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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 old Alexandria medical school
Hassan N. Sallam, M.D., F.R.C.O.G., Ph.D. (London)
Department of Obstetrics and Gynecology, The University of Alexandria, Alexandria, Egypt
ABSTRACT
A famous medical school was established in the old city of Alexandria during the third century BC. Although mainly Greek in essence, and following the Hippocratic teachings, it was heavily tainted by the medical practices of ancient Egypt. Anatomy was particularly advanced due to the possibility of dissecting the human body. The most important Alexandrian physicians were Herophilus and Erasitratus. Many graduates of this medical school traveled and practiced throughout the Mediterranean basin. Galen, the famous Roman physician studied in Alexandria and practiced in Rome. His teachings and writings survived well into the sixteenth century and formed the basis of more modern medical practices during the renaissance. These writings were conserved partly by Christian monks and partly by Arab and Jewish scholars of the middle ages. The medical school of Alexandria was still active until late in the 3rd century AD. However, it slipped slowly into oblivion after the fire of 389 AD, which also devastated its famous library.
Keywords: Alexandria medical school, Egyptian medicine, Alexandria Library, Gallen, Herophilus.
Computer assisted semen analysis (CASA)
combined with the hypoosmotic swelling (HOS) test with modified limits
predicts fertilization better: an IVF study
Ertan Kervancioglu, M.D., Ph.D. Semih Kaleli, M.D. Turgay Atasu,
M.D.
Istanbul University, Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology and Bilgi Hospital IVF Unit, Turkey
ABSTRACT
Objective: To test the predictability value of combined computer assisted semen analysis (CASA) and hypoosmotic swelling (HOS) on fertilization in IVF. Several tests have been proposed to predict the fertile outcome of in vitro fertilization. Many of these tests are related to sperm function. HOS test and CASA measure sperm function though these functions may be independent from each other. Combining the two tests we can predict the fertile outcome of IVF more exactly than using the tests separately.
Materials and methods: We investigated the two tests in 43 infertile couples undergoing IVF treatment. HOS test and CASA was performed in 43 patients. Conventional HOS tests and subtypes of HOS test were investigated as well as the most disciminatory value of HOS was determined. CASA was performed by using capacitated sperm and 11 parameters were investigated, besides, cutoff values for detection of fertilization of each parameter were determined.
Results: HOS test and HOS A and HOS C subtypes significantly altered in fertilizated cases as compared to non fertilized cases (p=0.007, p=0.026 and p=0.029 respectively). CASA also showed some differences in fertilized cases. ALH, VCL, VAP, hyperactivity and motility were significanly higher in fertilized cases than non fertilized cases (p<0.001, p=0.004, p=0.27, p=0.001 and p=0.027 respectively). ALH, hyperactivity, motility (p<0.001), and VCL correlated with fertilization (p<0.02) as well as the HOS test (p<0.01). We observed that conventional HOS test limits were not sufficient to predict the fertilization and found at 50% level without a gray zone more useful though it was still insufficient.
Conclusion: When we combined the HOS test with CASA parameters, positive predictive value has increased up to 99%. Sensitivity, specificity and negative predictive values also had values over 90%.
Key words: IVF, HOS test, CASA, fertilization.
Correlation of vaginal ultrasound and
hysteroscopy with endometrial histopathology in postmenopausal women
Ahmed M. Elewa, M.D. Mohamed A. Abd El Karim, M.D. Samy A. Saad,
M.D. Mohamed A. Ramadan, M.D. Moharram A. Abd El Hai, MSc.
Obstetrics & Gynecology Dep. Benha Faculty of Medicine, Zagazig University, Egypt.
ABSTRACT
Objective: To assess the value of both transvaginal ultrasonography (TVS) and hysteroscopy in the detection of endometrial abnormalities compared to histopathology in postmenopausal women.
Study design: The study was conducted on 80 postmenopausal women grouped into: Group-A included 50 patients with postmenopausal bleeding (PMB), and Group-B that included 30 cases with another complaint rather than bleeding. They were subjected to full history taking, clinical examination, TVS, hysteroscopy then dilatation & curettege.
