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To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. Retrospective cohort analysis. Tertiary university-affiliated medical center. Four-hundred one women who were diagnosed with ectopic pregnancy and were treated with MTX. Forty-one women with ruptured ectopic pregnancy (study group) and 300 women with non-ruptured ectopic pregnancy (control group). Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment. Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1-25). β-hCG percentage change in the 48 hours preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04–1.12, p < 0.001 for every percent change in β-hCG; OR = 1.001, 95% CI = 1.0003–1.002 for every unit change in β-hCG, respectively). In a decision tree analysis model, in women with β-hCG percentage increment >69% in the 48 hours preceding methotrexate the probability for tubal rupture was 85%. Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low. [ABSTRACT FROM AUTHOR]

To estimate the impact of Asherman's Syndrome (AS) following hysteroscopic adhesiolysis on short term reproductive outcomes and the time to achieve pregnancy in infertile patients during IVF cycles. Retrospective cohort study. Tertiary university affiliated medical center. Fifty-one infertile patients who were treated for Asherman's syndrome (AS) and underwent IVF cycles (study group). Patients were matched with controls in a 1:1 ratio, according to their age and etiology of infertility (control group). The collected date was obtained from medical records and telephonic survey. There was no difference in the mean number of embryo transfer per patient between the two groups (4.9 ±4.6 vs. 6.22 ±4.3, p=0.78). The mean endometrial thickness before embryo transfer was significantly higher among women in the control group (8.7 ±1.8 vs. 6.95±1.7, respectively, p=0.001). Women with AS had significantly lower cumulative live birth rate and significantly higher miscarriage rate as compared to women in the control group (23.5% vs 56.8, p=0.001 and 41% vs. 15.6%, p=0.008 accordingly). The mean endometrial thickness was significantly higher among women with AS who had live birth (8.2 (±1.4) 6.9 (±1.2), p=0.001). The Overall time to conception was significantly longer among with AS (407.962 ±74.7 Vs 785.6 AS has an impact on the reproductive potential in infertile patients following hysteroscopic adhesiolysis. Endometrial thickness was shown to be an important predictor for live birth among women with AS that utilizing IVF. [ABSTRACT FROM AUTHOR]

Identifying risk factors for recurrent ovarian torsion and evaluation of the efficacy of ovarian fixation techniques. Retrospective cohort study. Tertiary-care medical center. Seventy-nine women with recurrent ovarian torsion (study group) were matched with 158 women with a single episode of ovarian torsion (control) during the same year of their first episode. Demographic data, clinical and surgical characteristics were retrieved between the years 2001-2020. In order to identify risk factors for recurrent ovarian torsion, the first episode of ovarian torsion in the study group was compared to the only episode of the control group. A second analysis was performed between women with ovarian fixation (success and failure). Women with recurrent torsion were significantly younger and the percentage of premenarchal women was significantly higher (25.6±8.6 vs. 30.6±7.1, P<0.001, and 10% vs. 0.6%, P<0.001, respectively). Fertility treatment and pregnancy were significantly more common in the control group (37.7% vs. 23.6%, P=0.03, and 36.4% vs. 20.7%, P=0.01, respectively). Ovarian pathology was significantly more common in the control group (89.0% vs. 38.1%, P<0.001), whereas the number of ovarian twists was significantly higher in the recurrent torsion group (2.6±0.01 vs. 2.0±0.1, P=0.04). Ovarian fixation was performed in 63 women (79.7%) of the study group with an overall success rate of 71%. Long duration of pain before admission was associated with ovarian fixation failure (37.5±6.3 hours vs. 11.7±6.0, P=0.003). Ovarian fixation during pregnancy was shown to be safe with low failure rate (6% vs. 36%, P=0.03). None of the fixation procedures was shown to be superior to the others in terms of success. Recurrent ovarian torsion is more common in young premenarchal women. Ovarian fixation is a safe procedure with a 70% success rate. We found no advantage in one fixation techniques over the others. [ABSTRACT FROM AUTHOR]