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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 impact of follicular phase levels
of LH on IVF outcome in normogonadotrophic women
Lars Grabow Westergaard and Claus Yding Andersen
Fertility Clinic, Odense University Hospital, Odense and Fertility Clinic Trianglen; and Laboratory of Reproductive Biology, Rigshospitalet, Copenhagen, Denmark
ABSTRACT
Refinements in protocols for controlled ovarian stimulation over the last decade has focussed on reducing the levels of circulating LH. Two measures were undertaken to achieve this: i) use of GnRH agonists to down-regulate the pituitary output of gonadotropins and ii) the introduction of gonadotropin preparations containing little or no LH activity. This has resulted in protocols which effectively reduce concentrations of LH to levels considerably lower than those observed during the follicular phase of the normal menstrual cycle. Actually, a number of recent studies give evidence to suggest that the currently employed stimulation protocols reduce LH levels so profoundly, that the reproductive outcome may become jeopardised. These results open the question: do the current used stimulation protocols result in LH levels below the requirements of a follicle needed to produce oocytes with optimal chances of conception and birth of child? The present review attempts to present the pros et contras of this question. Based on recent studies it is suggested that levels of LH and hence treatment outcome can be enhanced either by using gonadotropin preparations containing LH or HCG, or by adjusting the administration of the GnRH agonist in order to obtain a milder pituitary down-regulation.
Keywords: COH, LH suppression, GnRH-a down-regulation, ART, reproductive outcome.
Endometrial thickness and vaginal bleeding
as predictors of pituitary desensitization using long protocol GnRH-agonists
in IVF
Khaldoun Sharif, Masoud Afnan, Ibrahim Yassen, Awoniyi Awonuga,
Nahed Hammadieh, Bolarinde Ola and Spyros Papaioannou.
Assisted Conception Unit, Birmingham Women's Hospital, Birmingham, UK.
ABSTRACT
Objective: To assess the accuracy of using an ultrasonically measured endometrial thickness of <4 mm and/or the occurrence of vaginal bleeding in predicting pituitary desensitization, as measured by serum E2 levels, following 2 weeks of long protocol GnRH-a.
Materials and Methods: The data were analyzed
at 2 different thresholds of E2; < 50 pg/ml (virtual hypo-estrogenism)
and < 100pg/ ml (relative hypo-estrogenism).
Results: Out of 274 cycles who had 2 weeks of GnRH-a, a history
of vaginal bleeding and/or endometrial thickness of < 4 mm were present
in 258 (94.2%). In 211 (81.7%) of those the E2 was < 50 pg/ml and in
252 (97.4%) it was < 100 pg/ml. For vaginal bleeding and/or endometrial
thickness of < 4 mm the sensitivity, specificity, positive predictive
value, negative predictive value, positive likelihood ratio, negative likelihood
ratio and accuracy for desensitization at 50 pg/ml level were 100%, 24%,
81%, 100%, 1.32, 0 and 81%, respectively. At a level of 100 pg/ml the corresponding
values were 98%, 60%, 97%, 75%, 2.46, 0.03 and 95%, respectively. History
of vaginal bleeding was more predictive than endometrial thickness, but
the combination (in an 'and/or' form) provided the best prediction.
Conclusion: We conclude that a state of relative hypo-estrogenism after long-protocol GnRH-a, indicative of pituitary desensitization, can be predicted with a high degree of accuracy from a history of vaginal bleeding and/or endometrial thickness of < 4 mm. These criteria could be used instead of measuring serum E2 levels.
Key Words: Endometrial thickness, GnRH-a, IVF, pituitary desensitization, simplification, ultrasound, vaginal bleeding.
Magnetic resonance imaging in the management
of congenital anomalies of female reproductive system
Mostafa A. Shokry and Sahar N. Saleem.
Departments of Obstetrics & Gynecology, and Radiology, Cairo University, Egypt.
ABSTRACT
Objective: To assess the expanded applications of magnetic resonance (MR) imaging in the diagnosis and management of congenital anomalies of the female reproductive system.
Design: prospective clinical study with comprehensive review of literature.
Subjects: Fifteen patients, aged 14-36 years, with clinical suspicion of congenital abnormality of their reproductive system.
Methods: all patients underwent MRI using body coil. Pelvic phase array coil (n=6), coronal oblique images (n=10), and transvaginal endocavitary MR coil (n=1).
