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The Official Journal of the Middle East Fertility Society Abstracts of
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The Official Journal of the Middle East Fertility Society Abstracts of
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The value of prenatal genetic diagnosis
Theodore A. Baramki
Johns Hopkins University and Greater Baltimore Medical Center, Baltimore, Maryland, USA
ABSTRACT
Prenatal Genetic Diagnosis has progressed from “blind” amniocentesis in the mid 1960s to midtrimester ultrasonography in the 1970s to second trimester biochemical markers in the 1980s to chorionic villus sampling (CVS) in 1989. First trimester biochemical markers became available in the 1990s. These together with nuchal translucency measurement and maternal age detect Down syndrome in almost 90% of the cases. Preimplantation Genetic Diagnosis utilizing blastomeres obtained by micromanipulation remains confined to in vitro fertilization laboratories that are equipped to offer the technology with adequate interpretation. The clinician and genetic counselor should be familiar with all these services in order to offer the best advice to the patient.
Keywords: Ultrasonography, triple screen, amniocentesis, chorionic villus sampling, nuchal translucency.
Infertile women with ultrasound findings
of polycystic ovaries in the absence of the polycystic ovary syndrome are
distinct
Afaf Felemban, Chantal Mayer, Seang Lin Tan and Togas Tulandi
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
ABSTRACT
Objective: The objective of this study was to evaluate the endocrine profiles of eumenorrheic and non-hyperandrogenic women with ultrasound findings of polycystic ovaries and to compare them with women without polycystic ovaries and women with classical polycystic ovary syndrome.
Design: Retrospective study.
Materials and Methods: 105 women with infertility, normal menstrual cycle and absence of hirsutism, who were found to have polycystic ovaries on ultrasound were the subject of the study (study group). Their hormonal profiles were compared to 39 women with “classical polycystic ovary syndrome” (PCOS group) and 55 women with normal ovarian ultrasound (control group). Body mass index and serum gonadotropin, ovarian androgen and adrenal androgen of these women were compared.
Results: The body mass index of women in the study group was similar to that of the control women, but lower than that in the PCOS group. Compared to the control group, women in the study group had a significantly higher serum LH and lower FSH concentrations comparable to those found in the PCOS group. No difference was found in the total and free testosterone levels between the study and the control group. The levels were significantly higher in the PCOS group. Similar to those in the PCOS group, the serum concentrations of DHEA and DHEAS in the study group were significantly higher than those in the control group.
Conclusions: Infertile women with incidental ultrasound findings of polycystic ovaries are hormonally distinct from women with normal ovaries. They have higher LH, lower FSH and higher DHEA and DHEAS concentrations than normal women.
Key Words: Polycystic ovary syndrome, polycystic ovaries, ultrasound, anovulation
Agonist stop and adjuvant growth hormone:
Treatment of the extrapituitary suppressive action of the agonist
Hassan A. Hassan, Dalal El-Gezeiry, Hossam Azab, Iman Baghdady
and Ashraf H. Abdel-Rahman
Obstetrics and Gynecology department, Faculty of Medicine, Alexandria University; Alexandria IVF and ICSI center; and Clinical Pathology department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
ABSTRACT
Objective: To evaluate the role of growth hormone (GH) and/or gonadotropin releasing hormone (GnRH)-agonist discontinuation to rescue intracytoplasmic sperm injection (ICSI) cycles that would otherwise be cancelled in poor responders.
Design: Prospective randomized study.
Setting: Private infertility center.
Patients(s): Poor responders with long agonist protocols (n= 145).
Intervention(s): In study one, on stimulation
day 10 patients were divided into 4 groups: Group A (GnRH agonist + hMG),
group B (hMG only), group C (hMG + GH only), group D (group A+ GH). In
“study 2”, 43 “non pregnant patients from “study 1” were stimulated with
agonist stop, and adjuvant growth hormone from the start.
Main outcome measure(s): Additional stimulation days (ASD), cancellation
rate, E2 level, and rate of transferred embryos.
