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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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Endometriosis and pain
John N. Bontis, M.D., Ph.D.; Dimitrios Vavilis, M.D.
1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
ABSTRACT
Pain is frequently associated with endometriosis presenting either as dysmenorrhea, dyspareunia or more continuous pain. It is estimated that among patients with endometriosis 20%-70% complain of pain. The cause of pain in endometriosis has not been well defined. Endometriosis can invoke several mechanisms that can provoke pain such as local peritoneal inflammation, tissue damage, release of chemical mediators of pain, adhesion and scar formation. There is no consistent relationship between severity of pain and disease stage, but there appears to be a positive correlation between severe pelvic pain and deep endometriotic lesions. Numerous therapies including both medical and surgical approaches are available to treat women with endometriosis-associated pain, but the optimal therapy has not been found and treatment should be individualized for each patient.
Key words: Endometriosis, pain.
The role of assisted hatching in human
IVF
L. Cem Demirel, M.D.*; Oya Evirgen, M.D.*; Safaa Al-Hasani, D.M.V.,
Ph.D.
Department of Obstetrics and Gynecology, Medical University of Ankara, Ankara, Turkey and Department of Obstetrics and Gynecology, Medical University of L?beck, Lbeck, Germany
ABSTRACT
Assisted hatching of embryos before intrauterine transfer has been implemented as a micromanipulation method to increase the chance of implantation in some of the in vitro fertilization programs. Most studies favor the use of assisted hatching in embryos with thick zona pellucida, slow cleavage rate, excessive fragmentation, poor morphology and in women with advanced age, increased basal FSH level and prior IVF failures; though the usefulness of assisted hatching could not be confirmed by some other studies. The mechanism by which assisted hatching facilitates implantation is not clear but most probably it involves an earlier in vivo hatching of the treated embryos. Nevertheless this is an ever growing field of embryology and the discrepancies about its place in IVF stem from the diversities of the hatching techniques used, the experience with its use, different methods of embryo transfer and different ovulation induction cycle managements. Further research is needed to document the real place of assisted hatching.
Key words: Assisted hatching, IVF
Remifentanil and fentanyl concentrations
in follicular fluid during transvaginal oocyte retrieval
Jody L. Bovenschen, B.S.N., R.N.A.S.*; Keith A. Lawrence, B.S.N.,
R.N.A.S.*; Mostafa Abuzeid, M.D. ü†; Mary Lou Jones, C.R.N.A., M.S.
†; Mohan Achwal, M.D. †; Harland Verrill, Ph.D. †; Francis Gerbasi, C.R.N.A.,
Ph.D.† .
Hurley Medical Center, Flint, Michigan, and University of Michigan-Flint, Flint, Michigan
ABSTRACT
Objective: To evaluate the level of diffusion of Remifentanil, compared to Fentanyl, in conjunction with propofol, into the follicular fluid during transvaginal oocyte retrieval.
Materials and Methods: This double-blinded study consisted of two groups of randomized subjects having in vitro fertilization. One group A (n=20) received Remifentanil and propofol, and the other group B (n=20) received Fentanyl and propofol. Blood samples were taken thirty minutes after the start of the agents infusion. Follicular fluid samples were obtained by the surgeon on initial follicular aspiration. The fluid samples were analyzed for opioid levels using gas and liquid chromatographic-mass spectrometric procedures, and then compared by Chi-Square analysis.
Results: The mean level of drug detected in the follicular fluid was 0.068 ng/ml for Fentanyl group versus 0.038 ng/ml for Remifentanil group (p = 0.01). Significantly fewer subjects (5/20) in the Remifentanil group had detectable drug levels in their follicular fluid compared to the Fentanyl group (13/20), (p = 0.01). Recovery time for Remifentanil subjects (5 min) was significantly less than for Fentanyl subjects (8 min), (p = 0.001).
