 |
The Official Journal of the Middle East Fertility Society Abstracts of
|
|
The Official Journal of the Middle East Fertility Society Abstracts of
|
A comparison of ovarian response in women undergoing in vitro
fertilization with polycystic ovary syndrome and ultrasound-only polycystic
ovaries
Renda Bouzayen, William Buckett, Robert Hemmings,
Louise Lapensée, François Bissonnette & Seang Lin Tan
Département d'Obstétrique et de Gynécologie, Hôpital St-Luc, Université de Montréal; Department of Obstetrics and Gynaecology, and McGill Reproductive Centre, Royal Victoria Hospital, McGill University, Montréal, Canada
ABSTRACT
Objective: To compare the effects of ovarian stimulation on women undergoing in vitro fertilization and embryo transfer (IVF-ET) with classical polycystic ovary syndrome (PCOS) and those with ultrasound-only polycystic ovaries (PCO).
Design: Prospective observational study.
Setting: Tertiary referral and university center.
Subjects: 31 women with classical PCOS undergoing 40 cycles of ovarian stimulation for IVF-ET and 59 asymptomatic women with PCO undergoing 76 cycles of ovarian stimulation for IVF-ET.
Interventions: Ultrasound scan and early follicular phase serum FSH and LH prior to any downregulation. Ovarian stimulation for IVF-ET, oocyte retrieval, embryo transfer and luteal support.
Main Outcome Measures: Duration of ovarian stimulation, total dose of gonadotropins, number of follicles, number of oocytes retrieved, peak serum estradiol and hospital admissions for severe ovarian hyperstimulation syndrome (OHSS).
Results: The total gonadotropin dose needed was lower in the PCOS group. The peak serum estradiol, number of follicles, number of oocytes, and admission rate for severe OHSS was higher in the PCOS group.
Conclusions: These results demonstrate that there is a spectrum of response to ovarian stimulation in women with PCOS/PCO, with the more severe phenotype being more sensitive to stimulation.
Key Words: Ovarian response, PCOS, PCO, Ultrasound, IVF, OHSS
Effect of high dose, short course
dexamethasone in clomiphene citrate resistant women with polycystic ovary
syndrome
Mohammad Ebrahim Parsanezhad, Saaid Alborzi, Shahdokht Motazedian
and Gholamhossein Omrani
Division of Infertility, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
ABSTRACT
Objective: To evaluate the effects of short course administration of dexamethasone (DEX) combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome(PCOS) and normal DHEAS.
Design: Prospective double blind, placebo controlled, randomized study.
Setting: Referral university hospitals.
Patients: Two hundred and thirty women with PCOS and normal DHEAS who failed to ovulate with a routine protocol of CC.
Interventions: Treatment group received 200 mg of CC from day 5 to 9 and 2 mg of DEX from day 5 to 14 of the menstrual cycle. Control group received the same protocol of CC combined with placebo.
Main Outcome Measures: Follicular development, hormonal status, ovulation rate, pregnancy rate.
Results: Mean follicular diameters were 18.4124±2.4314 mm and 13.8585±2.0722 mm (P<0.001) for treatment and placebo group respectively, Eighty-eight percent of the treatment and 20% of the control group had evidence of ovulation. The difference of cumulative pregnancy rate in the treatment and control groups was statistically significant (P<0.0001).
Conclusions: Hormonal levels, follicular development and cumulative pregnancy rate improved with the addition of DEX to CC in CC-resistant patients with PCOS and normal DHEAS. This regimen is recommended before any gonadotropin therapy or surgical intervention.
Keywords: Polycystic ovary, DHEAS, clomiphene citrate, dexamethasone.
Poor response to ovulation induction in
females more than 35 years old: is it justifiable to continue an IVF/ICSI trial?
A controlled trial
Ahmed N. Hosni, Ashraf Ramadan, Omaima Idris, Mohamed Zayed, Ayman
Abdel Haleem & Amr Hussein
Infertility and IVF Center -Women's Medical Center-Cairo- Egypt
ABSTRACT
Objective: to evaluate the outcome of IVF/ICSI in females patients more than 35 years old and normal FSH hormonal assay.
Design: Prospective controlled study
Participants: Seventy subfertile couples undergoing IVF/ICSI were included in this study Group I =18 cases with poor response and Group II = 52 cases with good response to the same stimulation protocol.
Outcome measures: pregnancy rate was the primary outcome while the number of embryos obtained, embryos transferred were the secondary outcomes.
