Avraham Ben-Chetrit

Maternal serum creatine kinase: a possible predictor of tubal pregnancy.

Tubal pregnancy remains a clinical challenge in spite of improvements in diagnostic tests and procedures. In a prospective study we evaluated the role of the serum creatine kinase as a possible marker for tubal pregnancy. Three groups of 17 patients each were included in the study: group A, documented tubal pregnancy; group B, spontaneous abortion; and group C, normal pregnancy. Serum was tested for creatine kinase in all of the patients. Creatine kinase level was > 45 IU/L in all patients with tubal pregnancy, significantly higher than the level in patients in either of the two other groups (p < 0.0001). We conclude that a high serum creatine kinase level can be an important diagnostic test in the evaluation of a suspected tubal pregnancy.

Familial Mediterranean fever and menstruation

Objective To study the prevalence, the nature and the genotype correlation of menstruation associated familial Mediterranean fever attacks.

Pregnancy outcomes in women with Familial Mediterranean Fever receiving colchicine: Is amniocentesis justified?

To evaluate the outcome of pregnancies in women with familial Mediterranean fever (FMF) who are taking colchicine, and to reconsider the justification for amniocentesis in these women.

Ultrasonographic endometrial changes after intrauterine insemination: a comparison of two catheters.

OBJECTIVEnTo determine and compare the transvaginal ultrasonographic (US) endometrial changes immediately after IUI using the Edwards Wallace (H.G. Wallace, Limited, Colchester, Essex, UK) and Tom-Cat (Sherwood Medical, St. Louis, MO) catheters.nnnDESIGNnProspective study.nnnSETTINGnIVF unit.nnnPATIENT(S) AND INTERVENTION(S)nEighty-two infertile patients underwent 112 cycles of ovulation induction with IUI. Either the Edwards Wallace catheter (group 1, n = 32) or the Tom-Cat catheter (group 2, n = 80) was used for sperm insemination. The presence of an endometrial three-layer pattern before IUI was a prerequisite for inclusion in the study. After each IUI, the endometrium was reassessed by transvaginal US.nnnMAIN OUTCOME MEASURE(S)nUltrasonographic endometrial changes, clinical pregnancy rates (PRs), complications, and patients complaints were compared between the two groups.nnnRESULT(S)nTotal destruction of the endometrial three-layer pattern was observed in 12.5% of the cycles in group 1, compared with 50% of the cycles in group 2. Clinical pregnancies occurred in 14 (12.5%) of the 112 IUI cycles. A higher PR was achieved when the endometrial three-layer pattern was preserved after IUI. The patients in group 2 had more complaints of bleeding and pain during the procedure.nnnCONCLUSION(S)nUltrasonographic changes after IUI suggest that the Edwards Wallace catheter is significantly less traumatic to the endometrium than the Tom-Cat catheter. Although both catheters yielded the same overall PR, there was a trend indicating that sparing the endometrial three-layer pattern from damage increases the chance of conception.

Does estrogen directly modulate anti-müllerian hormone secretion in women?

OBJECTIVEnTo investigate whether estrogen may modulate anti-müllerian hormone (AMH) expression in women.nnnDESIGNnProspective analysis.nnnSETTINGnFertility clinic of tertiary university hospital.nnnPATIENT(S)nCycling infertile women.nnnINTERVENTION(S)nBlood samples were taken at the early, middle, and late follicular phase in five groups: spontaneous cycle (n=10), ovulation induction with clomiphene-citrate (n=15) or gonadotropins (n=9), controlled ovarian hyperstimulation for IVF (COH-IVF; n=10) and in women who were treated with exogenous E2 for frozen-thawed embryo-transfer (FET) with no follicular development (n=20).nnnMAIN OUTCOME MEASURE(S)nAMH and E2 serum levels.nnnRESULT(S)nBasal serum AMH and E2 levels were similar in all groups. AMH levels were stable in all women during the follicular phase except for significant reduction in the COH-IVF group. In women in the FET group with high E2 levels, comparable to the COH-IVF group, AMH levels remained stable.nnnCONCLUSION(S)nIn women, estrogen does not appear to have a direct role in AMH regulation.

Transfer of embryos from yeast-colonized dishes

OBJECTIVEnTo report yeast colonization in IVF dishes, where ET was carried out, and the IVF outcome was not compromised.nnnDESIGNnRetrospective study of patients who underwent IVF cycle during the last 4 years.nnnSETTINGnIn vitro fertilization program at the Shaare-Zedek hospital in Jerusalem.nnnPATIENTSnFive couples who underwent standard IVF cycles and whose dishes were colonized with yeast. After thorough discussion ET was carried out.nnnRESULTSnAlthough colonized with yeast, the quality of the embryos was not compromised. One to three of these embryos were transferred. All five women conceived.nnnCONCLUSIONSnIn vitro fertilization outcome is not necessarily compromised by yeast colonization. Nevertheless, the possible teratogenic effect of yeast on embryos has not been investigated and research is required to address this concern.

Successful conservative management of primary nonmetastatic cervical choriocarcinoma

Primary cervical choriocarcinoma is a rare disease; since 1915 only about 60 cases have been published. The case presented here can be defined as primary cervical choriocarcinoma since it fulfills all the criteria delineated previously.