Conclusion: We observed a lower drug detection rate in the Remifentanil group. Also, subjects receiving Remifentanil had a shorter recovery time. Our data suggests that there is significantly less diffusion of Remifentanil into follicular fluid compared to Fentanyl.
Keywords: anesthesia, infertility, opioids, fentanyl, remifentanil.
Follicular fluid MMP-2 and MMP-9 in
stimulated IVF patients
Diaa M. El-Mowafi, M.D.*; Umnia A. El-Hendy, M.D..
Departments of Obstetrics & Gynecology and Microbiology & Immunology, Benha Faculty of Medicine, Egypt.
ABSTRACT
Objectives: To detect the level of both MMP-2 and MMP-9 and their gelatinolytic activity in the follicular fluid of stimulated IVF patients and to correlate all the other hormonal and clinical criteria in these patients to each other.
Design: Prospective randomized clinical study.
Setting: Assisted Reproduction Unit, Benha University Hospitals, Egypt.
Patients: Twenty patients complaining of infertility for more than one year and listed for IVF-ET or ICSI procedures.
Intervention: Patients were stimulated according to the long protocol. Follicular fluid samples were collected during oocyte retrieval.
Main outcome measures: The different clinical, ultrasonographic and hormonal parameters of the patients were correlated together and to the MMP-2 and MMP-9 detected by zymography and ELISA, as well as their gelatinolytic activity.
Results: Our results showed that MMP-9 in the follicular fluids from patients treated with Metrodin was significantly higher (p< 0.05) than in patients treated with Metrodin HP. There was a positive correlation between the number of gonadotrophin ampoules given to the patient and MMP gelatinolytic activity. The activity of MMP-9 is significantly correlated (p< 0.05) with the log of serum progesterone level at time of embryo transfer. Serum E2 at pick-up was strongly correlated (p< 0.0001) with serum E2 at the time of hCG injection. None of the studied parameters has any relation to the pregnancy outcome.
Conclusion: Level of MMP-9 which may be one of the triggers of ovulation increases in the follicular fluid of stimulated IVF patients particularly with Metrodin than Metrodin HP and with the increased number of given gonadotrophin ampoules. This increase is still positively correlated with the level of serum progesterone at the time of embryo transfer. None of the investigated parameters was related to the pregnancy outcome in our studied group.
Key words: MMP-2, MMP-9, Follicular fluid, IVF-ET..
Severe ovarian hyperstimulation syndrome
in insulin resistant polycystic ovarian syndrome: improved results after
metformin treatment, with low dose recombinant FSH induction and serum
FSH monitoring
Hassan Ali Hassan, Dr.chGO Alex.* #; Dalal El-Gezeiry, M.D.C.Path
Alex *; Iman Baghdady, MchGO Alex#; Mervat Sheikh-El-Arab Elsedeeq; Tamer
M. Nafea, MChGO Alex *
Obstetrics and Gynecology department, and Clinical Pathology department, Faculty of Medicine, Alexandria University. and Alexandria IVF & ICSI Center.
ABSTRACT
Objective: To study the effect of the insulin sensitizer metformin on the incidence of ovarian hyperstimulation syndrome (OHSS) after recombinant FSH (rFSH) ovulation induction that is monitored by serum FSH estimation in women with polycystic ovary syndrome (PCOS).
Design: Prospective analysis.
Setting: Alexandria IVF/ICSI center
Intervention: Patients were pre-treated with metformin till their serum insulin and testosterone levels were normalized, then ovulation was induced with 37.5 IU of rFSH. If serum FSH failed to rise to more than 7mIU/ml after 3 days of initiation, the dose was increased to 75 IU/d.
Main outcome measures: Incidence of mono-ovulation, singleton pregnancy and ovarian hyperstimulation syndrome (OHSS)
Results: Out of 41 cycles of ovulation induction in 14 women, mono-ovulation was attained in 30 cycles (73%), 2 follicles in 4 cycles (10 %), more than 3 follicles in 3 cycles (7%) and four cycles failed to respond (10 %). The resulting pregnancies were: four Singletons (more than 21 weeks)(30%) and two twins (15 %), no abortions or ectopic pregnancies.
