PGD for aneuploidy screening
Peter Platteau and Catherine Staessen

Centre for Reproductive Medicine, Free University of Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium

 ABSTRACT

Preimplantation genetic diagnosis for aneuploidy screening (PGD-AS) is a procedure that allows us during IVF treatment, to select the best embryos before transfer not only according to their morphology and cell number but also on the basis of the number of chromosomes. PGD-AS should only be used at the moment in a selected group of patients who make a lot of chromosomal abnormal embryo's: firstly patients who are older than 35-37 years, secondly patients who had already several failed IVF attempts, thirdly patients who had 3 or more recurrent miscarriages and last but not least couples where the male partner has a non obstructive azoospermia. There is a strong feeling that PGD-AS will give some extra information for the selection of the best embryos in this group of patients. It would however be premature to jump to conclusions about the possible advantages of PGD-AS without clinical randomized studies.

Keywords: PGD-AS, IVF, recurrent miscarriage, poor implanter, non-obstructive azoospermia.

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Does the addition of menopausal gonadotropin to recombinant FSH in pituitary suppressed women improve clinical pregnancy in an intracytoplasmic sperm injection program?
Dimitris Loutradis, Konstantinos Stefanidis, Peter Drakakis, Konstantinos Kallianidis, Georgios Kallipolitis, Alexandros El Sheih, Spyridon Milingos & Stylianos Michalas

IVF Unit, "Alexandra" Maternity Hospital, 1st Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece.

 ABSTRACT

Objective: To investigate the benefits of the addition of menopausal gonadotropin to recombinant FSH in comparison to recombinant FSH alone in pituitary-suppressed women undergoing intracytoplasmic sperm injection.

Design: Prospective, randomized study.

Patients: 382 infertile patients with a history of one to six previous attempts of ICSI were treated according to one of the two treatment protocols.

Intervention(s): Randomization to rFSH or rFSH+hMG

Main Outcome Measure(s): Oocytes retrieved, embryos developed, implantation rates and pregnancy rates.

Results: Patients treated with the rFSH + hMG protocol were stimulated in a shorter time and achieved higher E2 levels. A significantly higher percentage of oocytes retrieved was found after treatment with rFSH. The mean numbers of fertilized oocytes and transferred embryos were similar in both groups. The clinical pregnancy rate per started cycle was 34.7% and 29.7% (p=0.4), respectively.

Conclusions: This study shows that the addition of hMG to rFSH in pituitary suppressed women undergoing ICSI does not improve clinical pregnancy rate.

Key Words: hMG, rFSH, IVF-ET, long protocol, ICSI

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Efficiency of Sil-Select and Percoll to recover spermatozoa with normal chromatin and morphology and the effect of these parameters on fertilization, embryo quality and cleavage score
Mohammad. Nasr-Esfahani, Shahnaz. Razavi, Mohammad. Mardani & Safora. Tofigh-Hesabi

Royan Institute, Department of clinical and experimental embryology and Andrology, Tehran, and Isfahan Fertility and Infertility center, Isfahan, Iran

 ABSTRACT

Objective: To evaluate and compare efficiency of Sil-Select with Percoll to recover sperms with normal chromatin or morphology and also to study the effect of these parameters on fertilization, embryo quality and cleavage score.

Materials and methods: Assessment of semen parameters, protamine deficiency (CMA3) and excessive histone (aniline blue) were carried out before and after sperm processing on 46 semen samples from IVF patients referring to Isfahan fertility and infertility center.

Results: Both Sil-select and Percoll were efficient to reduce sperm chromatin and morphology anomalies. Significant correlation, were obtained between sperm morphology (strict criteria), protamine deficiency and excessive histone with in vitro fertilization rate. Among these parameters only sperm morphology showed a significant correlation with embryo quality and cleavage score.

Conclusion: Sil-Select is a suitable alternative for Percoll to recover sperm with normal chromatin and morphology. Furthermore density gradient techniques are recommended for sperm processing for IVF and especially for ICSI.

