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Introduction: Choriocarcinoma (CC) is a rare malignant tumor of trophoblastic tissue. This tends to invade rapidly to the vasculature and metastasis to the lung, vagina, brain, and liver. CC can present with a variety of manifestations, such as hemoptysis, gastrointestinal (GI) bleeding, and abnormal uterine bleeding. Commonly, the latent period to the development of CC is not more than 1 year after the antecedent molar or normal pregnancy. In this report, the patient developed CC about 32 months after her previous known pregnancy. We reported a rare case of gestational CC that occurred about 32 months after her antecedent pregnancy. Case Presentation: A 21-year-old admitted in shock with abnormal uterine bleeding, pain, and lower abdominal pain. The patient had one previous cesarean section 32 months prior to admission. The vaginal examination demonstrated a fused solid cervical mass with an irregular border measuring about 7 x 7 cm. In further workup, there was evidence of a 103 x 94 x 89 mmmass with the hemorrhagic area and central necrosis in the middle and lower segments of the uterus and cervix. The patient underwent a total abdominal hysterectomy and left side salpingo-oophorectomy. The diagnosis of CC was made after microscopic examination. Conclusions: There are few case reports of choriocarcinoma with more than a year latent period after antecedent pregnancy. The strongest hypothesis is having asymptomatic pregnancy during the period between the last pregnancy and the development of CC. However, the possibility of non-gestational choriocarcinoma in such cases should be considered. Treatment with a single- or multiple-agent chemotherapy regimen should be immediately initiated after diagnosis in these cases. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the effect of piroxicam adjuvant therapy on the clinical and biochemical pregnancy rate in patients undergoing in vitro fertilization (IVF) and frozen–thawed embryo transfer (ET) cycles. Methods: In a randomized, double‐blinded, placebo‐controlled clinical trial, 178 patients eligible for IVF‐ET received either single dose of piroxicam 1–2 h before frozen–thawed ET or a placebo at the same time. Study participants were then followed and compared regarding the primary outcome of the study, which was biochemical (positive β‐human chorionic gonadotrophin test) and clinical pregnancy (detected fetal heart beat in ultrasound) rate. Results: The results of this study indicated that there is no significant association between the piroxicam administration before frozen–thawed ET and the clinical or biochemical pregnancy rate (P = 0.208 and P = 0.699, respectively). Conclusion: The findings of the current study suggest that piroxicam administration before ET has no beneficial effects on pregnancy rate among women undergoing IVF and frozen–thawed ET. However, further studies with larger sample sizes and longer follow‐ups are recommended. [ABSTRACT FROM AUTHOR]

Small cell carcinoma of the ovary is an aggressive malignant tumor with no standard treatment. Despite surgery, chemotherapy and radiation, this tumor has a poor prognosis with rapid progression. The authors report a case of small cell carcinoma of the ovary in a 37-year-old woman who presented twice with an acute abdomen and unstable hemodynamics which led to two urgent laparatomies. The patient died two months after her diagnosis of small cell carcinoma of the ovary and one course of chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy. Objective: Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered. Materials and Methods: In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and beta-human chorionic gonadotropin (β-hCG) that suitably discriminated between double-dose methotrexate and surgery management. Results: The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass >34.50 mm in diameter or with an initial β-hCG level >6419 mIU/ml. The β-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the double-dose protocol. Conclusion: Surgery is proposed as the best option for the cases with large ectopic mass or high β-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the double-dose protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results. [ABSTRACT FROM AUTHOR]

Background: The endometrial preparation with stimulating natural cycles for frozen embryo transfer (FET) have benefits like lower cost and ease of use. Objective: Comparing the clinical outcome of letrozole versus hormone replacement (HR) for endometrial preparation in women with normal menstrual cycles for FET in artificial reproduction techniques. Materials and Methods: A total of 167 participants who had frozen embryos and regular ovulatory cycles were randomly divided into two groups for endometrial preparation. One group (82 women) was stimulated with letrozole 5mg/day and the other group (85 women) was hormonally stimulated by oral estradiol valerate (2 mg three times a day). All participants were followed serially by ultrasonography. Any patient who did not reach optimal endometrial thickness was excluded from the study. Implantation, biochemical and clinical pregnancy and abortion rate were reported. Results: There was no significant difference in the mean age, duration, and primary or secondary infertility, cause of the infertility, number, and quality of transferred embryos between the groups. The mean estradiol level on the day of transfer was 643 ± 217 in the HR group and 547 ± 212 in the letrozole group (P = 0.01), which was significantly different. The clinical pregnancy rate was 38.7 in the letrozole group, higher than the HR group (25.3) but not significantly different (P = 0.06). Conclusion: For endometrial preparation in women with a normal cycle, letrozole yields higher pregnancy rate although it is not significant; due to its cost, ease in use, and lower side effects, letrozole is a good choice. [ABSTRACT FROM AUTHOR]