Conclusion: The incidence of severe OHSS in insulin-resistant PCOS could be reduced by the use of metformin and low-dose stimulation monitored by serum FSH levels.
Key words: Metformin, FSH, Ovarian hyperstimulation syndrome (OHSS), Polycystic ovary syndrome (PCOS)..
Embryo transfer done after 2 and 3
days of embryo culture following ICSI: does the sperm origin have any impact
on the results?
Mostafa M. El Sadek, M.D.*?; Medhat K. Amer, M.D.?
Departments of Obstetrics and Gynecology, and Andrology; Cairo University; Middle East Fertility Center and Adam International Clinic; Giza, Egypt..
ABSTRACT
Objective: To evaluate the clinical outcome of day 2 versus day 3 embryo transfer after ICSI and to evaluate whether using sperm from patients with different pathologies: ejaculate (from patients with oligoasthenoteratozoospermia), epididymal or fine testicular needle aspirates (from obstructive azoospermia) and testicular extraction (from functional azoospermia) has any effect on outcome of the day of transfer.
Study design: Prospective study.
Intervention: Patients were prospectively divided into 2 groups: GROUP I, 80 patients in which the only 3 or 4 non-selected available embryos were transferred 48 hours after oocyte retrieval and sperm injection and GROUP II, 70 patients in which 4 selected embryos were transferred after 72 hours.
Main outcome measures: Pregnancy rate, implantation rate, multiple pregnancy rate and abortion rate.
Results: There was no statistically significant difference as regards the clinical pregnancy rate per transfer (22.5% versus 31.4%); implantation rate (8.9% versus 12.9%), multiple pregnancy rates (27.8% versus 45.4%) and the abortion rate (22.4% versus 18.2%) between day 2 and day 3 embryo transfers collectively. When the results were compared as regards the clinical pregnancy rate per transfer according to the sperm origin, no statistically significant difference between the two groups was found.
Conclusion: Day 3 embryo transfer offers no advantage over day 2 embryo transfer after ICSI.
Key Words: Embryo transfer, day 3, ICSI, implantation rate, pregnancy rate, male infertility.
Genetic polymorphism in endometriosis
among infertile Egyptian women
Essam El-Gindi, M.D. * ?; Ahmad Reda El-Adawy, M.D. *; Mohammad
Faris, M.D.; Diaa El-Moghazy, M.D. *; Manal El-Hamshary, M.D. ?.
Department of Obstetrics and Gynecology, Minia University, and Dr. Faris Medical Center for Assisted Reproduction and Genetics, Cairo, Egypt.
ABSTRACT
Objective: To look for the estrogen receptor gene polymorphism, CRP, CA125 and correlate them with the severity of the disease.
Materials and Methods: 23 cases with a final diagnosis of endometriosis of different stages. PCR and digestion of its product with PvuII were used to identify the polymorphic form of the gene.
Results: A positive correlation was found between the severity of the disease and the presence of the polymorphic configuration of the gene. This form was also more common in cases with primary infertility. CRP did not correlate with the severity of the disease, while the CA125 did.
Conclusion: The estrogen receptor gene is linked to the severity of endometriosis and further molecular work may help a more precise definition of the anomaly involved.
Keywords: Endometriosis, genetic polymorphism, Egyptian women.
Bubble test: a method to improve the
diagnosis of endometriosis
Mohamed I. Amer, M.D.; Madiha G. Omar, M.D..
Department of Obstetrics and Gynecology and Medical Research Center, Ain Shams University, Cairo, Egypt.
ABSTRACT
Objective: To determine the clinical value of bubbling phenomenon as a method to improve the diagnosis of endometriosis during laparoscopy and to elucidate its biochemical background.
Setting: Infertility Unit and Medical Research Center, Ain Shams University Hospitals.