Results: Using 5mm endometrial thickness as a cut-off value for atrophic endometrium, TVS had 85% sensitivity, 96.7% specificity and accuracy of 92% in cases of PMB. The corresponding values in proliferative endometrium were 75%, 100% and 98%. In cases of endometrial hyperplasia, the sensitivity was 100%, the specificity 88.9% and the accuracy was 94%. However, TVS could not differentiate between different types of endometrial hyperplasia. The sensitivity and specificity of TVS in cases of endometrial carcinoma and submucous leiomyomas were 100%. However, in cases of endometrial polyps it showed sensitivity of 55.6% with a specificity and accuracy of 97.6% and 90% respectively. On the other hand, compared to hysteroscopy, there was no significant difference between the results of both techniques in diagnosis of various endometrial lesions except in cases of endometrial polyps where hysteroscopy showed a significant higher sensitivity and negative predictive value (P<0.05). In the non bleeding (Group B) postmenopausal women, there was no significant difference between the results of TVS and hysteroscopy in diagnosis of atrophic and hyperplastic endometrium.
Conclusion: In postmenopausal women, TVS is an excellent noninvasive screening method with high sensitivity & specificity values. In postmenopausal bleeding with endometrial thickness of 5mm or less, transvaginal sonography could reliably diagnose endometrial atrophy and exclude significant endometrial pathology. With more than 5 mm endometrial thickness another complementary diagnostic method as hysteroscopy & histopathology are recommended to establish precise diagnosis.
Key Words: Vaginal ultrasound, hysteroscopy, endometrial histopathology, menopause.
Comparison of pregnancy rates of frozen-thawed
human oocytes in the pronuclear stage transferred 2-3 hours after thawing
or after 24 hours culturing: a retrospective analysis
Nikos Nikolettos, M.D.* Safaa Al-Hasani, D.V.N. Ph.D. Cem Demirel,
M.D. Anna-Stephanie Hoepfner, M.D. Beate Sch?pper, Ph.D. Rita Sturm,
Monika Bals-Pratsch, M.D., Ph.D. Wolsgang Küpker, M.D., Ph.D. Klaus
Diedrich, M.D., Ph.D. Prof.
Democritus University of Thrace, Faculty of Medicine, Alexandroupolis, Greece and Department of Obstetrics/Gynecology, Medical University Lübeck, Germany.
ABSTRACT
Objective: To investigate whether in-vitro culture of frozen-thawed pronuclear oocytes can improve the results per transferred embryo.
Study design: We compared the implantation and pregnancy rates of oocytes in the pronuclear stage obtained after ICSI or IVF and transferred directly (2-3 hours) after thawing or after a 24 hours culturing. The study population consisted of patients who underwent IVF or ICSI between the years 1993 and 1998 and who had supernumerary embryos, which were cryopreserved. After thawing, all viable pronuclear oocytes were transferred to 511 patients in 566 thawing cycles. Until June 1997 our policy for frozen-thawed embryos had been to transfer them shortly after thawing. By this way we transferred 727 embryos obtained after ICSI in 298 thawing cycles and 80 embryos obtained after IVF in 36 thawing cycles. From July 1997 onwards the thawed embryos were cultured for a 24 hours period before being transferred. By this way we transferred 559 embryos obtained after ICSI in 227 thawing cycles and 9 embryos obtained after IVF in 5 thawing cycles.
Results: We found the pregnancy rate 14.53% and implantation rate 5.90% in the ICSI group with culturing of embryos after thawing and pregnancy rate 8.72% and implantation rate per transfer 3.57% in the ICSI group with direct transfer after thawing. The differences were statistically significant (P=0.030 and P=0.048 respectively). In the IVF group the number of patients were very small to draw any firm conclusion. There was no statistical difference in the distribution of different preparation protocols between two ICSI group (directly transfer and culturing).
Conclusion: Frozen-thawed 2 PN oocytes obtained from ICSI when they were cultured for 24 hours before being transferred can significantly improve the pregnancy and implantation rates per transferred embryo.
Keywords: pronuclear oocyte, cryopreservation, culturing, implantation.