Key Words: Chromatin, Morphology, Percoll, Sil-Select, Sperm, CMA3, Aniline blue

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Correlation between parity, lactation and period of menopause with bone density measured by dual energy X-ray absorptiometry (DEXA)
Sherif El Sharkawy, Sana El Fiky, Wisam Al-Inany & Zakaria Aboulmaaty

Department of Obstetrics & Gynecology, Department of Radiology and Department of Orthopedics, Cairo University, Cairo, Egypt

 ABSTRACT

Objective: To investigate the influence of parity, duration of lactation and postmenopausal period on the bone mineral density and occurrence of osteoporosis

Design: Retrospective study

Setting: Women Health Center-Naser Institute Hospital, Cairo

Participants: A consecutive series of 200 menopausal women referred with bone aches for checkup and / or for measuring their bone density.

Interventions: The bone density was measured at the spine A/P at regions L1-L2, femur at the region of the neck and the forearm at the region of radius using dual energy X-ray absorptiometry (DEXA) on all women in the study.

Result: BMD  (mean ±SD) was found to be 1.174±0.19 g/cm2 on antero-posterior spine L1-L2, for the femur neck 0.849±0.014 g/cm2 for the forearm (radius) 0.781±0.02g/cm2. There was no statistical significant difference influence of the parity, duration of lactation on bone density, after adjustment for age & bone mass index. Meanwhile, the crude BMD of the radius and hip were increased significantly with increasing parity (P<0.001) as well as lactation. Moreover, the length of postmenopausal period has a significant difference on bone density (P<0.05).

Conclusion: Parity, period of lactation do not influence bone density significantly, however, the duration of menopause is influencing.

Keywords: parity, lactation, menopause, bone density

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The efficacy of bromocriptine with and without ovarian stimulation in the treatment of hyperprolactinemic infertile women
Ali Esmail Al-Sanafi, Ali Taki Al-Baldawi, Amerra Kasim Al-Rubaei & Zainab Ali Al-Chalabi

Department of Pharmacology, Department of Gynecology, College of Medicine, University of Tikrit and Department of Pathology, Saddam College of Medicine, Iraq

 ABSTRACT

 Objective: To determine the effect of hyperprolactinemia on gonadotropins secretion, and the efficacy of bromocriptine with and without ovarian stimulation in the treatment of hyperprolactinemic infertility.

Design: Prospective clinical trial.

Setting: Teaching hospital of Tikrit College of Medicine and Saddam College of Medicine as well as many private clinics, from May 1996 till October 2000.

Patients: The study was conducted on 1282 hyperprolactinemic infertile woman. Because of infertile partner, 72 patients were excluded.

Intervention: Clinical trial and follow up study with the using of bromocriptine alone and with clomiphene citrate or Pergonal with and without induction of ovulation by HCG. Treatment program was continued for 3 cycles.

Results: The highest pregnancy rate was recorded when bromocriptine combined with Pergonal followed by induction of ovulation by HCG (43.22%). When clomiphene citrate was combined with bromocriptine, the pregnancy rate reached 38.33%. However, when this program was followed by HCG, the pregnancy rate increased to 40.33%.

Key words: hyperprolactinemia, treatment, bromocriptine, clomiphene citrate, Pergonal, HCG, pregnancy rate.

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The evaluation of parameters determining the prognosis of therapy in patients with imminent ovarian failure undergoing in vitro fertilization
Serap Yalti, Birg・G・b・& Cem Ficicioglu

Department of Reproductive Endocrinology and In Vitro Fertilization, Zeynep Kamil Women and Children's Hospital, Istanbul, Turkey

 ABSTRACT

Objective: To study the value of inhibin B, compared to other ovarian reserve parameters, such as FSH, Estradiol, Ovarian volume and Antral follicles.

Design: Prospective study.

Setting: Department of Reproductive Endocrinology and In Vitro Fertilization, Zeynep Kamil Women and Children's Hospital.

Interventions and subjects: The early follicular phase day three inhibin B, serum FSH, estradiol levels, number of antral follicles and ovarian volumes of 35 cases diagnosed with imminent ovarian failure, who applied to our IVF center, were compared with 25 infertile cases evaluated to have normal ovarian reserves. Their response to gonadotropin stimulation, total dose of gonadotropin, days of stimulation, and number of oocytes picked up were compared.

