RESUMEN
OBJECTIVE: To evaluate the plasma creatine phosphokinase (CPK) level after injection of methotrexate (MTX) as a predictor of treatment success in ectopic pregnancy (EP). MATERIALS AND METHODS: One hundred women treated with single dose of methotrexate for ectopic pregnancy were evaluated in a prospective study, for CPK and ß-subunit of human chorionic gonadotropin (ß-hCG) levels. They received intramuscular MTX at a dose of 50 mg/m2. The day of injection was considered as day 1 (D1). CPK level on the day of Methotrexate injection was compared between success group who were treated by a single MTX injection, and the unsuccessful groupwho were treated by two or three MTX injections or by surgery. RESULTS: The success rate of single dose of MTX injection was 78 (78%). The mean of CPK was higher in success group than unsuccessful group. (86 ± 10.7 vs. 73 ± 11.8), the difference was significant (p = 0.04). The mean of ß-hCG was significantly lower in treatment success group than unsuccessful group (1421.3 ± 443.6 vs. 1925.6 ± 185.4, p = 0.01). CONCLUSION: The success of single dose of MTX treatment in ectopic pregnancy may be predicted by CPK levels and the higher levels of CPK may be useful for detecting of patients with successful response to MTX.
RESUMEN
BACKGROUND: Recurrent implantation failure (RIF) is the absence of implantation after three consecutive In Vitro Fertilization (IVF) cycles with transferring at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under 40 years. The definition and management of RIF is under constant scrutiny. OBJECTIVE: To investigate the effects of Granulocyte colony stimulating factor (G-CSF) on RIF, pregnancy rate, abortion rate and implantation rates. MATERIALS AND METHODS: A double blind placebo controlled randomized trial was conducted at two tertiary university based hospitals. One hundred patients with the history of RIF from December 2011 until January 2014 were recruited in the study. G-CSF 300µg/1ml was administered at the day of oocyte puncture or day of progesterone administration of FET cycle. Forty patients were recruited at G-CSF group, 40 in saline and 20 in placebo group. RESULTS: The mean age for whole study group was 35.3±4.2 yrs (G-CSF 35.5±4.32, saline 35.3±3.98, placebo 35.4±4.01, respectively). Seventeen patients had a positive pregnancy test after embryo transfer [10 (25%) in G-CSF; 5 (12.5%) in saline; and 2 (10%) in placebo group]. The mean of abortion rates was 17.6% (3), two of them in G-CSF, one in saline group. The implantation rate was 12.3% in G-CSF, 6.1% in saline and 4.7% in placebo group. CONCLUSION: G-CSF may increase chemical pregnancy and implantation rate in patients with recurrent implantation failure but clinical pregnancy rate and abortion rate was unaffected.