AIM:This study aims to determine the accuracy of saline infusion sonohysterography (SIS) in the diagnosis of intrauterine pathologies in women with recurrent implantation failure (RIF).SETTINGS AND DESIGN:This is a prospective cross-over study which was carried out during the period between December 2013 and July 2014.MATERIALS AND METHODS:The study involved sixty subfertile women with a history of RIF. All cases underwent a transvaginal ultrasonography, SIS and then an office hysteroscopy (1 day after SIS) during early follicular phase. SIS was carried out by same sonographer, and then hysteroscopy was carried out by same gynecologist who was kept blind to findings at SIS.STATISTICAL ANALYSIS:Was done using IBM© SPSS© Statistics version 22. The sensitivity of SIS was calculated as it equals: True positive by SIS/all positive (true cases by hysteroscopy) and specificity was calculated as it equals: True negative by SIS/all negatives (normal by hysteroscopy).RESULTS:Overall uterine abnormalities were significantly less likely to be identified with SIS compared to hysteroscopy (P = 0.002), but analysis of each finding separately demonstrated a comparable difference between SIS and hysteroscopy (P > 0.05). We found that the sensitivity, specificity, positive predictive value, and negative predictive value of SIS to detect intrauterine pathology is 41.2%, 100%, 100%, and 81.1%, respectively.CONCLUSION:Our findings suggest a good role of SIS in the workup for RIF saving more invasive procedure for selected cases.

Objectives: To evaluate the prevalence of insulin resistance in polycystic ovary syndrome (PCOS) women and to compare the findings (clinical and laboratory) of PCOS in insulin resistance (IR) to non-IR PCOS women. Patients and methods:Fifty PCOS women included in this cross sectional comparative study. Studied women underwent complete physical examination with calculation of BMI, assessment of hirsutism and measurement of blood pressure. Hormonal and lipid profiles of the studied PCOS women also evaluated. Fasting glucose/insulin (G/I) ratio calculated and a ratio < 4.5 was predictive of IR in PCOS women above 18 years old. Studied PCOS women divided into two groups according to presence or absence of IR to evaluate the prevalence of IR in PCOS Egyptian women and to compare the findings (clinical and laboratory) of PCOS in IR to non-IR PCOS women.Results: IR (G/I ratio <4.5) detected in 46% (23/50) of studied PCOS women. BMI was significantly high in IR compared to non-IR PCOS women (32.6 ± 6.0 Kg/m 2 versus 29.5 ± 4.0) and the hirsutism (Ferriman Gallway score >8) was significantly more common in IR compared to non-IR PCOS women (20 (86.95%) versus 5 (18.5%)). There was no significant difference between IR and non-IR PCOS studied women regarding; mean age, blood pressure, age of menarche, menstrual regularity, acne and baldness. In addition, there was no significant difference between the IR women and non-IR PCOS studied women regarding; ultrasound ovarian findings, hormonal and lipid profiles. Conclusion:The prevalence of IR in PCOS Egyptian women is about 46%, BMI was significantly high in IR compared to non-IR PCOS women and the hirsutism was significantly more common in IR compared to non-IR PCOS women.

Objectives: This study designed to detect the prevalence of ovarian and/or adrenal hyperandrogenism in women with Polycystic Ovary Syndrome (PCOS). Materials:One hundred PCOS women included in this cross sectional study after informed consent and approval of the study by local institute ethical committee. Diagnosis of PCOS based on the Rotterdam ESHRE criteria. Studied women underwent complete physical examination with calculation of body mass index (BMI) and assessment of hirsutism by modified Ferriman Gallway score. Clotted blood sample taken from studied women for measurement of serum total testosterone, sex hormone binding globulin (SHBG) and dehydroepiandrosterone sulfate (DHEAS) to detect the prevalence of ovarian and/or adrenal hyperandrogenism in PCOS women.Results: 66% of studied PCOS women presented with hirsutism, 22% of studied PCOS women presented with menstrual irregularities (hypomenorrhea, oligomenorrhea) and dysmenorrhea was the presenting symptom in 12%. Free testosterone was elevated in 50 cases of studied women; DHEAS was elevated in 30 cases of studied women while the remaining 20 cases had elevated both free testosterone and DHEAS. Mean free testosterone was 2.6±1.8 pg/ml and mean DHEAS was 5.5±3.8 mg/l. Conclusion:The ovary is the main source of excess androgen in PCOS (50% of studied women) and excess adrenal androgen found in 30% of studied PCOS women, further large studies recommended to confirm this finding.

Background: polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with a prevalence of 6-10% in the general population. PCOS is characterized by the following: ovulatory dysfunction resulting in oligo-amenorrhea and/or anovulation, hyperandrogenism and/or hirsutism and the presence of polycystic ovarian morphology by ultrasound. Vitamin D also plays a physiologic role in reproduction including ovarian follicular development and luteinization via altering anti-Müllerian hormone (AMH), signaling, follicle-stimulating hormone sensitivity and progesterone production in human granulosa cells. Aim of the Work: this study aimed to compare levels of vitamin D in women with PCOS and healthy fertile women. Patient and Methods: this case control study was conducted in Ain Shams Maternity hospital in outpatient infertility clinics and family planning clinic during the period from March 2017 to October 2017. It was included 40 women diagnosed with PCOS based on Rotterdam criteria and 40 fertile women without PCOS who were recruited from family planning clinic. Results: 25(OH) vitamin-D level was significantly lower in PCOS group than in the control group. Conclusion: 25(OH) vitamin-D was significantly lower in PCOS group than in the control group, but not sufficient to be a diagnostic tool for PCOS. Recommendation: larger studies are still needed to clarify the rule of vitamin D in infertility.