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Khairy M.,Birmingham Womens Hospital Foundation Trust | Dhillon R.K.,Foundation Medicine | Chu J.,Foundation Medicine | Rajkhowa M.,Birmingham Womens Hospital Foundation Trust | Coomarasamy A.,Foundation Medicine
Reproductive BioMedicine Online | Year: 2016

Sub-endometrial junctional zone peristalsis is increased by ovarian stimulation and traumatic embryo transfer, and is linked with decreased implantation and pregnancy rates in assisted reproduction treatments. Various agents have been used to inhibit uterine hyper-peristalsis at the time of embryo transfer with conflicting results. This systematic review aimed to identify if uterine relaxants administered in the peri-implantation period during assisted reproduction treatments could improve pregnancy outcomes through literature search with no language restrictions. The review reports on 3546 patients in 17 randomized controlled trials published between 1993 and 2014. Women undergoing assisted reproduction techniques who either received a uterine relaxant agent in the peri-implantation period versus placebo or no treatment were included. Primary outcome was live birth rate. The meta-analyses did not show statistically significant benefit of any uterine relaxing agents on live birth rate. Other meta-analyses did not show a significant effect on the clinical pregnancy, spontaneous abortion, ectopic pregnancy and multiple pregnancy rate. Most of the included studies were of low quality and lacked significant power to detect minimally important effect. Evidence is insufficient to recommend using these agents in routine practice. Further methodologically robust randomized controlled trials with more refined selection criteria might reveal a beneficial effect. © 2016 Reproductive Healthcare Ltd.

Dhillon R.K.,Birmingham Womens Hospital Foundation Trust | Smith P.P.,Birmingham Womens Hospital Foundation Trust | Malhas R.,Birmingham Womens Hospital Foundation Trust | Harb H.M.,Birmingham Womens Hospital Foundation Trust | And 5 more authors.
Reproductive BioMedicine Online | Year: 2015

Success rates for IVF among women from different ethnic groups have been inconclusive. In this study, the relationship between ethnicity and IVF outcome was investigated. Results of a cohort study analysing 13,473 first cycles were compared with the results of meta-analysed data from 16 published studies. Adjustment was made for age, body-mass index, cause of infertility, duration of infertility, previous live birth, previous spontaneous abortion and number of embryos transferred. Black and South Asian women were found to have lower live birth rates compared with White women: Black versus White (OR 0.42 [0.25 to 0.70]; P = 0.001); South Asian versus White (OR 0.80 [0.65t o 0.99]; P = 0.04). Black women had significantly lower clinical pregnancy rates compared with White women (OR 0.41 [0.25 to 9 0.67]; P < 0.001). The meta-analysed results also showed that Black and South Asian women had statistically significant reduced odds of live birth (OR 0.62 [0.55 to 0.71); P < 0.001 and OR 0.66 [0.52 to 0.85); P = 0.001, respectively). Black and South Asian women seem to have the poorest outcome, which is not explained by the commonly known confounders. Future research needs to investigate the possible explanations for this difference and improve IVF outcome for all women. © 2015 Reproductive Healthcare Ltd.

Quadri A.M.,Birmingham Womens Hospital Foundation Trust | Ganesan R.,Birmingham Womens Hospital Foundation Trust | Hock Y.L.,Walsall Hospitals NHS Trust | Karim S.N.,NHS England | Hirschowitz L.,Birmingham Womens Hospital Foundation Trust
International Journal of Surgical Pathology | Year: 2011

This study reports 3 unusual cases of malignant transformation in mature cystic teratoma of the ovary (dermoid cyst), namely carcinosarcoma, atypical choroid plexus papilloma, and papillary thyroid carcinoma, the last case involving both ovaries and with peritoneal dissemination. Adequate sampling is essential in such ovarian tumors to establish their teratomatous origin and avoid an erroneous diagnosis of primary ovarian or metastatic tumors. The authors present the clinicopathological findings in these 3 cases with a review of literature. © SAGE Publications 2011.

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