Results: There was no significant difference between both groups regarding the female age, years of infertility and FSH levels. Group I produced significantly lower oocytes (2.7 ± 0.3), significantly lower embryos (1.7 ± 0.2 vs. 5.8 ± 0.4 in Group II) resulting in significantly lower number of embryos transferred (1.1 ± 0.3 vs. 4.1 ± 0.3 in Group II). Group I did not achieve any pregnancy while 5 cases got pregnant in group II (9.6%)
Conclusion: Subfertile couples more than 35 years old who show poor response to stimulation should be counseled before continuation in IVF/ICSI program. The poor results should be clearly explained to the couples.
Key words: IVF, ICSI, Sub-fertility, Infertility, Poor response.
Laparotomy findings of tuberculous
salpingitis among Ethiopians with tubo-peritoneal infertility
Tadesse Kitilla
Obstetrics & Gynecology Department, Faculty of Medicine, Addis Ababa University
ABSTRACT
Objective: To study the incidence of genital tuberculosis and to compare its pre- and intra-operative clinical findings with the non-tuberculous (NTB) group among suspected tubo-peritoneal infertility patients in Ethiopia.
Design: A Prospective cohort study.
Setting: Department of Obstetrics and Gynecology, Addis Ababa University Teaching Hospital, Ethiopia.
Patients: Two hundred and sixty-eight infertile women between the ages of 19 and 45 years were operated from 1995 to 2000 after preliminary investigations.
Intervention: Laparotomy followed by adhesiolysis, tissue biopsy, tuboplasty and trans-cervical hydrochromopertubation as required.
Results: Tuberculous salpingitis was diagnosed intraoperatively in 67 (25%) women and 61 of them (91%) had histology confirmation. Hysterosalpingogram pictures of tuberculous group revealed significantly higher proximal tubal occlusion than the NTB (p=0.003). Preoperative suspicion of tuberculosis by HSG features were more sensitive (19/21,91%) than the endometrial biopsy yield (5/92, 5.5%). Tuberculous group, compared with the NTB (201) were: younger (58 to 40% were < 30 years of age) and more nulligravidas (45/67(67%) to 79/201(39%), P=0.02); had more severe peritoneal adhesion (51/67 (76%) to 68/201(39%), P=0.006) and more rural (46 to 30%), had more operative failure to restore tubal patency (27/67(40%) to 9/201(5%), P=0.0000) and poorer prognosis for pregnancy (55/67(82%) to 36/201(18%), P=0.0000).
Conclusion: Tuberculous salpingitis is one of the major etiologic factors among women with tubal infertility in the area. Young women with primary infertility and HSG features of tuberculosis are important diagnostic clues for more specific diagnostic tests and procedures. When accessible, pre-laparotomy investigation of menstrual and endometrial fluid and tissue biopsy for bacteriological and histological examination supplemented with hysteroscopy and diagnostic laparoscopy is advisable.
Keywords: Infertility, Pelvic tuberculosis, Adhesions, reconstructive surgery and laparotomy
A retrospective comparison of day-3 and
day-5 blastocyst transfer: does blastocyst transfer really impact clinical
outcome in ICSI patients?
Mostafa M. El Sadek and Medhat K. Amer
Middle East Fertility Center; Department of Andrology, Cairo University; and Adam International Clinic, Cairo, Egypt.
ABSTRACT
Objective: To compare the clinical pregnancy rate per transfer as well as the implantation rate between day 3 and day 5-blastocyst transfer.
Study design: A retrospective study.
Materials and Methods: The study was done from the beginning of November 1999 to the beginning of October 2000 over 66 cycles in 66 patients. The results of day 3 (Group I: 46 cases) and day 5 blastocyst (Group II: 20 cases) transfers were analyzed as regards the clinical pregnancy rate per transfer and the implantation rate.
Results: There was no statistical significant difference in the clinical pregnancy rate per transfer and the implantation rate between the two groups; however they were higher in day 3 compared to day 5 blastocyst-stage embryo transfer (41.3% versus 30% and 15.3% versus 9.1% respectively).
Conclusion: Day 3 and day 5 blastocyst transfer had similar pregnancy and implantation rates and currently; since day 5 transfer offers no advantage over day 3 transfer; it was decided to follow the policy of day 3 cleavage stage embryo transfer.
Key Words: Day 3, day 5, blastocyst, embryo transfer, ICSI.
Insulin-like growth factor-1 (IGF-1) and
hormonal patterns in polycystic ovarian syndrome (PCOS)
Mohamed Amer, Emaad Awad, Mohamed A. Fatah, Tarek Hassan and Olfat
Fawzy
Department of Obstetrics and Gynecology and Department of Internal Medicine, Ain Shams University, Cairo, Egypt.
