It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Background: Hysteroscopy has revolutionized the field of Gynecology and the management of many gynecological conditions. It has now become a standard part in the diagnosis of postmenopausal bleeding by the gynecological surgeons. Cost, convenience, accuracy, and patient acceptability of these procedures are clearly superior to those of traditional surgeries. As gynecologists have grown better acquainted with the benefits and techniques of operative hysteroscopy, it has become the method of choice for treatment of intrauterine pathology. Cervical ripening is a complicated process, being mediated by cytokines, growth factors, hormones and other biochemical compounds. Both dinoglandin and Misoprostol can be used for cervical ripening before introduction of hysteroscopy and hence reduce the incidence of complications. Objects: This study aims to assess the efficacy of dinoprostone compared to misoprostol in cervical ripening in nulliparous women undergoing diagnostic hysteroscopy. Methodology: a randomized controlled clinical trial comparing dinoprostone versus misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women, it included 2 groups, 33 patients each. In the first group named (group D) dinoprostone 3 mg was applied vaginally 6 hours before diagnostic hysteroscopic procedure while in the second group named (group M) 400 mcg misoprostol was applied vaginally at the same timing. Results: There was no statistically significant difference between the groups that received misoprostol or dinoprostone with regard to age, duration of marriage, medical disorder, history of gynecological operations and type of gynecological operations. However, the use of misoprostol caused slightly less pain compared to dinoprostone but more side effects occurred with the use of misoprostol. Conclusion: There was no significant difference between dinoprostone and misoprostol in priming of cervix before diagnostic hysteroscopy in nulliparous women regarding ease of hysteroscope entry, pain or side effects.

Background PCOS, the commonest endocrinalogical disorder affecting women of age group between 18 and 44 years. PCOS compromises fertility through various pathways as hyperandrogenism, insulin resistance and impedance of the uterine and endometrial blood flow. Metformin improves the blood flow to the endometrium through reducing androgen level and correction of insulin resistance. The commonest parameters used to detect the endometrial receptivity outcome are endometrial vascular indices. Aim of the Work to evaluate the outcome of metformin administration in anovualtory PCO patients and its effect on the endometrium, including its role in ovulation and improvement of pregnancy rates. Patients and Methods this study included 85 patients from Ain Shams University outpatient gynecology and infertility clinic during the period from January 2018 till June 2018. These patients were investigated before treatment with ultrasound on day 14, 21 to evaluate the endometrial receptivity parameters such as endometrial thickness, uterine artery vascularity, endometrial and subendometrial vascularity. The patients received metformin 500mg three times per day for three months. After this duration they were reevaluated by ultrasound at days 14, 21 to detect any improvement. Results metformin therapy resulted in a significant increase of endometrial thickness and had a significant effect on uterine RI and PI. On the endometrial level, the endometrial and subendometrial R.I and P.I were significantly reduced after metformin treatment indicating better blood flow. Conclusion Metformin therapy improves endometrial vascularity, in addition to increasing endometrial thickness and improved impedance observed in uterine artery flow.

BackgroundThe aim of this study was to evaluate the association of Chlamydia trachomatis (CT) infection with primary tubal and high-grade serous ovarian cancers.MethodsThis is a cross-sectional, retrospective study conducted at Ain Shams University Maternity Hospital, Egypt, from February 2008 to October 2017. Sixty-seven paraffin archival blocks specimens were retrieved from cases who underwent staging laparotomy due to high-grade serous ovarian cancer (30 cases), primary tubal serous cancer (25 cases), and control specimens of (12) tubal specimens from cases of benign gynecological conditions. All samples were examined for CT DNA using semiquantitative qRT-PCR.ResultsCT DNA was detected in 84% of high-grade tubal serous cancer, 16.7% of high-grade serous ovarian cancer, and 13.3% in controls (P<0.0005). Mean CT DNA relative quantity was significantly high (256) in tubal carcinoma, in comparison to that in high-grade serous ovarian cancer and controls (13.5 and 0.28, respectively; P<0.0005).ConclusionTo the best of our knowledge, this is the first report on relation of CT to the tubal serous cancer, so the responsibility of CT tubal infection in the pathogenesis of primary tubal cancer needs to be considered.

Background: Polycystic ovarian syndrome (PCOS) is considered the commonest endocrinological disorder affecting reproductive aged women. PCOS compromises fertility through various pathways. These pathways include hyperandrogenism, insulin resistance and impedance of the uterine and endometrial blood flow. Metformin improves the blood flow to the endometrium. It acts by reducing androgen level and correction of insulin resistance. Endometrial vascular indices were evaluated in this study to evaluate endometrial receptivity in anovulatory patients with PCOS. Aim of the Work: To evaluate the outcome of metformin administration in anovulatory patients with PCOS and its effect on the endometrium. This included its role in ovulation and improvement of pregnancy rates. Patients and Methods: This study included 85 patients from Ain Shams University outpatient infertility clinics from 1 st of January, 2018 till 30 th of June, 2018. We investigated these patients before treatment with ultrasound on day 14, 21. We evaluated endometrial thickness, uterine artery flow pattern, endometrial and subendometrial flow patterns. The patients received metformin 500 mg three times per day for three months. After this duration, we reevaluated them by ultrasound at days 14, 21. Results: Metformin therapy resulted in a significant increase of endometrial thickness and had a significant decrease on uterine, endometrial and subendometrial resistance index (R.I) and pulsatility index (P.I) at day 14, 21 compared to pre-treatment values indicating better blood flow. Conclusion: Metformin therapy resulted in improvement of endometrial flow patterns. Also, it resulted in increase in endometrial thickness and improvement of uterine artery flow.