Results: Group C had significantly less additional stimulation days (5.5±1.6), lower cancellation rate (10.8%) than the other groups. Estradiol on day of hCG (695±174) pg/ml was significantly higher with more embryos transferred as compared to the other groups.
Conclusions: Stopping GnRHa and adding GH on stimulation day 10 in low responders may rescue otherwise cancelled LAP ICSI cycles.
Key words: GH, GnRH agonist, poor responders, ICSI.
Antisperm antibodies and gamete intrafallopian
transfer
Zouhair O. Amarin and Hassan S. Jamal
Human Reproduction and In Vitro Fertilization Centre, Fakeeh Hospital, Jeddah, Saudi Arabia, and Department of Obstetrics and Gynaecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
ABSTRACT
Objective: To investigate the possibility of inducing an antisperm antibody reaction in patients undergoing gamete intra-fallopian transfer (GIFT).
Design: Clinico-immunological prospective study.
Setting: Private IVF Centre.
Subjects: Fifty five patients undergoing gamete intra-fallopian transfer were tested for antisperm antibodies using sperm agglutination, sperm immobilization and indirect immunobead assay.
Interventions: Serum was collected at 2, 4, 8 and 12 weeks post-operatively.
Main Outcome Measure(s): Incidence and type of antisperm antibodies.
Results: Seven patients (12.7%) demonstrated tail to tail type agglutination in the serum collected at 2 and 4 weeks but not at 8 and 12 weeks post-operatively. All sera proved negative for antisperm antibodies in the immobilization and indirect immunobead assay.
Conclusion: Gamete intra-fallopian transfer does not appear to be a sufficient antigenic stimulus to initiate a significant and lasting immune response.
Keywords: Antisperm, antibodies, gamete, fallopian, transfer.
A modified microdose GnRHa/gonadotrophin
protocol for ovarian stimualtion in IVF: Experience in 102 cycles
Fady I. Sharara and Howard D. McClamrock
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
ABSTRACT
Objective: Various stimulation regimens have been used in some assisted reproductive technology (ART) patients at higher risk for poor outcome. Typically, these women have advanced age, high basal FSH and/or oestradiol (E2), low peak E2, require high gonadotrophin use, have low number of retrieved oocytes, low implantation and pregnancy rates (IR, PR), or high cancellation rates. Recently, the use of a microdose of gonadotrophin releasing hormone agonists (GnRHa) along with high dose gonadotrophin, adjunct growth hormone, and assisted hatching was used with high IR and PR.
Design: Retrospective.
Setting: University-based ART program.
Subjects: Eighty five women undergoing 102 cycles.
Interventions: None.
Main Outcome Measure (s): IR and PR.
Results: The cancellation rate secondary to inadequate follicular development was 17/102 (16.7%). The mean number of gonadotrophins used was 4,312 ± 787 IU, mean duration of stimulation was 10.1 ± 1.6 days. The mean peak E2 was 1,970 ± 1,102 pg/ml, and the mean number of retrieved oocytes was 13.4 ± 6.5. Mean progesterone (P4) on day of HCG was 1.7 ± 1.4 ng/dl. The number of ET ranged from 1 to 6 (mean 3.8 ± 1.2). The clinical PR was 36.5% (31/85) with an IR of 17.7% (56/317).
Conclusions: In our center and in the largest number of cycles reported, this modified protocol used as the stimulation protocol of choice resulted in acceptable oocyte yield, cancellation rate, IR and PR. No adjuvant GH was needed, resulting in substantial savings.
Key Words: microdose GnRHa/IVF/implantation/pregnancy
Progesterone supplementation in clomiphene
citrate treated anovulatory patients with menstrual irregularities: a randomized
controlled trial
Gamal Youssef, Ahmed Abdel Maguid and Hesham Al-Inany
Department of Obstetrics and Gynecology, Cairo University, Egypt
ABSTRACT
Objective: To evaluate the effect of progesterone supplementation in the second half of the luteal phase in infertile females with amenorrhea or oligomenorrhea receiving ovulation induction with clomiphene citrate.
Design: randomized controlled trial. Allocation was done using sealed envelopes.