ABSTRACT
Aim: To investigate the hormonal pattern in PCOS aiming at better understanding of its patho-physiology.
Setting: Department of Obstetrics and Gynecology, Ain Shams University.
Design: A case controlled study.
Subjects: 75 women, Forty-five with PCOS and thirty controls.
Methods: History, clinical examination and estimation of plasma glucose, serum Insulin, Luteinizing Hormone, Follicular stimulating Hormone, Testosterone, Sex Hormone Binding Globulin, IGF-1 and IGFBP-1. Follicular fluid estimated for IGF-1 and IGFBP-1.
Results: Insulin resistance was detected in 21(63.6%) obese PCOS women, 2(16.7%) non-obese PCOS and 1 (6.7%) of obese controls and non-of non-obese controls. Hyperandrogenemia was found in 33 (100%) of obese PCOS and 11 (91.7%) of nonobese PCOS versus 8 (53.3%) in obese controls and none of non-obese controls. S.IGF-1 levels did not differ significantly in the four groups. Serum IGFBP-1 concentrations (ng/ml) were significantly lower in PCOS patients compared to weight matched controls. Obese PCOS women showed a significant decrease in their serum IGFBP-1 levels (30.36± 13.25) compared to their non-obese counterparts (47.50± 19.79). Follicular fluid IGF-1 (ng/ml) did not differ in PCOS patients (53.13±15.16) and controls (53.20±23.32). Follicular fluid IGFBP-1 (ng/ml) was significantly higher in PCOS women (211.93±67.65) compared to controls (140.00±53.27).
Conclusion: Obesity has a profound impact on the clinical picture and endocrine profile of PCOS women. Insulin resistance plays a pivotal role in pathogenesis and metabolic sequelae of the syndrome. Changes in the levels of bioavailable IGF-1, modulated by changes in the concentrations of both serum and follicular IGFBP-1, contribute to the hyperandrogenemia and the arrested state of folliculogenesis characteristic of this syndrome.
Key words: Insulin resistance, IGF-1, IGFBP-1, Obesity, PCOS.
Vascular endothelial growth factor (VEGF) expression in human
granulosa cells of stimulated cycles for ICSI: correlation with steroid profile
and outcome
Hassan Ali Hassan, Dalal El-Guiziry and Mervat Sheikh-El-Arab
Departments of Obstetrics and Gynecology, and Clinical Pathology, Faculty of Medicine, Alexandria University; and Alexandria IVF & ICSI Center, Alexandria, Egypt
ABSTRACT
Objective: To detect the expression of vascular endothelial growth factor (VEGF) by reverse transcription polymerase chain reaction (RT-PCR) in luteinized granulosa cells obtained on retrieval, and correlate the results with the steroid profile of the cycle in terms of peak serum estradiol, and mid-luteal estrogen and progesterone, as well as with other intermediate variables in these cycles.
Design: Prospective analysis.
Setting: Alexandria IVF, and ICSI center.
Subjects: twenty patients undergoing controlled ovarian hyperstimulation in preparation for ICSI for various indications.
Intervention: Detection of VEGF transcript in granulosa cells by RT-PCR.
Main Outcome Measures: Peak serum estradiol, mid luteal estradiol, and progesterone, number of oocytes retrieved, embryos transferred, and pregnancy rate.
Results: Significant positive correlation was found between VEGF expression and peak estradiol values as well as mid-luteal estrogen and progesterone. There was no significant difference however between VEGF mRNA positive and negative women regarding the number of oocytes retrieved embryos transferred or the ultimate pregnancy rate.
Conclusions: VEGF expression by human granulosa cells in the pre-ovulatory follicle is a positive finding that is correlated with higher steroid profile, possibly indicating better ovarian follicular and luteal performance.
Keywords: vascular endothelial growth factor, granulosa, steroid profile, controlled ovarian hyperstimulation, intracytoplasmic sperm injection.
Assessment of the accuracy of transvaginal ultrasonography in
determining the presence of retained products of conception in patients
presenting with spontaneous abortion
Sherif Negm, Hesham Al-Inany and Hassan Omar
Department of Obstetrics & Gynecology, Cairo University, Egypt
ABSTRACT
Objective: to evaluate the accuracy of transvaginal ultrasound assessment of retained products of conception following spontaneous abortion and whether a cut-off value could be detected
Design: A prospective clinical trial
Setting: Department of Obstetrics & Gynecology, Cairo University
Participants: Seventy five females presenting with spontaneous abortion with gestational age less than 12 weeks were examined by transvaginal ultrasound and curettage was done. Every woman was considered as herself control and endometrial thickness was estimated. The accuracy of transvaginal ultrasound assessment in prediction of retained products of conception was evaluated using different statistical analysis and a cut-off value was tested by Receiver Operating Characteristic curve.