Main Outcome measures: The value of inhibin-B was observed to detect the ovarian response.

Results: Basal inhibin B levels in imminent ovarian failure cases were 31.34±4.64 pg/ml compared to 69.64±16.9 pg/ml (p<0.001) in the control group. In the ovarian failure and control groups, FSH levels were 11.9 2±0.96 mIU/ml compared to 4.60±1.35 mIU/ml (p<0.001), estradiol levels were 38.51±7.01 pg/ml and 24.24±1.96 pg/ml (p<0.001), antral follicle numbers were 3.05±1.67 and 6.56±1.12 (p<0.001), and ovarian volumes were 3.37±0.59 ml and 7.44±1.26 ml (p<0.001), respectively. The gonadotropin dose required for ovarian response in imminent ovarian failure cases was 6.82±0.82 ampoules/day compared to 5.56±0.87 day/day in the control group (p<0.001). Number of oocytes picked up in the study group was 1.37±1.00 compared to 8.84±2.09 oocytes in the control group (p<0.001). In the imminent ovarian failure and control groups the days stimulation was 11.77±0.94 and 10.36±1.07 (p<0.001), respectively.

Conclusions: We suggest that the combined use of basal serum FSH, inhibin-B levels and number of antral follicles can be used to predict ovarian reserve and the infertile patient's response to controlled ovarian hyperstimulation.

Key Words: Infertility, Imminent ovarian failure, Inhibin B

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Association of autoantibodies with repeated in-vitro fertilization and embryo transfer failure
Najwa A. Al-Mousley & Raja Z. Karaki

Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Isra University and Fertility and Assisted Reproduction Unit, Al-Amal Maternity Hospital, Amman-Jordan

 ABSTRACT

Objective: To analyze the prevalence and association of several auto antibodies with repeated in-vitro fertilization (IVF) and embryo transfer (ET) failure.

Design: Prospective comparative study.

Setting: Private assisted reproduction unit.

Patient(s): A total of 200 patients attempted to conceive through IVF-ET programmed were involved in the study. They were divided into the study group, which consisted of 102 patients with three or more previously failed IVF-ET cycles, and the control group, which included 98 patients having their first or second IVF-ET trial. Both groups were matched for causes of infertility that were classified as tubal, ovarian, endometriosis, male and unexplained infertility.

Intervention(s): Sera were collected from all patients included in the study and tested for antiphospholipid (anticardiolipin (ACL) and lupus anticoagulant (LA)), antinuclear (ANA), anti-DNA, anti-smooth muscle (ASM), anti-thyroid (anti-thyroglobulin (AT) and anti-microsomal (AM)) antibodies, as well as, rheumatoid factor (RF).

Result(s): ACL antibodies and ANA were detected in 26% and 21% of patients in the study group while they were expressed in 11% and 9% in the control group respectively. These differences between the two groups reached statistical significance (P<0.05). Although other tested autoantibodies showed variable positivity, no statistical difference was found between the two groups.

Conclusion(s): The high occurrence of autoantibodies, especially ACL and ANA in patients who failed at least three IVF-ET trials may be one of the possible causes of IVF-ET failure. Accordingly, the autoantibody profile may be included as a part of the work up in this category of patients to show people at risk and large scale studies are needed to determine whether treatment for autoimmunity is necessary.

Key word(s): Autoimmunity, repeated IVF-ET failure, anti-phospholipid antibodies, antinuclear antibodies, implantation.

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Appropriate embryo transfer technique improves the pregnancy rate in human in vitro fertilization
Pelin Ocal, Ismail Cepni, Mehmet H. Idil, Funda Salihoglu, Tulay Irez & Feridun Aksu

Cerrahpaｺa Medical Faculty and IVF-ET Research and Practice Center, Istanbul University, Turkey.

  ABSTRACT

Objective: Comparison of two different embryo transfer techniques in an IVF program.

Design: Prospective, randomized clinical study.

Setting: The IVF Research and Practice Center of Istanbul University, Istanbul, Turkey.

Subjects: 298 patients undergoing IVF-ET.

