of 0.72 (95% CI = 0.55 to 0.89). ConclusionThis study found that low initial β-hCG levels can be used to predict successful methotrexate treatment of ectopic pregnancy. In this cohort of patients, the cut-off level of initial β-hCG for successful treatment was 2141 IU/L.

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Objectives:To compare follicular reduction prior to human chorionic gonadotropin (HCG) trigger and coasting in terms of ovarian hyper-stimulation syndrome (OHSS) reduction, pregnancy, and cancellation rates in in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles.Methods:This study was designed as a prospective study. The setting was the IVF unit at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. A total of 39 patients undergoing IVF/ICSI cycles, who were at risk of OHSS, 20 were put into a coasting group and 19 had follicular reduction instead. This occurred between October 2010 and January 2011. Our main outcome was OHSS reduction.Results:Six (30%) women developed OHSS in the coasting group and 2 (10.5%) women developed OHSS in the follicular group (p-value=0.235). The pregnancy rates in the cycles were similar for both groups: 4/20 (20%) in the coasting group and 3/19 (15.8%) in the follicular group (p-value=1.000). The cancellation rate of the cycles was similar for both groups, 6/20 (30%) in the coasting group and 1/19 (5.3%) in the follicular group (p-value=0.09). The median number of punctured follicles was significantly lower in the follicular group (16 follicles, interquartile range (IQR)=21-12) compared to the coasting group (29 follicles, IQR=37.8-19.8, p-value=0.001). The retrieved, fertilized, and cleaved oocytes, as well as the number of embryos transferred, were similar amongst both groups.Conclusion:There was no difference between follicular reduction prior to HCG and coasting, in terms of OHSS reduction, pregnancy, and cancellation rates in both the IVF and ICSI cycles.

Background: Uterine leiomyomas are the most common uterine neoplasm; their symptoms could be related to the size and position. They could affect patients' capability to conceive and/or to continue the pregnancy. Ultrasound is the main diagnostic tool. However, accurate assessment might be affected by fibroid characteristics. Objective: To evaluate the relationship between fibroid size, presenting symptoms, previous obstetric history and accurate ultrasound fibroid assessment preoperatively in patients who had abdominal myomectomy. Design: A retrospective data analysis. Setting: University of Dammam Teaching Hospital. Method: All patients who had abdominal myomectomy between 1 December 2007 and 30 November 2012 were reviewed. Personal characteristics, obstetric history, indication for the myomectomy and myoma preoperative and intraoperative features were reviewed. Result: One hundred thirty-seven procedures were performed during the study period. The mean age of the patients was 36 years, 81 (59.1%) were married and 112 (82%) were Saudi nationals. Menorrhagia was the leading presentation in 66 (48.2%) patients, followed by pain in 26 (19%), mass in 16 (12%), sub-fertility in 14 (10.2%) and pressure symptoms in 9 (7%) patients. However, 6 (4.4%) had combined presentations. The median of the two largest diameter myoma was 7 cm and the weight was 320 gm. However, fibroid size had a significant effect on the presenting symptoms. Previous parity was not affected by the size of the fibroid. The size of the fibroid on ultrasound had no effect on the accuracy of the assessment.

Myomectomy as an organ-preserving procedure has become an established alternative to hysterectomy 1-3. An increasing number of women in their fourth to fifth decade request conservative surgery to preserve their reproductive potential 2,3. New advances in assisted reproductive techniques permit women in later reproductive years to bear a child if the uterus is still intact. Submucous and intramural myoma decreases fertility and its removal is beneficial and necessary when the myoma is

Syphilis in pregnancy is a worrisome topic due to its fetal consequences. The diagnosis and management of such a case might be intriguing when overlapped with Behçet’s disease, an inflammatory disease involving multiple organ systems. This case presents a 35-year-old pregnant female, a known case of Behçet’s disease and hypothyroidism, presenting at 33 weeks to the emergency department at Bahrain Defense Force (BDF) hospital with vaginal leaking and a solitary oral ulcer. As per the guidelines of the ministry of health, she underwent perinatal screening and was found to be positive for the venereal disease research laboratory (VDRL) test and was diagnosed with latent syphilis. The diagnosis of latent syphilis in a known case of Behçet’s disease presenting with a solitary oral ulcer is unpredictable. The importance of perinatal screening is emphasized in this case report.