Results: A cut-off value of endometrial thickness ³ 6mm has been found to be of sensitivity 87.5%, specificity 81.3%, positive likelihood ratio 4.68 and negative likelihood ratio 0.28. This cut-off value was found to have area under curve more than 90% confirming its reliability in diagnosis of retained products of conception.
Conclusion: Transvaginal ultrasonographic evaluation of uterine cavity for females presenting with spontaneous abortion is an easy, practical method that should be adopted in decision making. In this study, endometrial thickness ³ 6mm warranted surgical evacuation as it indicated the presence of retained products of conception. Further studies with larger sample size are awaited to confirm our findings.
Keywords: Transvaginal ultrasound, retained products of conception, spontaneous abortion.
A comparison of hysteroscopic endometrial ablation for
abnormal uterine bleeding in two groups of patients with or without endometrial
preparation
Saeed Alborzi, Mohammad Parsanezhad and Sedigheh Dehbashi
Department of Obstetrics and Gynecology, Division of Endoscopy, Shiraz University of Medical Sciences, Shiraz, Iran.
ABSTRACT
Objective: To assess the efficacy of endometrial ablation for abnormal uterine bleeding in two groups of patients with or without preoperative medication for endometrial suppression.
Design: A prospective, randomized study.
Setting: Shiraz University Hospitals.
Materials and Methods: Between September 1995 to February 1999, 90 patients with chief complaint of menorrhagia who were in the reproductive age and who had no response to medication and D & C, underwent endometrial ablation. Forty-five patients received preoperative medication for endometrial suppression (group A) while forty-five patients did not (group B). All patients had preoperative endometrial sampling that demonstrated benign histology. The minimum follow-up period was one year.
Results: In group A: 20% of patients developed amenorrhea, 51.1% of patients became hypomenorrhic, 22.2% had normal menstruation, and 6.7% did not respond (had heavy bleeding). In group B, these figures were 15.6%, 48.9%, 28.9% and 6.7% respectively. There was no significant differences between the two groups of patients in their response rate. Operation time was significantly longer in group B (40 min ± 5) than in group A (25 min ±4) {p<0.05}.
Conclusion: Overall, the result of this study clearly indicates that endometrial ablation is effective in both groups of patients with or without preoperative medication for endometrial suppression. Although operation time and amount of fluid which was infused were more in those who did not receive preoperative medication, major complication rate was the same in both groups.
Key word: Endometrial Ablation, Menorrhagia, Hysteroscopy, Resectoscope.
Department of Obstetrics and Gynecology, Faculty of Medicine, Basrah, Iraq
ABSTRACT
The presence at the same time of intrauterine and ectopic (heterotopic) pregnancy is unusual. Two cases of heterotopic pregnancies were reported. Both of them presented as acute abdomen. Urgent laparotomies were performed in both cases with unilateral salpingectomies for ruptured tubal pregnancies.
The intrauterine pregnancies were diagnosed by ultrasonic examination. The first case was multiparous with a history of pelvic infection while the second one was nulliparous infertile with a history of treatment with gonadotrophin injection. The intrauterine pregnancy carried to term with normal progress in the first condition while mid-trimester abortion was the end result in the second case.
Keywords: Acute abdomen, ruptured tubal pregnancy, pelvic infection, treatment with gonadotrophin.
Livebirth resulting from emergency TESE, after unexpected three consecutive
total necrozoospermic samples on the day of oocyte recovery: a case report
Samuel
Marcus, Martyn Blayney, Emad Louis, Adam Burnley and Peter Brinsden
CARE at The Three Shires Hospital, Northampton, and Bourn Hall Clinic, Bourn, Cambridge United Kingdom
ABSTRACT
Objective: To present a case of unexpected total necrozoospermia on the day of oocyte recovery rescued by emergency TESE.
Design: Case report.
Setting: Bourn Hall Clinic, a tertiary referral centre
Subject: A 39-year-old male who had had a vasectomy 11 years previously and a reversal of vasectomy the previous year.
Intervention: Surgical sperm retrieval by PESA and TESE
Main outcome measure (s): Successful sperm retrieval and livebirth
Results: Successful pregnancy following the transfer of two fresh embryos
Conclusion (s): Men who have had vasectomy reversal should be counselled about the possibility of necrozoospermia on the day of oocyte recovery. Surgical sperm retrieval offers a possible option.
Key words: vasectomy reversal, necrozoospermia, testicular sperm retrieval, ICSI, livebirth.