O.S. Abdalmageed

A randomized clinical trial of the efficacy of single versus double-daily dose of oral iron for prevention of iron deficiency anemia in women with twin gestations

Abstract Objective: The study aims to assess the efficacy of single versus double-daily oral iron dose on prevention of iron deficiency anemia in women with twin gestations. Materials and methods: A randomized controlled trial (NCT02858505) conducted at Womans Health Hospital, Assiut, Egypt, between August 2015 and June 2016 included 120 non-anemic pregnant women with twin gestations in the first trimester. Women were randomly assigned to either group I (27 mg elemental iron) or group II (54 mg elemental iron) daily starting from 12 weeks of pregnancy till 36 weeks. The primary outcomes included the mean level of hemoglobin, hematocrit and serum ferritin at 36 weeks’ gestation. Results: Both iron doses maintained the mean hemoglobin and hematocrit within the normal level from 12 weeks to 36 weeks (p = 0.378 and p = 0.244, respectively). However, the mean serum ferritin level was higher in group II than group I (p = 0.000) at 36 weeks’ gestation. Moreover, women in group II reported more side effects than group I at 36 weeks’ gestation. Conclusions: Doubling the prophylactic iron dose is comparable to single dose in the prevention of iron deficiency anemia among women with twin gestations with more side effects.

Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Controlled Trial:

Objectives: To evaluate the impact of metformin on in vitro fertilization (IVF) outcomes in overweight and obese women with polycystic ovary syndrome (PCOS). Methods: This was a randomized double-blind placebo-controlled study (ClinicalTrials.gov: NCT 02910817) carried out in a University IVF Center. The study included 102 overweight and obese women (body mass index [BMI] >24 kg/m2) with PCOS who underwent their first fresh autologous IVF-embryo transfer cycle and agreed to participate in the study. The study participants were randomized into 2 groups: metformin group received metformin (1000 mg per day) at the start of controlled ovarian stimulation (COH) until the day of the pregnancy check, and placebo group received placebo tablets in the same duration. The primary outcome measure was the total number of retrieved oocytes. Results: Both groups were homogenous in baseline demographic characteristics. Metformin group versus the placebo group demonstrated decrease in the mean number of the retrieved oocytes (9.06 ± 4.23 vs 16.86 ± 8.3, P < .01) and similar live birth rate (LBR; 25.5% vs 17.6%, P = .34). The number of fertilized oocytes was lower in the metformin group (5.65 ± 2.66 vs 9 ± 4.55, P < .01). However, the fertilization rate was similar in both groups (62.3% vs 53.4%, P = .10). There was no difference in the implantation rate (15.7% vs 11.8%, P = .32), multiple pregnancy rate (13.4% vs 3.9%, P = .08), or miscarriage rate (23.5% vs 35.7%, P = .46). No cases of ovarian hyperstimulation syndrome (OHSS) were observed in both groups. Conclusion: Short-term administration of metformin to overweight or obese women with PCOS undergoing IVF decreased number of the retrieved oocytes but did not improve the LBR. Synopsis Metformin use could decrease the number of retrieved oocytes in overweight and obese women with polycystic ovary syndrome undergoing IVF.

Prevalence of prior reproductive surgery among women scheduled for IVF

OBJECTIVE: Optimization of the function and anatomy of reproductive organs either by medications or surgery is the main target of many clinicians prior to IVF in order to get favorable cycle outcomes. Our objective was to evaluate the prevalence of reproductive surgery in women scheduled for IVF, and to correlate the baseline characteristics of these women to the probability of undergoing a reproductive surgery. DESIGN: Prospective cross-sectional cohort. MATERIALS AND METHODS: Through one-year cross sectional survey, infertile women scheduled for IVF were categorized into 3 groups based on their history of prior reproductive surgery. Group 1 comprised women who did not undergo any reproductive surgery before; group 2 included women with history of one reproductive surgery; while group 3 included subjects with history of 2 or more surgeries. The 3 groups were compared as regards their baseline demographic and clinical characteristics. Statistical methods used for comparisons included t-test, Chi-square test, Wilcoxon rank sum test and logistic regression. RESULTS: 244 women accepted to participate in the study; 76% of them (n1⁄4185) reported prior reproductive surgery.Women in group 3 (n1⁄459) were more likely to have a longer duration of infertility (Mean SD; 5.8 3 vs. 5.2 3.2 vs. 4.5 3; p1⁄40.009), and comprised more women with endometriosis (50.8% vs. 21.45% vs. 1%; p1⁄40.000) and tubal block (22% vs. 11.1% vs. 3.4%; p1⁄40.000), when compared to groups 2 and 1 respectively. The total number of surgical procedures in the whole cohort was 238 surgical procedures. Out of them; 29.4%, 18.9%, and 16.4% were procedures for endometriosis, uterine procedures, and diagnostic laparoscopies, respectively. In stepwise multivariate regression analysis, after adjustment of other variables; longer duration of infertility (aOR 1⁄4 1.2, 95% CI1⁄41.04-1.3, P1⁄40.007), having moderate endometriosis (aOR1⁄4 12.1, 95% CI1⁄45.6-26.4, P1⁄40.000), and having tubal disease (aOR 1⁄4 6.7, 95% CI1⁄42.7-16.6, P1⁄40.000) were significantly associated with likelihood of an IVF woman to have 2 surgical reproductive procedures through her infertility treatment. CONCLUSIONS: Reproductive surgeries are common among IVF women presenting a sort of financial burden. Women with endometriosis have substantial probability of undergoing a high order reproductive surgery.