 |
The Official Journal of the Middle East Fertility Society Abstracts of
|
|
The Official Journal of the Middle East Fertility Society Abstracts of
|
Blastocyst culture and transfer: an
overview
Tarek El-Toukhy, M.D., M.R.C.O.G., Yakoub Khalaf, M.D., M.R.C.O.G.
Assisted Conception Unit, Guy's and St Thomas Hospital, London, UK.
ABSTRACT
The availability of new culture media that can support the later
stages of embryo development in-vitro has increased interest in blastocyst
culture and transfer. The potential benefits of transfer at the blastocyst
stage include better embryo selection, higher implantation rate and lowering
of the multiple pregnancy rates by transferring fewer embryos. However,
doubts over the safety of extended culture as well as efficacy of the procedure
in various patient groups are yet to be resolved before blastocyst transfer
can be routinely practiced.
Key Words: Blastocyst transfer, IVF treatment,
advantages and concerns.
Follicular fluid cytokines and IVF
outcome
Wafaa M. Aboul Enien, M.D.*, Ian D. Lewis- Jones, M.D.†, Gill
S.Vince, Ph. D.†.
Department of Obstetrics and Gynaecology, Shatby University Hospital, Alexandria Egypt, and Reproductive Medicine Unit, Liverpool Women's Hospital, Liverpool, United Kingdom.
ABSTRACT
Objective: To investigate the correlation between fertilization rate and pregnancy outcome after IVF and a range of cytokines in periovulatory follicular fluids.
Design: Retrospective study.
Setting: Reproductive Medicine Unit, Liverpool Women's Hospital, Liverpool, U.K.
Materials and methods: Follicular aspirates
collected at oocyte recovery from thirty women superovulated using the
gonadotrophin releasing hormone analogue (GnRH-a) / human menopausal gonadotrophin
(HMG) regimen.
Interventions: Aspirates pooled from individual patients and
cytokines measured using an enzyme linked immunosorbent assay (ELISA) technique.
Interleukin-2 (IL-2), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10
(IL-10), Interleukin-12 (IL-12), Interferon-gamma (IFN-¡) and Tumour
Necrosis Factor- alpha (TNF-a) were measured.
Main outcome measures: Fertilization rate and pregnancy outcome after IVF.
Results: Significant correlation was found between IL-12 and each of IL-8, IL-10 and IFN-¡. Significant correlation was also found between IL-2 and TNF-a. There was no significant correlation between fertilization rate and pregnancy outcome and any of the follicular cytokines. Similarly, cytokine levels did not differ significantly according to infertility diagnosis.
Conclusions: IL-2, IL-6, IL-8, IL-10, IL-12, TNF-a and IFN-¡ exist in preovulatory follicular fluids but do not seem to be suitable markers for IVF. Interaction between cytokines may be important for optimal follicular development and oocyte maturation.
Keywords: Cytokines, IVF, follicular fluid, superovulatory cycles.
Developing a rapid and simple method
of sperm preparation for intracytoplasmic sperm injection (ICSI)
Farhang Abed, M.D.
Infertility Research Center, Fathemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
ABSTRACT
Objective: To develop a rapid and simple method of sperm preparation for intracytoplasmic sperm injection (ICSI).
Subject: We have previously found a phenomenon that when sperm are put into a fluid flow, the motile sperm align themselves and swim against the flow. We have suggested that this method of alignment against fluid flow acts as a natural selection mechanism for sperm.
Materials and Methods: A piece of capillary tube, shaped like an hourglass, was inserted into a plastic slide that had a well and a groove in it. Twenty three semen samples were processed count 3(±0.5)×106 and progressive motility 10(±3.55)% and normal morphology(WHO criteria) 39(±11.29)%). Using a needle, approximately 3µl of semen was placed into the upstream conical segment of the hourglass. The well adjoining this section of the hourglass was then filled up with50µl warm Ham's F-10 medium. The medium entered the capillary tube and flowed through the hourglass section. After 2 minutes the downstream conical segment of the hourglass was observed under an inverted microscope. Motile sperm were observed swimming upstream close to the narrowing of the hourglass segment. These sperm can be easily aspirated by a micropipette.
