This study investigated the potential effect of adrenomedullin (ADM) on metabolic and endocrinal dysfunctions in experimentally induced polycystic ovary. Twenty‐four female Wistar rats were allocated into three groups: control; polycystic ovary syndrome (PCOS) in which PCOS was induced by letrozole, orally in a dose of 1 mg/kg once daily for 3 weeks; and ADM group in which ADM was injected intraperitonally in a dose of 3.5/μg/twice daily for 4 weeks. At the end of the experimental period, the serum sex hormone profile, ADM, fasting glucose, insulin, homeostatic model assessment of insulin resistance, and lipid parameters were determined. Ovarian tissue homogenates were used to determine malondialdehyde, total antioxidant capacity, glutathione peroxidase activity, tumor necrosis factor α, interleukin 6, B cell lymphoma‐2 (Bcl‐2), and Bcl‐2 associated X protein. The profibrotic growth factors, including transforming growth factor β1 and connective tissue growth factor, were determined; and also, the relative gene expression of endoplasmic reticulum (ER) stress, including (Xbox‐binding protein‐1 [XBP‐1], activating transcription factor 6 [ATF6], and homologous protein [CHOP]), serine/threonine kinase 1 (Akt1), phosphatidylinositol 3‐kinase (PI3K), and peroxisome proliferator‐activated receptor γ (PPAR‐γ) were determined. Finally, histopathological analysis of the ovaries was evaluated. PCOS group exhibited increased ER stress, suppressing of PI3K/Akt1 and PPAR‐γ pathways, imbalance of sex hormonal profile, hyperglycemia, insulin resistance, dyslipidemia, increased profibrotic factors, and abnormal ovarian histopathological picture, while ADM treatment alleviated these disturbances occurring in the PCOS model. We concluded that ADM mitigated PCOS via attenuating the ER stress, in addition to activation of PI3K/Akt1 and PPAR‐γ pathways, its antioxidant, anti‐inflammatory, antiapoptotic, and antifibrotic properties.

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Obesity is linked to reproductive disorders. Novel neuropeptide phoenixin demonstrated many therapeutic actions. In this study, we aim to evaluate phoenixin’s potential effect in obesity-induced infertility through modulating mitochondrial dynamics. Ninety adult female rats were divided to 4 groups: (I), fed with normal pellet diet; (II), given phoenixin; (III), fed with high-fat diet. Rats that developed obesity and infertility were divided to 2 groups: (III-A), received no further treatment; (III-B), given phoenixin. Our results showed that phoenixin treatment in obese infertile rats significantly decreased serum levels of insulin and testosterone and ovarian levels of dynamin-related protein1(Drp1),reactive oxygen species ROS, TNF-α, MDA, and caspase-3. Phoenixin treatment also significantly increased serum estrogen progesterone, LH, and FSH together with ovarian levels of GnRH receptor (GnRHR), mitofusin2(Mfn2), mitochondrial transmembrane potential (ΔΨm), and electron transport chain (ETC) complex-I significantly when compared with obese group. Ovarian histopathological changes were similarly improved by phoenixin. Our data demonstrate phoenixin’s role in improving obesity-induced infertility. Graphical abstract

ObjectiveThe current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation.MethodsA randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term ≥37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups.ResultsFour hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (P=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, P=0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (P=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (P=0.045).ConclusionCervical dilatation during elective CS is associated with thick scars with low incidence of scar defects.

Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages as the female is under anesthesia so no extra manipulation needed, decrease pain, and also the female at the period of delivery had high motive for family planning. Post placental IUD insertion also had many disengages like bleeding and displacement. Material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to May 31 2019. Two groups of patients were selected; each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion during cesarean section and group II was subjected to interval IUD insertion (3 months after cesarean delivery). The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients' satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 12 months was 13.72% in study group compared to 16.66% in the control group. The satisfaction rates in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 1.96% in study group and 4.17% in control group with p value = 0.949. Conclusion: Post-placental IUD insertion is found to be safe, easily applied during cesarean section with slight prolongation of cesarean section duration. Post-placental IUD insertion