Resistant ovary syndrome (ROS) is a presentation of hypergonadotrophic hypogonadism condition with very low incidence. Infertility is one of the most common complaints of women with this syndrome. We herein present a case of a 27-year-old woman with all features of secondary amenorrhea and secondary sexual characteristics. In 2018, the patient was referred to the Hazret-e-Zeinab Infertility Center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. She was diagnosed with secondary amenorrhea and increased gonadotropin secretion after menopause. However, the patient had a normal antral follicle count, anti-Müllerian hormone level, 46, XX karyotype, and thyroid function. After taking oral contraceptives her menstruation started, but she showed no response to high doses of exogenous gonadotropins. She was advised to have an embryo derived from in vitro maturation. By using patients' own oocyte maturation, this technique could be a better treatment for infertile women with ROS. This case report is particularly interesting due to the rarity of its prevalence and similarity with primary ovarian insufficiency. [ABSTRACT FROM AUTHOR]

Diminished ovarian reserve (DOR) significantly decreases the success rate of the assisted reproductive technique (ART). In this study, we assessed the effect of melatonin on the ART outcomes in women with DOR. A double-blinded, randomized, clinical trial was performed on 80 women with DOR as a pilot study in Shiraz, between 2014 and 2015. DOR was defined as the presence of 2 of the following 3 criteria: 1) anti-Müllerian hormone =1, 2) follicle-stimulating hormone =10, and 3) bilateral antral follicle count =6. The women received 3 mg/d melatonin or a placebo since the fifth day of one cycle prior to gonadotropin stimulation and continued the treatment up to the time of ovum pickup. The ART outcomes were compared between the groups using SPSS software. Finally, there were 32 women in the case and 34 in the placebo groups. The mean age and basal ovarian reserve test were the same between the groups. The serum estradiol level on the triggering day was significantly higher in the case group (P=0.005). The mean number of MII oocytes was higher in the case group, but the difference did not reach statistical significance. Number of the patients who had mature MII oocytes (P=0.014), top-quality embryos with grade 1 (P=0.049), and embryos with grades 1 and 2 (P=0.014) was higher among the women who received melatonin. However, the other ART outcomes were not different between the groups. The serum estradiol level was higher and more women with DOR had good-quality oocytes and embryos after receiving melatonin; however, no other outcome was different between the case and control groups. Trial Registration Number: IRCT2014041417264N1 [ABSTRACT FROM AUTHOR]

Objective: Reproductive medicine needs to find some ways to predict pregnancy outcomes and implantation, which are non-invasive and accurate. Immunologic factors and interleukins are good choices reported in the literature. The purpose of this study was to evaluate whether or not HCG administration can modulate interleukin 1β as a successful pregnancy predictor., Methods: This is a prospective cross-sectional study involving women with regular menstrual cycles who had frozen their embryos. They prepared their endometria with letrozole and human chorionic gonadotropin (HCG). Their interleukin 1β serum levels were checked on the day of HCG administration and embryo transfer. Its value assesses pregnancy outcome., Results: We had 44 women with mean age of 32.2±5.4, and clinical pregnancy rate of 31.8%, mean interleukin 1β before and after HCG injection in women who did not achieve pregnancy was 15.82±6.68pg/ml before HCG injection and 18.38±13.76pg/ml on the embryo-transfer day. It was high, but not significant (p value=0.210). In those participants who had clinical pregnancy before HCG injection, the mean interleukin 1β level was 17.29±7.00pg/ml and 29.72±10.41pg/ml on the day of embryo transfer, with significant changes (p value=0.001)., Conclusion: HCG did increase the mean level of interleukin 1β, but it was not significant. High interleukin 1β level is a significant predictor of successful pregnancy in IVF cycles.