Results: Thirteen patients were diagnosed as uterovaginal anomalies, while two as sex differentiation disorders. Uterovaginal anomalies were classified into four classes. Class I (n=2) included uterine hypoplasia/ageneses. Class II disorders of vertical fusion (n=2). Class III disorders of lateral fusion (n=6). Class IV of combined or unusual anomalies (n=3). Two patients with sex differentiation disorders were androgen insensitivity syndrome, and true hermaphroditism. The MR imaging criteria of each type were recorded and the results were correlated with previous similar studies.
Conclusion: MRI demonstrated accurately the morphology of the anomalous genital system and helped their classification, thus their management. Uterine agenesis/hypoplasia was best seen on sagittal images; whereas vaginal agenesis on trans-axial. Fundal contour was used to differentiate bicornuate and didelphic from partial and complete septate uteri. Images in the oblique coronal plane defined uterine fundal contour more than other planes. Pelvic phase array coil and endovaginal MR imaging are recommended in complex anomalies. New fast MRI sequences enabled shorter time of the examination. MRI has established itself as a non-invasive clinical tool that reduced the costs of the diagnostic work ups for female genital anomalies.
Key words: uterovaginal anomalies, MR imaging, hermaphrodite, endovaginal MRI.
Oocyte cytoplasmic morphology predicts
the outcome of ICSI in patients with male factor infertility
Mohamed A. Sasy, Tarek I. Abuzeid, Hussein Salem, Mohammed Ashraf,
Galal Abdo, Mohamed Shmoury and Mostafa I. Abuzeid
Center for Reproductive Medicine, Hurley Medical Center, Flint, and Michigan State University College of Human Medicine, Michigan, USA.
ABSTRACT
Objective: To evaluate the relationship between oocyte cytoplasmic morphology and fertilization rate, embryo quality, implantation rate, pregnancy rate and outcome after intracytoplasmic sperm injection (ICSI).
Design: Retrospective study.
Materials and Methods: Two hundred consecutive cycles of ICSI done in the period between 4/97 and 6/99 for patients less than 36 years of age were studied. ICSI procedure was performed for treatment of male factor infertility. The patients were divided into two groups according to cytoplasmic characteristics of the oocyte. Group A had 176 cycles with normal cytoplasm and Group B had 24 cycles where all the oocytes had abnormal cytoplasm in the form of accumulation of saccules, vacuoles, refractile bodies or dark granular cytoplasm.
Results: The pregnancy rate and delivery rate were significantly higher in Group A compared to Group B, while there were no significant differences in fertilization rate, cleavage rate or embryo quality.
Conclusion: Oocyte cytoplasmic morphology predicts the outcome after ICSI in patients under 36 years old. Cytoplasmic abnormalities had no effect on fertilization or embryo quality; however, the pregnancy rate appears to be markedly reduced when such abnormalities are present.
Key Words: Cytoplasmic abnormalities, oocyte, male factor infertility, intracytoplasmic sperm injection.
Comparative study between ovarian artery
Doppler velocimetry and transvaginal 3D ultrasonographic folliculometry
for precise ovulation prediction in infertile patients in clomiphene citrate
induced cycles.
Essam Moustafa Aboul Fetooh, Amr Mohammed Aboul Ela and Ahmed
Rezk Al Sharif
Departments of Obstetrics and Gynecology Cairo University and Al Azhar University, Cairo, Egypt.
ABSTRACT
Objective: to compare between ovarian artery Doppler velocimetry and transvaginal 3D ultrasonographic folliculometry for precise ovulation prediction in infertile patients in clomiphene citrate induced cycles.
Setting: Outpatient gynecological clinic at Kasr El Aini and El Hussein hospitals, Cairo and AlAzhar universities.
Patients: 60 patients presenting with infertility due to ovulatory factors.
Interventions: All patients given clomiphene
citrate for ovulation induction .
Main outcome measures: Patients were divided into 2 groups: group
I, 30 patients were followed up by 3D transvaginal ultrasound alone. group
II: 30 patients were followed up by 3D transvaginal ultrasound and color
Doppler velocimetry for the ovarian artery of the active ovary showing
the dominant follicle .
Results: The combined use of 3D transvaginal ultrasound and color Doppler velocimetry had better accuracy (77%) for precise ovulation prediction compared to the accuracy of the use of 3D transvaginal ultrasound alone (47.5%).
Conclusion: The study concluded that the addition of ovarian artery Doppler indices to 3D transvaginal folliculometry improve its ability for prediction of ovulation in clomiphene citrate induced cycles.