Participants: Anovulatory infertile females with amenorrhea or oligomenorrhea were randomized into 3:1 groups to have progesterone supplementation (group 1, n=54) or no supplementation (group 2, n=18). All participants had complete infertility work up and were all normoprolactinemic. Anovulation was documented by mid-luteal progesterone and repeated ultrasound examinations.
Interventions: Clomiphene citrate 100mg was given to all participants and progesterone (dydrogesterone) was given twice daily from day 21-26 of the cycle to group 2. Follow up was done by folliculometry and mid-luteal progesterone. There was 3 drop out cases.
Outcome measures: regularity of the cycle and patient compliance were our primary outcomes. Conception rate was our secondary outcome of interest.
Results: regular menses were resumed in 94.4 % of non-conception progesterone supplemented cycles as compared to 68% in the control group (P<0.05). Pregnancy rate/ treated cycle was 7.35% for the progesterone supplementation group but for the control group it was 5.7% (P>0.05).
Conclusion: Progesterone supplementation in the second half of luteal phase should be adopted in anovulatory infertile females with menstrual irregularities receiving clomiphene citrate for ovulation induction. Although it does not improve the conception rate, it is safe, easily administered and enhances patient compliance
The use of ultra-low doses of gonadotrophin
releasing hormone -agonist for induction of midcycle endogenous surge of
LH for follicular maturation in patients at high risk of OHSS
Dan A.G. Imoedemhe, Edgardo Pacpaco, Arturo Olazo and Roger C.W.
Chan
Jeddah-Sydney Assisted Conception and Reproductive Endocrinology Center, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
ABSTRACT
Objective: To evaluate the effectiveness of ultra-low doses of GnRH-a analogue in inducing endogenous surge of LH for the purpose of follicular maturation in patients considered at high risk of OHSS.
Design: Prospective randomized study.
Setting: Assisted Conception Unit within a tertiary care private medical center.
Subjects: Sixty women in 3 groups of 20 who following ovarian stimulation for in vitro fertilization treatment were considered at high risk of OHSS.
Intervention: Each patient received either 5, 10 or 20 ug of GnRH-agonist subcutaneously for inducing LH surge following ovarian stimulation with ‘pure’ FSH.
Main Outcome Measure: LH response pattern, recovery of mature oocytes, outcome of IVF. Luteal phase length in non pregnant patients and the occurrence of OHSS.
Results: LH surge was successfully induced in all GnRH-a dosage groups. Mature oocytes were recovered in all patients with fertilization rates of 70.8%, 64% and 65.6% in the 5 ?g, 10 ?g and 20 ?g groups respectively and corresponding clinical pregnancy and implantation rates of 30%, 25% and 35% and 13%, 12% and 13%. These parameters were comparable between the groups. No severe OHSS was recorded. Luteal phase length was similar in the non-pregnant patients whether following ET or not.
Conclusion: Ultra-low doses of GnRH-a can effectively induce adequate LH surge enabling oocyte maturation. Our dosage schemes enabled the prevention of the adverse luteal phase shortening effect reported with higher doses and also allowed for the avoidance of cycle cancellation in our patients. We suggest that a dose of 20 ug and no more than 50 ug of GnRH-agonist should be used for midcycle induction of LH surge.
Key words: Ultra-low, GnRH-a, High risk, OHSS, Endogenous LH Surge, Follicular maturation
High incidence of pelvic adhesions
detected by second-look laparoscopy after laparoscopic ovarian drilling
Mohamed El-Saeed, Mohamed Hasan, Zakaria Aboulmaaty, Rawia Ezzat,
Bassam Elhelw and Mohamed Aboulghar
Department of Gynecology and Obstetrics, Faculty of Medicine, Cairo University, Egypt
ABSTRACT
Objective: To evaluate the incidence and degree of adhesion formation after laparoscopic ovarian drilling for anovulatory patients with clomiphene-resistant polycystic ovary disease.
Design: Prospective study.