Results: The aspiration procedure was repeated every 2 minutes at least 5 times. At each aspiration approximately 20(±3) sperm were collected with enhanced progressive motility 80(±6.97)% versus 10(±3.55)% and increased normal morphology 84(± 6.81)% versus 39 (±11.29)% which improvement was significant P<0.0001.
Conclusion: Using the flow alignment phenomenon, this method can separate sperm for ICSI which have a rapid linear motility. This simple, rapid method does not damage the sperm, as this procedure does not require any centrifugation or non-physiological chemical agents
Key words: sperm, sperm preparation, ICSI, IVF, natural selection mechanism for sperm, flow alignment phenomenon, flow .
Cytogenetic analysis of failed-fertilized
oocytes from Iranian infertile women after in vitro fertilization (IVF)
and intracytoplasmic sperm injection (ICSI) procedures
Hossein Mozdarani , Ph.D.*†, Farin Aghdaei, M.Sc.*
Dept of experimental and clinical Genetics, Royan Institute, and School of medical sciences, Tarbiat Modarres University, Tehran, Iran.
ABSTRACT
Objectives: To investigate the incidence
and types of chromosomal abnormalities as well as the frequency of sperm
premature chromosome condensation (PCC) in failed fertilized oocytes following
IVF and ICSI programs.
Materials and Methods: In this study, 364 air-dried preparations
of failed fertilized oocytes after either IVF (91 samples) or ICSI (273
samples) were analyzed. The zona pellucida of the oocytes was removed by
Tyrode's acid. The oocytes were subjected to a hypotonic shock followed
by sequential fixation in fixative consisting of methanol, acetic acid
and distilled water. After staining in Giemsa (10%), cells were analyzed
under a light microscope at 1000x magnification.
Results: Of the analyzed oocytes, 39% were haploid and 61% were aneuploid. Chromosomal aberrations such as structural aberrations (5.2%), polyploidy (2.81%), sperm PCC (14.3%), oocyte chromosome stickiness (5.8%) and decondensation of oocyte's chromatin (6.6%) were also observed. There was no statistical difference between the incidence of chromosomal abnormalities in failed-fertilized oocytes following IVF or ICSI procedures. The frequency of sperm PCC was higher in ICSI than IVF failed oocytes (P<0.01).
Conclusion: Results are indicating that chromosomal abnormalities are the major cause of oocyte's unfertilization. The type and frequency of chromosomal aberrations depend on several factors such as, physical and chemical agents; hormones and genetic constitution of the patient and non-disjunction during anaphase I & II, which is the prime cause of aneuploidy. Hence frequency of chromosome abnormality may vary in different populations. Results also show that occurrence of aneuploidy is probably the main cause of failed fertilization after IVF and ICSI procedures.
Key words: chromosomal abnormalities, fertilization failure, human oocytes, IVF, ICSI.
Is uterine thermal balloon ablation
an effective treatment for menorrhagia?
Ashraf M. N. Refaie, M.D., M.R.C.O.G., Consultant, Mohamed S.
Salim, M.R.C.O.G., S.H.O., Sow S. Cheah, M.R.C.O.G., Consultant, Trevor
Anderson, F.R.C.O.G., Consultant
Department of Obstetrics & Gynecology, Erne Hospital, Enniskillen, UK.
ABSTRACT
Objective: Evaluation of the efficacy and safety of uterine thermal balloon for treatment of menorrhagia.
Design: Prospective study.
Setting: Erne Hospital, Enniskillen, UK, a district hospital.
Materials: Thirty-two women complaining of intractable menorrhagia were included in this study. Fertility was no longer desired in those patients. They had normal uterine cavities of < 12 cm in depth. The endometrial histopathology of those patients showed no malignancy or atypical hyperplasia.
Methods: The procedure of balloon ablation was performed using the same technique in the 32 patients between June 1999 and October 2000. The treatment involved the insertion of the balloon into the uterus through the cervix. Then the balloon was inflated with 5% dextrose, which was heated to 87°C for eight minutes. General anaesthesia was used in all patients.