The use of metformin to augment the
induction of ovulation in obese infertile patients with polycystic ovary
syndrome
Magda Mostafa El-Biely, M.D.*Mohamed Habba, M.D.
Department of Obstetrics &Gynecology and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
ABSTRACT
Objective: To compare the effectiveness of clomiphene citrate alone with that of a combination of metformin and clomiphene citrate in infertile obese patients with polycystic ovary syndrome (PCOS).
Materials and Methods: 90 obese infertile patients with PCOS, 18-35 years old, euthyroid, with normal prolactin level, were divided into two groups: group A, and group B, each one consisted of 45 patients. All the patients received clomiphene citrate 50 - 150 mg for 5 consecutive days beginning on day 5 of the cycle and folliculometry was done, ovulation was triggered with hCG when one or more follicles measuring > 18 mm in diameter were seen on ultrasound examination. The patients with group A received also 500mg of metformin tablet three times daily for 6 months. Ovarian response and pregnancy rate were assesed in both groups.
Results: Patients in the both groups received similar total doses of clomiphene citrate for six cycles. There was a significant difference in the number of large mature follicles at the time of hCG injection. There was significant difference in the incidence of ovulation 80% in group A and 65% in group B. 13 pregnancies occurred in patients given clomiphene citrate and metformin (group A), 4 pregnancies occurred in patients given clomiphene citrate only (group B).
Conclusion: Adding metformin treatment to clomiphene citrate enhances and regulates the ovarian response in obese patients with PCOS. These medications may provide a novel therapy for PCOS.
Key words: Polycystic ovary syndrome, clomiphene citrate, metformin, folliculometry
Intense dehydration during cryopreservation
by vitrification of the mammalian embryo is essential for subsequent embryo
survival and viability: a preliminary report
Jaffar Ali, Ph.D.
IVF Laboratory, Assisted Conception Unit, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
ABSTRACT
Objective: To determine the events that ensue in the embryo after exposure to the VS, in particular volume changes. The determination of the changes in the volume of the embryo with time after exposure to VS will provide useful insights into the osmotic behavior of embryos, the factors that contribute to and the extent of equilibration required for successful cryopreservation of embryos by vitrification.
Materials and Methods: Swiss outbred mouse day 4 and Merino sheep day 6 compacted morulae were used to determine volume changes following exposure to VS11 (6.0 M ethylene glycol and 1.8 M glycerol) from 0 to 20 minutes at room temperature. Two mathematical models and an image analyzer were utilized to calculate the changes in the volume of the embryo.
Results: There was a significant change in the relative volume between embryos (p<0.001), between duration of exposure (p<0.001), and a significant interaction between embryo and duration of exposure (p<0.001). The relative volumes ranged between 15.7 to 30% (sheep); 20.3 to 26.1% (mouse) at 3 and 5 minutes of exposure respectively. At 20 minutes the range increased to 25.2 to 50.5% (mouse) and 31.4 to 49.1 (sheep).
Conclusion: These findings suggest that a very high degree of dehydration was induced immediately after exposure to VS. When mouse and sheep embryos were successfully vitrified after exposure to VS for 1 to 3 minutes the intracellular water and VS content were very low. The latter in combination with the highly concentrated cellular macromolecules and solutes promoted intracellular vitrification. Complete equilibration (when intracellular and extracellular solute concentrations are identical) is unnecessary for vitrification and may be lethal.
Keywords: cryopreservation, dehydration, embryo, image analysis, morula, ultrarapid vitrification, VS11, mathematical model, volume.
Role of magnetic resonance imaging
in differentiation of histological subtypes and pre-operative evaluation
of uterine leiomyomas
Sahar N. Saleem, M.D. Mohamad E. Eid, M.D.
Departments of Radiology, Obstetrics & Gynecology, Cairo University, Egypt.
ABSTRACT
Objective: To evaluate the role of magnetic resonance imaging of uterine leiomyomas prior to surgery, its reliability for differentiating histological subtypes of leiomyoma and between leiomyoma and adenomyosis.
