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To assess the feasibility of laparoscopic-guided local injection of etoposide or methotrexate (MTX) in the management of unruptured tubal pregnancy and compare the effectiveness of the two regimens.Retrospective cohort study.Medical center.Thirty-one women with laparoscopically diagnosed unruptured tubal pregnancy.A regimen of etoposide 50 mg via laparoscopic-guided local injection (n = 17) compared with a conventional MTX 50 mg regimen (n = 11), after 3 patients were excluded (2 refusals and 1 with salpingostomy).Serial serum β-hCG levels and the success rate in both groups.General characteristics of the patients were similar in both groups. The overall success rate was 96.4% (27 of 28). The duration between treatment and nadir of serum β-hCG level (5 mIU/mL) was significantly shorter in the etoposide group than in the MTX group (19.7 ± 13.0 days vs. 33.4 ± 8.1 days). No patient in the etoposide group and only 1 in the MTX group needed reintervention, which led to 100% and 91% success rates for the etoposide and MTX groups, respectively. Three women in the etoposide group had subsequently successful term deliveries.Both regimens-etoposide 50 mg and MTX 50 mg via laparoscopic-guided local injection-were acceptable in the management of women with unruptured tubal pregnancy because of their similar and high success rates. More studies are needed to confirm this observation.

Objective To present a case of cesarean scar ectopic pregnancy (CSEP) successfully diagnosed and treated with a laparoscopic local injection of 100 mg etoposide under transvaginal ultrasound assistance. Design Case report. Setting University-affiliated teaching hospital. Patient(s) A 37-year-old woman with CSEP. Intervention(s) Local injection of 100 mg etoposide. Main Outcome Measure(s) Serial serum levels of β-hCG and return of normal menstruation. Result(s) Serial serum β-hCG levels were 572.2 mIU/mL before operation, 340.7 mIU/mL on the first postoperative day, 28.1 mIU/mL on postoperative day 9, and 5 mIU/mL on postoperative day 17. Menstruation was initiated on postoperative day 45. Conclusion(s) Use of laparoscopic local injection of 100 mg etoposide with transvaginal ultrasound guidance might be an effective method for the management of CSEP.

OBJECTIVE: In human IVF, many studies have shown that embryos cultured in lower oxygen tension (5% O2) have higher pregnancy rate, when compared with normaxic condition (20% O2). However the beneficial effect of low oxygen tension in embryogenesis remains unclear. This study aimed to investigate the expression of oxygen and antioxidant genes in mouse embryo cultured under hypoxic and normaxic conditions. DESIGN: A control study of animal experiment in a university hospital. MATERIALS AND METHODS: The 2-cell ICR mouse embryos were cultured to blastocyst stage under 3% O2 tension (N1⁄4186) and 20% O2 tension (N1⁄4189), respectively. The blastocysts were collected from each experiment. The expression of oxygen-related genes (HIF-1a and HIF-2a) and antioxidant genes (MnSOD and PRDX5) were analyzed by real-time RT PCR. Protein levels were validated by Immunofluorescence analysis. The apoptosis and mitochondrial membrane potential (mtMP) were assessed by TUNEL and JC-1 stain, respectively. Student‘s t test or one-way ANOVA test was used to evaluate statistical significance. RESULTS: The blastocyst formation and hatching rate (Mean SE) increased significantly in 3% O2 group when compared to 20% O2 group (90.5 3.3% vs. 77.8 2.4% and 82.9 6.9% vs. 70.7 2.3%, respectively, P

antagonists on the day of hCG effect the pregnancy and live birth rate during GnRH-antagonist protocol. DESIGN: A retrospective observational study. MATERIALS ANDMETHODS: A total of 209 eligible IVF cycles in 188 women who underwent gonadotropin-releasing hormone (GnRH) antagonist protocols were evaluated retrospectively. The patients were divided into two groups according to the administration of the GnRH antagonists until the day of hCG (GroupA, 135 cycles) or abandoning on the day of hCG (Group B, 74 cycles). The differences between Group A and Group B were tested by Student’s t test or MannWhitney U test. Pearson Chi-square test was applied for categorical comparisons. RESULTS: No differences were found in peak serum estradiol levels, serum progesterone levels, endometrial thickness on the day of hCG, number of oocytes retrieved and number of mature (MII) oocytes among the groups. Total doses of gonadotropins used was less in Group B (1945.1 942.9 IU) than Group A (2551.8 1432.8 IU) (p 0.05) whereas no significant differences were found regarding cancellation rates between the groups (10%,12%;p>0.05). CONCLUSION: During a flexible multiple-dose GnRH antagonist protocol, abandoning of the GnRH antagonist on the day of hCG administration does not compromise IVF results in terms of clinical pregnancy and live birth rates.