Background: Polycystic ovary syndrome affects 7 to 8% of women and may be the most common cause of female infertility. Anovulation, early pregnancy loss has all been implicated in the low fecundity. The aim of this study was to compare between the use of clomiphene citrate by stair-step protocol and use of combined clomiphene citrate and gonadotropins in patients with polycystic ovary syndrome. Methods: This randomized non blinded controlled clinical study was carried out on 60 Patients who was selected from outpatient clinic of Tanta university hospitals from September 2019 to September 2020. Selected patients were allocated into two groups with 1:1 ratio. Group (A): was subjected to clomiphene citrate stair-step stimulation protocol. Group (B): was subjected to combined clomiphene and gonadotropins stimulation protocol. Results: Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Age, BMI and duration of infertility). Significance defined by p < 0.05. Chi-square analysis was used for the categorical variable (number of MGF). Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Size of larger follicle and Endometrial thickness), Chi-square analysis was used for the categorical variables (Ovulation rate and Pregnancy rate). Mann-Whitney U test was used to compare quantitative data which are not normally distributed (FSH and LH). Student t test was used for the quantitative data which are normally distributed (Prolactin and TSH). Conclusions: In conclusion, the CC stair‐step protocol is a safe, simple option for the management of PCOS patients, having a larger number of mature Grafian follicle, lower endometrial thickness and higher ovulation rate compared to combined clomophine and gonadotrophin protocol.

Background: Vitamin D3 (VD3), a seco-steroid that is synthesized in skin and sequentially metabolized in liver and kidneys in humans, has been well-known for its function in maintaining calcium and phosphorus homeostasis and promoting bone mineralization. Polycystic ovary syndrome (PCOS) is a common cause of ovarian dysfunction in women with anovulation. Aim of this study is to show and evaluate VD3 level in women who are suffering from polycystic ovarian syndrome.Methods: This study was conducted on 200 women; group A: (study group) 100 infertile women who were suffering from PCOS and group B: (control group) 100 patients were selected with other cause of infertility than PCOS. US examination, hormonal profile (FSH, LH, AMH, TSH and prolactin level) and laboratory assay of serum VD3 level (postmenstrual) were done for every patient to evaluate relationship between VD3 deficiency and PCOS patients.Results: There was a significant relationship between group A compared to group B as regards irregular menstrual cycle, clinical hyperandrogenism, LH/FSH ratio and AMH. There was no significant difference between both groups as regards TSH, prolactin and VD3 level. VD was deficient in both groups as it was lower than normal level. There was a negative significant correlation between VD3 level and both hyperandrogenism and AMH.Conclusions: There was VD3 deficiency in PCO patients and infertile cases due to another factor, and negative significant correlation between VD3 level and clinical hyperandrogenism, LH/FSH ratio, menstrual cycle and AMH.

Background: Placenta accrete occurs when there is abnormal attachment of the placenta to the uterine wall either partially or totally. Placenta accreta had many complications mainly intraoperative and postpartum including injury to local organs (e.g. bowel, bladder, ureters) and neurovascular structures in the retroperitoneum. The aim of the present study was to evaluate the uterine cavity after conservative management of placenta accreta by using hysteroscope. Materials and Methods: This is prospective study was carried on 40 pregnant at Tanta University Hospital with age >35 years, to detect Presence or absence of intra uterine changes after conservative management of placenta accrete by hysteroscopy, easiness of performing diagnostic hysteroscopy and Correlation between intrauterine changes and operative data. Results: Hysteroscopic examination of the participants showed that 30.0% with incidences of Cervical stenosis, 15.0% with uterine cavity irregularity, 15.0% with intrauterine adhesions, 10.0% with endometrial fibrosis, 5.0% with scar dehiscence and 5.0% with Remnant. There was a statistically significant positive correlation between development of cervical stenosis and endometrial thickness by US (correlation coefficient r = 0.323 with p value 0.042) .There was a statistically significant negative correlation between Endometrial fibrosis and scar thickness (correlation coefficient r = -0.538 with p value <0.001). There was a statistically significant negative correlation between Intra uterine adhesions and scar thickness (correlation coefficient r = -0.470 with p value 0.002). There was a statistically significant negative correlation between uterine cavity irregularity and duration of CS  (correlation coefficient r = -0.320 with p value 0.044). Conclusion: The frequency of abnormal hysteroscopic findings after conservative management of placenta accreta is high, for at least several months after the procedure. The most frequently found abnormalities, associated with conservative treatment, are cervical stenosis, uterine cavity irregularity and Intrauterine adhesions.