Interventions: Patients were randomly assigned to undergo ET by different techniques. All patients were transferred with the TDT catheter. The tip of the outer catheter was straight in group 1(n=152) and it was bent to approximate the curvature of the cervical canal in group 2(n=146).

Main Outcome Measures:  Pregnancy rate and simulate technical difficulty with ET.

Results: Pregnancy rate in group 2 was significantly higher than group 1 (27.4% vs. 17.7%). Technical difficulty was similar for both techniques.

Conclusions: Bending the tip of the transfer catheter to simulate the curvature of the cervical canal improves the pregnancy rate.

Key words: Embryo transfer, IVF, pregnancy rate.

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Precoital sexual stimulation and its effects on seminal characteristics
Panayiotis M. Zavos, Juan R. Correa, Khalied Kaskar & Panayota N. Zarmakoupis-Zavos

Andrology Institute of America and Kentucky Center for Reproductive Medicine and IVF, Lexington, KY, USA; and Centro de Fertilidad del Caribe, Rio Piedras, Puerto Rico

 ABSTRACT

 Objective: To assess the quantity and quality of spermatozoa produced as a function of various degrees of precoital sexual stimulation (PSS) within the same patient group.

Patient(s): Twenty male partners of couples with female factor infertility only were randomly selected from a large group of patients that were attending the Andrology Institute of America for infertility workup, to be included in this study.

Materials and methods: Each male (n=20) was provided with nonspermicidal condom-shaped devices (Male Factor PakTM) and instructed to produce 3 ejaculates, in a random fashion according to semen production and stimulation method, over a 12 day period (4 days of abstinence each time) via three different modes of PSS. The three methods of PSS consisted of Mode A, B and C. Mode A consisted of attempting intercourse until before the time of ejaculation and stopping at this time (Attempt 1). Patients were instructed to repeat the procedure after 12 hours (Attempt 2), followed by entering a 5-minute resting (refractory) period and then trying again to complete ejaculation (Attempt 3). Mode B consisted of producing an ejaculate as in Mode A by attempting incomplete intercourse (Attempt 1), followed by a 5 minute resting period and reattempting complete intercourse (Attempt 2). Mode C consisted of producing an ejaculate at the first attempt (Attempt 1).

Main Outcome Measures: Seminal characteristics of ejaculates produced via different stimulatory methods during intercourse.

Results: Statistically significant increases in almost all seminal characteristics assessed were noticed in specimens collected via Mode A as compared to those in specimens collected via Mode B or C (P<0.05). Seminal characteristics in specimens collected via Mode B tended to be higher, but not statistically significant (P>0.05), than those in specimens obtained via Mode C.

Conclusions: Precoital sexual stimulation proved to be an important factor and, as applied in this study, brought about increases in seminal characteristics. Extended precoital sexual stimulation could be used further as a possible modality to maximize the sperm harvest in specimens with spermatogenic dysfunctions, and to thereby improve fertilization and pregnancy rates in the various assisted reproductive technologies.

Key words: coitus, sexual stimulation, seminal characteristics, spermatozoa, sperm quality

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Pregnancy outcome of ovarian hyperstimulation syndrome cycles: a case control study
Shamma A.J. Thwaini Al-Inizi, Magdy Asaad & Juergen Schick

Fertility Clinic, Department of Obstetrics and Gynecology, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates

 ABSTRACT

 Objective: To assess the outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles complicated by moderate- severe ovarian hyperstimulation syndrome (OHSS) and compare it with a control group.

Settings: Department of Obstetrics and Gynecology, Fertility Clinic, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates.

Design: A retrospective controlled study.

Materials and Methods: In the period between January 1994 and August 2000, 3174 IVF/ICSI cycles were performed and 2918 cycles had reached embryo transfer, 564 women achieved pregnancy (19.33%). 92 women (3.15%) developed moderate-severe OHSS and were hospitalized and their medical and IVF records were reviewed. Supportive management was applied to all patients included in the study. Pregnancy test was performed 17 days after ovum pick-up. A control group of 320 consecutive non OHSS pregnancies during the period of the study was included.