Key words: Ovarian artery, Doppler, 3D ultrasound, ovulation
The effect of pentoxifylline on motility
of spermatozoa from asthenozoo-spermic samples: fresh ejaculates, cryopreserved
ejaculates, epididymal, and testicular
Mohammad A. Khalili, Serajeddin Vahidi and Hossain Fallah-Zadeh.
Research and Clinical Center for Infertility, Yazd University of Medical Sciences, Yazd, Iran
ABSTRACT
Objective: To evaluate the effect of Pentoxifylline (PX) on sperm motility of asthenozoospermic samples which were obtained from the following four standard sources: fresh ejaculates, cryopreserved ejaculates, epididymis, and testis.
Design: Prospective study.
Setting: University Infertility Center.
Materials & Methods: A total of 80 asthenozoospermic and 80 men with obstructive azoospermia were allocated to this study. Following preliminary evaluation, each sample was processed with washing and/ or swim up procedure and then divided into two aliquots of control (non- PX treatment) and PX (3.5 mMol PX, Sigma Co.). Following 45 min. of incubation at 37°C, motility was evaluated using Mackler Chamber.
Results: PX was very effective on the progressive motility of spermatozoa from both fresh and cryopreserved samples (p<0.001). Non-progressive motility from these groups was enhanced from 8.27±5.0 to 11.25±6.2, and 6.12±3.3 to 7.5±5.2, respectively, with PX incubation. In addition, with PX treatment, the non-progressive motility of percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE) groups were improved dramatically: 5.3±4.9 to 9.0±7.4, and 0.48±0.06 to 7.88±0.8, respectively (p<0.001). Also, following PX treatment, the ratio of progressive to non-progressive motility was significantly enhanced in all ejaculates, except PESA/TESE samples.
Conclusion: PX was successful in enhancing sperm motility in all groups of infertiles, especially PESA/ TESE samples. PX is considered to be effective with easy application and may be used for improving the male infertility treatment program. With its dual role as motility enhancer and vitality detector of spermatozoa, it can be used for the intracytoplasmic sperm injection (ICSI) treatment of severe cases of asthenozoospermia- total sperm immotility.
Keywords: Pentoxifylline, Sperm Motility, Male Infertility, Asthenozoospermia.
Autoantibodies and circulating immune
complexes in unexplained infertility and recurrent miscarriage
Wafaa M. Aboul Enien, Mona H. El- Sayed and Hossam M. Ghoniem.
Department of Obstetrics and Gynecology, Shatby University Hospital and Department of Immunology, Medical Research Institute, Alexandria University, Egypt.
ABSTRACT
Objective: To determine the prevalence of autoantibodies and circulating immune complexes in recurrent aborters and unexplained infertility.
Design: Prospective study.
Setting: Department of Obstetrics and Gynaecology Shatby University Hospital, Alexandria, Egypt.
Materials and Methods: Included twenty patients with unexplained infertility, twenty recurrent aborters and twenty controls.
Interventions: Serum specimens were analyzed
for the presence of anti-smooth muscle, anti-nuclear, anti-mitochondrial
and anti-cardiolipin antibodies as well as for circulating immune complexes.
Main outcome measures: Reproductive failure.
Results: Anticaroliolipin antibodies were significantly elevated in recurrent aborters and unexplained infertility compared to controls (p= 0.0002, p= 0.005 respectively). In recurrent aborters, there was a significent correlation between patients' age and levels of anticardiolipin antibodies (r = 0.8082, p = 0.003). Moreover, antinuclear antibodies were significantly increased in patients' groups compared to controls (X2 =2.99, p= 0.04).However, antimitochondrial and antismooth muscle antibodies were negative in all study groups and immune complexes did not differ significantly between groups.
Conclusions: An inconsistent immune derangement seems to be prescnt in recurrent aborters and unexplained infertility with the presence of anticardiolipin and antinuclear antibodies as the strongest representative markers of immune alteration.
Key words: Recurrent miscarriage, unexplained infertility, outoantibodies, immune complees.
Serum maternal carcinoembryonic antigen-125
(CA-125) levels in first trimester threatened abortion with demonstrable
fetal heart activity
Dimitrios Vavilis, Aristotelis Loufopoulos, Aikaterini Karavida,
Vassiliki Zournatzi, Stergios Tzitzimikas, Constantinos Dinas, Theodoros
Agorastos and John N. Bontis
2nd Department of Obstetrics and Gynecology, Aristotelian University, Hippokration Hospital, Thessaloniki, Greece.