Results: The reported rates of amenorrhea, hypomenorrhea, and euomenorrhea were 34%, 47% & 6% respectively. Success rate of the procedure in terms of subjective reduction of menses to eumenorrhea or less was 87% after a mean period of follow up of seven months. Treatment led to a significant reduction in both the amount and duration of menstrual flow (p < 0.05). A significant reduction was also reported in period pain (p<0.05). Pre-operative thinning of endometrium using gonadotrophin releasing hormone agonist (GnRHa) was not better than preoperative endometrial curettage or no preparation at all. No intra-operative complications were reported and postoperative morbidity was minimal.
Conclusion: The use of intrauterine balloon ablation for treatment of menorrhgia was found to be safe and effective in selected patients.
Key words: menorrhagia, endometrial ablation, endometrial thermocoagulation.
Histological study of the effect of vitrification using ethylene glycol as cryoprotectant on the mouse ovarian tissue
Mojdeh Salehnia, Ph.D.*, Sayed Mohammad Moazzeni, Ph.D.†
Departments of Embryology and Immunology, School of Medical Sciences, Tarbiat Modarres University, Tehran, Iran.
ABSTRACT
Objective: To investigate the effect of vitrification procedure using Ethylene Glycol as cryoprotectant on the morphology of the mouse ovarian tissue.
Design: experimental study.
Setting: Tarbiat Modarres University Embryology Lab.
Materials and Methods: Ovaries from 8-10 weeks old Balb/c mice were obtained, vitrified using a solution of RPMI containing 30% (W/V) ficol 70, 0.5 M sucrose, 10.7% (V/V) acetamide and 40% (V/V) ethylene glycol (EGFS40%) and stored in liquid nitrogen. After thawing with 1 M sucrose solution and equilibration with RPMI medium, the frozen-thawed and fresh ovarian tissues were fixed in Bouin's fixative, embedded in paraffin, serially sectioned and stained with Hematoxylin and Eosin.
Results: The proportion of morphologically normal follicles was calculated in frozen and fresh ovaries. Almost all of the follicles appeared normal in ovaries frozen in EGFS40% with two equilibration times (5 and 8 min), the integrity of ovarian tissues were also completely preserved during vitrification and thawing procedure.
Conclusion: The vitrification of ovarian tissues can be an efficient method for storage of oocytes especially before cancer therapy.
Key words: Vitrification, Ovarian tissue, Ethylene glycol and Cryopreservation.
Hysterosalpingo-contrast-sonography
as a triage for tubal patency in a population at risk for pelvic action
Eric T.M. de Jonge, M.D., M.Med (OetG), Ph.D.*, Carlos
R. Hartman, M.B.Ch.B., M.Med (OetG)†, Henriette M. Swaenepoel, M.B.Ch.
B. ‡, Lou R .Pistorius, M.B.Ch.B., M.Med (OetG), F.C.O.G. (SA) †, Willem
Ombelet, M.D., Ph.D.*.
Department of Obstetrics and Gynecology, ZOL Genk, Belgium, Departments of Obstetrics and Gynecology and Department of Diagnostic Radiology, Division Ultrasonography, Kalafong Academic Hospital, University of Pretoria, South Africa.
ABSTRACT
Aim: To evaluate the performance of Hysterosalpingo-Contrast-Sonography (Hy-Co-Sy) in a population with a high prevalence of tubal pathology as well as its validity as a triage to identify women with patent tubes.
Design: A prospective descriptive study.
Setting: University-based regional teaching hospital serving mainly an urban black population.
Patients and Methods: One hundred consecutive women complaining of primary infertility for more than one year were included in the study. A systemic and gynecological examination was done to exclude pelvic pathology prior to inclusion in the study. Fallopian tubes were visualised using transcervical instillation of Echovist-200® and tubal patency was evaluated by transvaginal ultrasound. The ultrasound findings were compared to laparoscopy and chromopertubation as the gold standard for diagnosis of tubal patency. Analysis was done, only considering women with bilateral blocked tubes to be infertile as a result of a tubal factor.