Results: Ninety-two women developed moderate-severe OHSS. Clinical pregnancy was achieved in 37 of the 92 cases (40.2%). 51.4% were singletons and 48.6% were multiple pregnancies. The control group contained 89 multiple pregnancies (27.8%). Women with OHSS had a significantly higher incidence of multiple pregnancy, preterm delivery and low birth weight (LBW), (P< 0.05). There was no significant difference in pregnancy complications such as pregnancy induced hypertension (PIH), gestational diabetes (GDM), Abruptio placentae and cesarean section (C/S) rates between the two groups. The group of multiple pregnancy with OHSS had a statistically significant higher incidence of preterm delivery and LBW than the control group of multiple pregnancy without OHSS (p< 0.0025, p< 0.05) respectively.

Conclusion: OHSS does not appear to be associated with adverse pregnancy outcome in general. There was no statistically significant difference in miscarriage, spontaneous fetal reduction (SFR), ectopic pregnancy, PIH, GDM, abruptio placentae and C/S rates when OHSS group was compared to a control group of non OHSS IVF/ICSI pregnant women. However there was a significantly higher incidence of multiple pregnancy, preterm delivery and LBW in the OHSS group when compared with a control group. Women with multiple pregnancy complicated by OHSS were more prone to deliver prematurely and their babies to have LBW when compared to a control group. This could be related to OHSS or other unexplained factors. This finding was not observed when singletons alone were considered.

Key words: OHSS, ovarian hyperstimulation syndrome, IVF/ICSI, in-vitro fertilization intracytoplasmic sperm injection cycles, pregnancy outcome.

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Correlation between apoptosis and angiogenesis in the development and progression of endometriosis
Osama A. Shawki, Abeer A. Bahnassy, Inas El-Attar & Abdel-Rahman N. Zekri

Gynecology & Obstetrics Department, Pathology Department, Epidemiology & Biostatistics Unit, and Virology & Immunology Unit, Cancer Biology Department, NCI,, Cairo University.

 ABSTRACT

 Objective: To determine the contribution of apoptosis and angiogenesis in the pathogenesis and progression of endometriosis.

Study Design: Tissue samples obtained from 50 patients with endometriosis and 16 normal endometrium from healthy women were investigated for apoptosis and angiogenesis. The 3' end-labeling assay (TUNEL), DNA ladder formation and the expression of bcl-2, Bax were used to assess apoptosis. CD34 expression was used to determine the microvessel density.

Results: Apoptotic index (AI) was markedly reduced in endometriotic tissues with a higher bcl-2 expression, lower Bax and infrequent ladder formation (p.value 0.001). The mean vascular density (MVD) was higher in endometriosis than in normal controls (p. = 0.0001). There was a strong negative correlation between AI and the MVD, AI and bcl-2, MVD and Bax and a strong positive correlation between AI and Bax, MVD and bcl-2.

Conclusions: Apoptosis and angiogenesis are implicated in the pathogenesis of endometriosis with a possible inhibitory effect of angiogenesis on apoptosis. Reduced apoptosis provides a survival advantage to the ectopic endometrium to which neovascularization is essential. In addition, the incidence of spontaneous apoptosis is markedly influenced by the extent of angiogenesis suggesting a possible inhibitory role for angiogenesis on apoptosis.

Key words: Endometriosis, Apoptosis, Angiogenesis

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Recurrent abnormal fertilization with oocytes at metaphase I maturation arrest
Mohamed Fahmy & Safaa Al-Hasani

Ob Gyn Dep. Menofia University, Menofia Egypt, and Dept. Of Obstetrics/Gynecology, Medical Univ. Luebeck, Germany

 ABSTRACT

 A case of 11 years primary infertility where the male partner was normal, the female partner only showed, few endometriotic spots on both ovaries with mild peritubal adhesions. The couples were subjected to 3 times IUI and 3 times ICSI with no success all the oocytes retrieved showed metaphase I arrest. Maturation block has been recently reported as a rare phenomenon. We discuss here the possibility of inherited disorder and the possible impact of endometriosis on the success of ART.

Keywords: ICSI, Metaphase arrest, endometriosis

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