ABSTRACT
Objective: To assess the predictive value of antigen CA-125 in maternal serum in first trimester pregnancy with demonstrable fetal heart activity complicated by uterine bleeding.
Design: A prospective study
Setting: University hospital and a district hospital
Subjects: Sixty-nine women between 7 to 11 weeks of pregnancy. Fifteen women with vaginal bleeding who ultimately aborted; 24 women with vaginal bleeding who progressed to the second trimester or beyond; 30 women with normal pregnancy.
Interventions: Ultrasound confirmation of fetal heart activity and blood samples for serum CA-125 measurements.
Main outcome measures: Serum CA-125 levels, pregnancy outcome
Results: There were no statistically significant differences among the groups with respect to maternal age, gravidity, number of previous spontaneous abortions, and gestational age. It was found that there was no statistically significant difference in CA-125 levels among the studied groups.
Conclusions: Maternal serum CA-125 measurement can not be useful as a pointer to outcome of early pregnancies complicated by bleeding with demonstrated fetal heart activity.
Key words: CA-125 levels, threatened abortion, fetal heart activity.
Department of Genetics, Royan Institute and School of Medical Sciences, Tarbiat Modarres University, Tehran, IRAN
ABSTRACT
Objective: To determine the relationship between morphology of the human preimplantation embryos and chromosomal abnormalities after IVF and ICSI procedures.
Design: Prospective study.
Setting: Royan Institute, Infertility Research Center.
Materials and Methods: For cytogenetic study of embryos, Dayban's air-dry method was used. Of 116 embryos studied from IVF samples, 68 and of 121 samples from ICSI, 70 were cytogenetically analyzable. Embryos of varying morphology between the pronucleated-stage and 8-cells stage were studied.
Results: The overall incidence of chromosomal abnormality among these embryos was 89.8% (41.7% at 2-4 cell stage and 85.3% at the 5-8 cell stage). Cleavage- stage embryos with poor morphology showed a higher incidence of chromosomal abnormalities (95.4%) than those of good morphology (68.9%). In both ICSI and IVF groups, aneuploidy was the most frequently observed abnormality. Comparison of the results of ICSI and IVF samples showed no statistical significant difference between the two groups.
Conclusion: This study indicates that there is progressive loss of chromosomally abnormal embryos during preimplantation development. Also, there is an association between chromosomal abnormality and embryo morphology. However, good and bad morphology embryos can have either normal or abnormal chromosome complements. Therefore, embryo morphology is not always an indication of chromosome status.
Keywords: chromosomal abnormalities, IVF, ICSI.
Ovarian sub-capsular and vaginal needle
site infiltration of local anaesthetic: evaluation of a novel method of
pain relief after oocyte retrieval
Abdel-Maguid Ramzy, Ossman Hefzy, Catherine Rhodes, Mehany Sattar,
Mohammed Al-Wasseef, Gamal Serour, Ragaa Mansour, Inas Al-Attar and
Mohammed Aboulghar
The Egyptian IVF-ET Center,Maadi, Cairo, Egypt
Objective: To study the effectiveness of local anesthetics in relieving the pain following oocyte retrieval.
Design: A prospective controlled computer randomised study
Setting: The Egyptian IVF-ET Center, Maadi, Cairo, Egypt
Subjects: 72 women undergoing IVF or intracytoplasmic sperm injection (ICSI). The patients were randomized as follows: Group A (n = 24) received lignocaine, Group B (n=24) received saline and Group C (n= 24) had no injection.
Intervention: Transvaginal ultrasound guided oocyte retrieval under general anaesthetic. Injection of local anaesthetic (Lidocaine) in the sub-ovarian "capsule" and vaginal puncture sites following oocyte retrieval
Main Outcome Measures: post operative pain assessment as measured by a blinded observer to the group allocation administered a visual analogue scale (VAS).
Results: Fifty-eight women (80.5%) reported pain with 27 (37.5%) requiring analgesia. The proportion of women requiring analgesia in the three groups was not significantly different: 10 (41.7%) in Group A, 10 (41.7%) in Group B, and 7 (29.2%) in Group C. The VAS results (mean ± standard deviation) in the three groups were not significantly different: 3.1 ± 2.4 for Group A, 3.0 ± 1.9 for Group B and 2.3 ± 2.2 for Group C.
Conclusion: ovarian sub-capsular local anaesthetic injection as administered in this study is not an effective means of post-operative analgesia following oocyte retrieval.
Key Words: oocyte retrieval, pain relief, local anaesthetic, in vitro fertilization.