Setting: Department of Gynecology & Obstetrics, Faculty of Medicine, Cairo University
Materials & Methods: 46 patients diagnosed as having clomiphene-resistant polycystic ovary disease were treated by laparoscopic ovarian drilling (LOD). The study group was subdivided into two subgroups. Group 1 (n=23): LOD was performed using a fine needle. Group 2 (n=23): LOD was performed using a thick needle. A second-look laparoscopy was performed for patients in each group after 3-4 weeks following LOD. Adhesions were scored using AFS classification of adnexal adhesions. Four patients from group 2 were excluded from the study because pelvic adhesions were visualized in these cases at LOD. Two patients failed to attend the follow-up appointment and were also excluded from the study.
Main Outcome Measure: Incidence and degree of de novo pelvic adhesion formation following LOD.
Results: After exclusion of six patients, the study group included 40 patients. 23 patients in Group 1 and 17 patients in Group 2. Adhesions were detected in 27 cases (67.5%) following LOD on second-look laparoscopy. Adhesions were seen bilaterally in 13(48.15%) and unilaterally in 14 cases (51.85%). There was a statistically significant difference in the incidence of adhesion formation between Group 1 and Group 2 (P < 0.05). Adhesions were present in 12 cases (52%) of Group 1 and in 15 cases (88%) of Group 2. However, there was no statistically significant difference in the mean score of adhesions (P > 0.05) between the two groups. Fifty percent of the ovaries were affected by adhesions and 32.4% of the tubes were affected by filmy adhesions. According to AFS classification; adhesions were minimal in (6 cases), mild in (12 cases), moderate in (4 cases) cases and severe in (5 cases).
Conclusion: The high rate of pelvic adhesion formation after "LOD" as shown in this study renders complete and comprehensive medical therapy mandatory before proceeding with surgical therapy, and if LOD will be carried out, every attempt at reduction of ovarian surface injury should be done.
Key words: PCOD, second-look laparoscopy, ovarian drilling, adnexal adhesion, cauterization.
Zeynep Kamil Women’s and Children Hospital, Reproductive Endocrinology and Menopause -Infertility- I.V.F.-ET Unit
ABSTRACT
Objective: During evaluation of tubular active transport function, this study has denoted that Radionuclide hysterosalpingography (RNHSG) is an important diagnostic method for the detection of the tubular motility in unexplained infertility cases beyond the methods like HSG and laparoscopy, which are mostly used to diagnose the tubular passage patency and tuboperitoneal factors.
Design: Prospective randomized study.
Setting: Zeynep Kamil Women’s and Children Hospital, reproductive endocrinology and menopause – infertility – IVF-ET unit.
Patients: Among the patients applying our hospital’s infertility department, 18 patients with the diagnosis of unexplained infertility are selected for the study group and 13 patients of male infertility for the control group randomly.
Interventions: 1 mCi Technetium 99m labeled sulfur colloid suspended with 1ml serum physiologic is injected to the cervical canal and posterior fornix, then scinthigraphic measures are documented in 30, 60, 90, 120 minutes.
Main outcome measures: Laboratory and clinical data.
Results: Among 31 patients, 23 of them (74.2%) have bilateral passage, 6 of them (19.3%) have bilateral passage, 6 of them (19.3%) have unilateral obstruction, 2 of them (6.4%) have bilateral obstruction.
Conclusion: With the help of RNHSG the active transport function of uterine tubes and especially of the endosalpinx can be evaluated. Also RNHSG can give important information about the tubal patency and transport function after all kinds of interventions to the tubes.
Key words: Unexplained infertility, Radionuclide hysterosalpingography
Combined intrauterine
pregnancy and abdominal pregnancy: a case report
Mostafa A. Shokry and Sahar N. Saleem
Departments of Obstetrics and Gynecology and Radiology, Cairo University, Egypt
ABSTRACT
Combination of intrauterine and extrauterine pregnancy though rare, is increasing in incidence. We report a case of a secondary abdominal pregnancy in a previous cesarean scar associated with an intrauterine pregnancy diagnosed by ultrasonography and MRI and treated by localized surgical resection with uterine preservation.
Key words: cesarean section scar, Secondary abdominal pregnancy, ectopic pregnancy, Heterotopic pregnancy