Pregnancy rate following one cycle of IVF and ET can be as high as 60%. But even in the very successful units, some couples fail repeatedly. The causes for repeated implantation failure (RIF) may be because of reduced endometrial receptivity, embryonic defects or multifactorial causes. Various uterine pathologies, such as thin endometrium, altered expression of adhesive molecules and immunological factors, may decrease endometrial receptivity, whereas genetic abnormalities of the male or female, sperm defects, embryonic aneuploidy or zona hardening are among the embryonic reasons for failure of implantation. Endometriosis and hydrosalpinges may adversely influence both. In this mini review, we discuss the suggested methods for evaluation and treatment of RIF: repeated hysteroscopy, myomectomy, endometrial stimulation, immunotherapy, preimplantation genetic screening (PGS), assisted hatching, zygote intra-Fallopian transfer (ZIFT), co-culture, blastocyst transfer, cytoplasmic transfer, tailoring stimulation protocols and salpingectomy for hydrosalpinges.

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Women with PCO have higher serum AMH levels during COH than controls. Hyperandrogenism is associated with an additional increase in AMH. It is conceivable that hyperandrogenism may reflect more severe disruption of folliculogenesis in women with PCO or may affect AMH secretion.

Case reportA 37 year old woman presented in her fourth pregnancy eight weeks of gestation with recurrent episodes of vaginal bleeding for seven days. Her first delivery was by a lower segment transverse caesarean section at 33 weeks of gestation due to pre-eclampsia. Her second and third pregnancies ended by a normal vaginal delivery. On admission her pulse and blood pressure were normal. Pelvic examination revealed moderate bleeding from the cervical canal; the cervix was long and closed. The size of the uterus was consistent with her dates. Transvaginal ultrasound demonstrated a live fetus with a crown-rump length of 19 mm equivalent to her menstrual dates. The gestational sac was 25 mm diameter which was located in the anterior wall of the uterus, just above the internal 0s. Only 4 mm thickness separated the sac from the urinary bladder, and the sac was located between two normal segments of the anterior uterine wall (Fig. 1). Based upon the ultrasound findings, a diagnosis of pregnancy in a very thin uterine scar was made. Following discussion, it was decided to terminate her pregnancy with methotrexate.A single dose of 80 mg (50 mg/m2) intramuscular methotrexate was given. Daily ultrasonography revealed loss of fetal heart beats three days following the injection. No adverse side effects were observed. Three days after the injection, the plasma level of the p subunit of human chorionic gonadotropin (p hCG) was 12,100 mIU/mL; it decreased to 1270, 107 and 20 mIU/mL after two, four and eight weeks, respectively.Despite the declining values of plasma p hCG levels, the patient had prolonged mild vaginal bloody discharge. Ultrasonography showed the same gestational sac containing amorphous tissue debris. Nine weeks after the methotrexate injection 10 ml of straw-like fluid was aspirated from the gestational sac by a transvaginal ultrasound guided needle, without any complications. Three months later transvaginal ultrasound showed complete disappearance of the gestational sac and normal uterine anatomy. Eight months after the

Objective. 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. Methods. The outcome of 179 pregnancies in a group of women with FMF taking colchicine was compared with the outcome of 197 pregnancies in women with FMF who did not take colchicine during pregnancy and with 312 pregnancies in another cohort of healthy pregnant women of similar age and ethnicity.Results. There was no difference in the 3 groups regarding early abortions, late abortions, or congenital malformations. There was a mild trend towards a better outcome for the colchicine-treated group but these results did not reach statistical significance. Conclusion. Treatment with colchicine during pregnancy in patients with FMF is beneficial in controlling the disease while not affecting the outcome of the pregnancy; therefore there is no justification for recommending amniocentesis in women taking colchicine solely because of this treatment.