Material and methods: Twenty patients underwent MRI prior surgery for leiomyomas. The radiologist mapped the uterine lesions, and recorded the MRI characteristics and classification of the largest leiomyoma. The surgeon planned the management according to the MRI data. Surgical specimens were examined histopathological ly and MRI; surgical and pathological findings were correlated.
Results: The main MRI signal patterns of leiomyomas studied were: uncomplicated, cellular and degenerative. The latter included hemorrhagic, cystic and calcified degeneration. The overall accuracy of MRI diagnoses of the leiomyoma subtypes of the studied cases was 73%. The three included cases of adenomyosis were, two diffuse and a focal adenomyoma, all shared uneven thickening of the JZ inT2 (range 20-35 mm). The margin of all the 19 leiomyomas was well-defined (2 bright rim, 17 dark rim). All the three cases of adenomyosis had ill-defined margin. Associated adnexal pathology was detected in two patients.
Conclusion: MRI accurately maps the position and number of leiomyomas and directs the optimum surgical management. MRI can reasonably differentiate the histologic subtypes of leiomyomas (73%); being accurate in uncomplicated and cellular, but less reliable in calcifications and hemorrhage except for red degeneration. MRI can distinguish leiomyomas from adenomyosis and reveal other associated pelvic abnormalities; findings that may affect the regimen of management.
Keywords: leiomyomas, magnetic resonance, leiomyomas histological subtypes.
Human embryo quality after culture
in vitro individually or in groups
Amparo Ruiz, M.D., Ph.D. * Josep Romero, M.D. * Ana C. Cobo,
Ph.D. * Jesús Zulategui, Ph.D. * Carmen Rubio, Ph.D. * Yolanda Minguez,
Ph.D.* José Remohi, M.D., Ph.D.* Antonio Pellicer, M.D., Ph.D.*
Instituto Valenciano de Infertilidad; Department of Pediatrics, Obstetrics and Gynecology, Valencia University School of Medicine; and Hospital Univarsitario Dr. Peset, Valencia, Spain.
ABSTRACT
Objective: To test whether or not the culture of human zygotes in groups may be beneficial for their development in vitro.
Materials and Methods: 140 couples undergoing IVF. Approximately 18 hours after insemination, those zygotes showing the presence of two pronuclei and two polar bodies were further cultured in 20 µl microdrops of IVF-medium either in groups (group 1) or individually (group 2), selected in a random manner. Embryos were observed approximately 24 hours after being randomized and checked for the number of blastomeres and the degree of fragmentation.
Results: The mean number of blastomeres per embryo were 3.2±0.5 in group 1 and 3.0±0.5 in group 2. The mean degree of fragmentation per embryo was 1.4±0.4 in group 1 and 1.5±0.3 in group 2. Fifty one embryo transfers were carried out exclusively with communal cultured embryos, resulting in 15 clinical pregnancies (29.4% of pregnancy rate), and 32 with individually cultured embryos with 10 clinical pregnancies (31.3%).
Conclusion: We conclude that the culture of human embryos in groups does not add any advantage to the outcome of IVF.
Keywords: Embryo culture, communal culture, In vitro fertilization.
Department of Obstetrics & Gynecology, Department of Pathology Cairo University, Egypt
ABSTRACT
Objective: To report a rare case of gestational trophoblastic disease presenting as cervical ectopic pregnancy
Setting: Kasr El-Aini Hospital
Intervention: Total abdominal hysterectomy was done after ultrasonography and CT scanning.
Results: Thick haemorrhagic cervix with an ill-defined mass 9x8 cm, formed of soft friable haemorhagic tissue, entangling smooth walled vesicles ranged in size from 0.2x0.2 up to 2x2 cm infiltrating the upper part of the cervix and histologically composed of syncitium proliferating fibromuscular stromal reaction, with areas of focal necrosis and haemorrhage were seen
Conclusion: In the medical literature, there are many reports of cervical ectopic pregnancy but up to our knowledge, this is the first case in the medical literature to report placental site trophoblastic disease as an ectopic pregnancy purely in the cervix.
Keywords: ectopic pregnancy, cervical pregnancy, trophoplastic disease.