Results: Eighty-nine women completed the study. The overall incidence of blocked tubes was 92%: 76 (85%) women had bilateral, and 6 (7%) women had unilateral blocked tubes. Hy-Co-Sy had a sensitivity, specificity, positive, and negative predictive value of 61%, 60%, 21%, and 90% respectively of diagnosing women with at least one patent tube. The concordance rate between Hy-Co-Sy and laparoscopy was 68%. Only three women (3%) had patent tubes in the absence of hydrosalpinx or peri-tubal adhesions. All of these women were shown to have bilateral tubal patency on Hy-Co-Sy. In all of the 10 fallopian tubes evaluated incorrectly by Hy-Co-Sy as being blocked, laparoscopy showed associated tubal abnormalities although the tubes were mechanically patent.
Conclusion: The incidence of primary infertility as a result of a tubal factor in this population proved to be very high. Hy-Co-Sy was identified as an appropriate triage in the fertility work-up of women in developing countries, able to identify the very few women who could benefit from intrauterine insemination.
Keywords: hysterosalpingo-contrast-sonography, female infertility, IUI.
The total dose of gonadotropins used
during controlled ovarian hyperstimulation as a predictor of pregnancy
outcome
Galal A. Abdo, Ph.D. Tarek I. Abozaid, BS., Ziad Massaad, M.D.
Elizabeth Formentini, BSN, MS., Sheryl Benford-loyer, RN. Mostafa I. Abuzeid,
M.D.
Center for Reproductive Medicine, Hurley Medical Center, Flint, Michigan, and Michigan State University, College of Human Medicine MI, USA.
ABSTRACT
Objective: To study the effect of increasing the dose of gonadotropins during controlled ovarian hyperstimulation on pregnancy outcome in various age groups.
Design: Retrospective study
Setting: Tertiary Teaching Medical Center.
Patients: 770 women undergoing controlled ovarian hyper-stimulation (COH)
Interventions: Institutional protocol for COH consisting of the "long protocol" for down regulation followed by daily administration of gonadotropins adjusted according to ovarian response on day 6.
Main outcome measure: Pregnancy rate.
Results: The patients were divided into 3 groups according to female age: group I (n=439)<35 years, group II (n=228) 35-39 years, and group III (n=103) > 40 years. The cycle cancellation rate and gonadotropin starting dose were higher in group III while the mean serum estradiol level and number of eggs retrieved were lower. Statistical analysis combining age group and total dose of gonadotropins used revealed a significant drop in pregnancy rate with higher gonadotropin dose in group I.
Conclusion: Women less than 35 years of age who require high doses of gonadotropins during controlled ovarian hyperstimulation (COH) have a lower pregnancy rate and should be counseled accordingly.
Key words: Controlled ovarian hyperstimulation, gonadotropin dose, pregnancy rate, age.
Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology and Fertility, Academisch Ziekenhuis Maastricht and the University of Maastricht, The Netherlands
ABSTRACT
Objective: To identify risk factors of life style associated with male subfertility with special concern on the effect of bicycling on semen quality.
Design: retrospective trial
Methods: Two hundred male partners of subfertility couples (age 23-45 years) were enrolled in the present study. All participants completed a self-administered questionnaire concerning different life style factors, which were later correlated with standard clinical semen analysis. Questionnaire included average duration of sitting /day, average amount of alcohol and coffee consumption / day, average time spent in hot environment (hot bath, shower, saunas)/ month, distance in kilometers of bicycling / day and whether there was exposure to toxic products or not
Results: No significant influence of different lifestyle factors were detected regarding quality of the semen. There was only significant relation between decline in progressive motility of sperms in those who rode bicycles more than 50 kilometers (P<0.008).
Conclusion: we were unable to find any relation between different life style factors and semen quality. Bicycling may have a negative impact on progressive motility of sperm; however, this should be confirmed in a prospective trial with large sample size.
Key words: semen quality, life style, smoking, alcohol, bicycling, temperature.