Recurrent pregnancy loss (RPL) is classically defined as the occurrence of three or more consecutive losses of clinically recognized pregnancies prior to the 20th week of gestation. The etiologies of RPL are: genetics, anatomic, immunologic, microbiologic, thrombophilic, endocrine, iatrogenic and environmental factors. The minimum diagnostic workup of couples with RPL consists of a complete medical, surgical, genetics, and family history and a physical examination, karyotype (both parents), ovarian reserve test, sonohysterography or HSG, lupus anticoagulant and anticardiolipin antibody, TSH, and evaluation of thrombophilias. The treatment of RPL consists of counseling, thrombopriphylaxis (heparin and aspirin), IVF/PGD, surrogacy, surgical interventions, and reassurance. It is important to remember that most women with RPL have a good prognosis for eventually having a successful pregnancy, even when a definitive diagnosis is not made and no treatment is initiated.

Recurrent implantation failure (RIF) has many definitions, but usually authors consider RIF, the failure to achieve a pregnancy fallowing 2-6 IVF cycles in which more than 10 high grade embryos were transferred to the uterus. There are a lot of causes for RIF but two main causes of that are related to embryo and endometrium.Chromosomal abnormalities, zona hardening and problems in culture media are causes of RIF due to embryo development.And the factors such as polyps, fibroids, endometriosis and thin endometrium can affect implantation related to endometrium. The relationship between ART failure and thrambophilia remain largely inconclusive.The exact mechanism by which thromobophilia can cause implantation failure is not fully understand, But many Theories are affected such as: impaired vascularization, impairment of trophoblast function and immunologic mechanism, other causes of RIF may related to presence of hydrosalpinx, endometriosis, adenomyosis.About the treatment of RIF, there are controversies. The aim of all infertility specialists is to provide an evidence bored treatment for these patients.Removing or occlusion of hydrosalpinx and doing hysteroscopy before any additional treatment, and injury of endometrium just before COH, assisted hatching, blasto cyst transfer, zift, PGD, treatment by heparin in thrombophilia and co -culture, … but all of them need more research for approval.

Background: Intussusception represents as the invagination of a part of the intestine into itself and is the most common cause of intestinal obstruction in infants and children between 6 months to 3-years-old.Objectives: The objective of this study was to determine the recurrence rate and predisposing factors of Recurrent intussusception.Patients and Methods: The medical records of children aged less than 13-years-old with confirmed intussusception who underwent reduction at a tertiary academic care in northern Iran (Mazandran), from 2001 to 2013 were reviewed. Data were extracted and recurrence rate was determined. The two groups were compared by chi square, Fisher, Mann-Whitney and t-test. Diagnosed cases of intussusception consisted of 237 children.Results: Average age of the patients was 19.57 ± 19.43 months with a peak of 3 to 30 months. Male to female ratio was 1.65 and this increased by aging. Recurrence rate was 16% (38 cases).87 (36.7%) underwent surgery. These were mainly children under one year old. In 71% (40) of episodes recurrence occurred 1 to 7 times within 6 months. The recurrence occurred in 29 (23.5%) children in whom a first reduction was achieved with barium enema (BE) and 5 (5.7%) children who had an operative reduction (P<0.001) in the first episode. Pathological leading points (PLPs) were observed in 5 cases; 2.6% in recurrence group versus 2% in non-recurrence group (P=0.91). Three patients had intestinal polyp, 2 patient’s lymphoma and Mackle’s diverticulum. Age (P=0.77) and sex (P=0.38) showed no difference between the two groups. PLPs were observed in 1.4% of children aged 3 months to 5 years. This was 13.3%, in older children (P=0.02).Conclusions: The recurrence of intussusception was related to the method of treatment in the first episode and it was 5-fold higher in children with BE than in operative reduction. Recurrent intussusceptions were not associated with PLPs, they were more idiopathic.

Introduction: In the past three decades considerable improvement has been achieved in stimulation protocols. However, the efficacy of assisted reproductive technology (ART) in term of live birth rate has remained relatively constant and has showed minimal progress in embryo implantation and pregnancy rates over the years. Approximately 30% of women undergoing in vitro fertilization and embryo transfer (IVF-ET) will achieve an ongoing pregnancy and the birth rate is still 29.9-43.7% per cycle. Thus, failure to obtain pregnancy occurs at the time of implantation or a short time thereafter. It has been estimated that 30% of embryos are wasted in the preimplantation period and 30% are wasted after implantation. So implantation failure following embryo transfer is a principle problem in ART cycles.Definition of RIF: Implantation is determined as a procedure depending on several step and a continuous embryo-uterus interaction is observed at every step. The maternal immune system plays a major role in the establishment and maintenance of a normal pregnancy. Local and systemic immunological factors have been recognized that decrease the immunogenicity of the allogenic embryo and/or change the maternal immune response to facilitate implantation and the maintenance of early pregnancy. The maternal-fetal relationship is bidirectional process that immunestimulation might be more important than immunosupression. A high rate of human leukocyte antigen (HLA) loci sharing is an expression of genetic similarity and may act to prevent the appearance of anti-paternal antibodies and most couples will share no more the one loci (of 10 alleles inherited from both parents). Furthermore, implantation require coordination of multiple parameters including growing trophoblast and proper expression of numerous molecules that play essential roles in invasion of the embryo into the endometrium. Implantation failure in patients undergoing IVF is comparatively common in spite of good quality embryos transfer. Implantation failure may be a repeated event in some couples even in successful units with high pregnancy and live birth rates and it is leading to disappointment in these couples and their supervisors. Recurrent implantation failure (RIF) is defined as failure to achieve a pregnancy following 2-6 IVF cycles with more than 10 good quality embryos transfer and endometrial receptivity. Recently, the definition of RIF is not obvious and it is due to a trend for transferring only one or two embryos.Etiologies of RIF: Implantation is a complex process dependent upon many variable, most of which have not been adequately defined.Some agents have been recognized that affect success or failure of IVF-ET procedure and include decreased endometrial receptivity (due to uterine cavity abnormalities, endometrial thickness, immunological factors, thrombophilias, altered expression of adhesive molecules such as cytokines, NK cells, ILs, and integrins), embryo quality defect (due to parental age, ovarian reserve, infertility etiology, stimulation protocols) and problems in embryo transfer technique.Assessment of RIF: It depends on assumed etiologies and proper diagnosis may help select those patients who benefit from appropriate treatment. Some of these methods include repeated hysteroscopy, change in stimulation protocols, PGS, HLA typing, and identification of specific antibodies and NK cells.Treatment of RIF: whereas therapeutic options are limited and RIF is a clinical definition that include several subgroup, each patient may be have exclusive treatment. Multiple experimental treatments have been presented such as low dose aspirin, low-molecular weight heparin, intravenous immunoglobulin (IVIG), pentoxyfylline, ET under ultrasonographic guidance, blastocyst transfer and ZIFT. There is evidence to suggest that immunological factors may be involved in RIF, immunotherapy with IVIG has been introduced empirically into IVF programs. Preliminary studies found variable success with IVIG. The use of IVIG is very controversial but may be justified after many failures in specific cases and need large randomized prospective studies. IVIG therapy may not be a relevant routine treatment for failed IVF and large randomized studies are needed but these studies are extremely difficult to conduct.Conclusion: We proposed that specialized investigation should be initiated after four or more implantation failure with good quality embryos transfer and also based on our experiences, we believed that the use of surrogacy is the best choice in couples with RIF who other exclusive treatments have failed.