Design: A prospective controlled study.
Subjects: 50 women with primary infertility undergoing laparoscopy for the first time. Of these, 17 with pelvic endometriosis (group A), and 33 controls without endometriosis, (group B).
Methods: During laparoscopy, a sample of the fluid in the cul de sac was aspirated for biochemical assay of triglycerides, cholesterol, total proteins and immunoglobulin G. Subsequent to visual inspection of the pelvis, the bubble test was performed by irrigation of the posterior cul de sac with short bursts of saline under controlled pressure, and in case of development of dense soap like bubbles that stayed for at least 5 seconds, the test was considered positive. Biopsies were taken for histopathology from suspicious areas of endometriosis and random peritoneal biopsies from posterior cul-de sac in controls.
Results: 14 (82.4%) patients and three (9.1%) controls demonstrated a positive bubble test. The test's sensitivity, specificity, positive and negative predictive values were 82.4%, 90.9%, 70% and 90.9%, respectively. In patients with positive Bubble test, only the concentration of triglycerides was significantly elevated (P<0.001).
Conclusion: A positive bubble test is a simple test that can be of value in improving the diagnosis of endometriosis, specially by signaling the need for further re-evaluation of the pelvis or obtaining random biopsies in the search for microscopic disease. The positivity of the test is apparently related to the increased level of triglycerides.
Key Words: Bubble test, Endometriosis, Infertility..
Treatment of cervical aplasia by a
graft of peritoneum: a new technique
Saeed Alborzi, M.D.; Maryam Yazdani, M.D.; Mohammad E. Parsanezhad,
M.D.
Department of Obstetrics and Gynecology, Shiraz University of Medical Science, Shiraz, Iran.
ABSTRACT
Objective: To evaluate efficacy of a graft of peritoneum for cervical aplasia.
Design: Clinical trial.
Setting: Shiraz University Hospitals.
Patients: Two patients with cervical aplasia who had functioning endometrium and hematometra
Interventions: Two cases were considered for this new technique. Through an abdominoperineal approach, a plastic stent was inserted between the endometrial cavity and upper part of the vagina, and a graft of peritoneum was used over that. One of these patients had an unsuccessful stent trial for reconstruction of the vagina and cervix, previously. This patient had congenital absence of the upper two thirds of the vagina and cervical aplasia. For the patient with absence of the vagina, a skin graft was also used. In one of the patients, the plastic stent was removed one month later and in the other one after one week.
Main outcome measure: Presence of regular menstrual cycle
Results: Up to one year of observation, both patients had regular cycles, with normal menstruation. Sonographic examinations also showed empty uterine cavity.
Conclusion: Classic textbooks of gynecology, almost always recommend hysterectomy in cases of cervical aplasia. This report presents a new technique using a graft of peritoneum, which was successful in treatment of two such cases. More trials are needed to choose the best treatment for these rare but very difficult cases.
Keywords: Cervical aplasia, peritoneal graft, reconstructive surgery, neo-endocervical canal.
Infertility Department, Sarem Medical Center, Tehran, Iran
ABSTRACT
Objective: To elaborate on the possibility of occurrence as well as the dangers, method of diagnosis and treatment of heterotopic pregnancy following ART.
Study design: A couple with the history of primary infertility was admitted to our center. The cause of infertility was male factor due to oligoasthenospermia. Patient was subjected to in-vitro fertilization (IVF), which resulted in no pregnancy. A year later, the patient was referred to our center again, and intracytoplasmic sperm injection was done.
Result: Four weeks after embryo transfer, ultrasound examination revealed the presence of three gestational sacs; one intrauterine and two in the right tube and the case was managed accordingly.
Conclusion: Heterotopic triple pregnancy can occur after ART and its early diagnosis and treatment is a must.
Keywords: Heterotopic triple pregnancy, assisted reproductive technology (ART), intracytoplasmic sperm injection (ICSI).