|
|
Middle East Fertility Society
Journal
Abstracts of
|
|
|
Middle East Fertility Society
Journal
Abstracts of
|
Embryonic and adult stem cells: you can't tell a cell by its
cover
Ian Rogers and Robert F. Casper
Division of Reproductive Sciences, Fran and Lawrence Bloomberg Department of Obstetrics & Gynecology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital and The University of Toronto, Toronto, Ontario, Canada
ABSTRACT
Embryonic stem cells (ES cells) are capable of unlimited self-renewal and have the ability to give rise to all tissue types in the body. The use of human ES cells for tissue and cell therapeutics has been suggested but is limited by ethical concerns since these cells are derived from the inner cell mass of human embryos. In addition, the need for HLA matching of ES cell-derived tissues for allogeneic transplantation would require a bank of several thousand ES cell lines to make tissue therapeutics practical. Recently, adult stem cells, of which those in bone marrow are the best studied, have been shown to be capable of multilineage differentiation into cells of various non-blood tissues. Umbilical cord blood hematopoietic stem cells have been shown to be equivalent to bone marrow stem cells for reconstitution of the hematopoietic system. Preliminary work has also demonstrated that umbilical cord blood hematopoietic stem cells are multipotent and capable of differentiating into non-blood cell types. This observation raises the exciting possibility of replacing human ES cells for tissue and cell therapeutics with umbilical cord blood hematopoietic stem cells that are normally discarded with the placenta after delivery.
Keywords: umbilical cord, hematopoeitic stem cells, transplantation, tissue therapeutics, adult stem cells.
Female genital organ
transplantation in Islamic countries
Atef Darwish
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
ABSTRACT
Vital organ transplantation is saving the lives of many people all over the world. The increasing research on female genital organ transplantation regained the hope for many young patients who lost their chances for fertility e.g. due to sterility-inducing chemotherapy or radiotherapy. Thanks to the advances in croyotechnology and the advent of cryoprotectants and vitrification, animal and human trials of transplantation of one or more of the genital organs, specially the ovary have been successful. Since 1999, few human studies proved the feasibility and efficacy of transplantation of the female organs. Microsurgical techniques, types, indications, pros and cons of transplantation will be demonstrated and summarized. Ethical issues controlling genital organ transplantation will be discussed. The Islamic regulations of these recent human trials will be addressed.
Key words: ovary, uterus, fallopian tubes, transplantation.
Comparison between
ultrasound-guided embryo transfer and tubal embryo transfer after
intracytoplasmic sperm injection
Sasy M, Abdel Fattah A., Abozaid T, Abdo G., Salem W, Ashraf M, Khan I. &
Abuzeid MI
Reproductive Endocrinology, IVF Michigan, Flint and Rochester Hills, Michigan, 48503, USA
ABSTRACT
Objective: The aim of this study was to compare the effectiveness of transabdominal ultrasound guided embryo transfer with tubal embryo transfer after intracytoplasmic sperm injection procedure severe male factor infertility.
Design: Retrospective study.
Materials and Methods: Between April 1997 and December 2000, 584 ICSI/ET cycles were performed for male factor infertility. Patients were placed into one of four groups based on female age (Group I < 35 years, Group II 35-37 years, Group III 38-40 years, Group IV < 41 years). Each age group was divided into 2 subgroups according to the method of embryo transfer; abdominal ultrasound-guided embryo transfer (USET), or tubal embryo transfer (TET). The clinical pregnancy (CP) rate, delivery rate and implantation rate were calculated. Statistical analyses were performed using analysis of variance and Chi-square.
Results: There were no significant differences in the means of duration of infertility, endometrial thickness, number of oocytes retrieved and the number of embryos transferred between the 2 subgroups in each age group. The CP rate, delivery rate, and implantation rate in the TET subgroup was similar to the USET subgroup for all ages.
Conclusions: Transabdominal ultrasound guided ET appears to be as effective as tubal embryo transfer after ICSI for treatment of severe male factor infertility. Therefore, TET should only be used in selected cases.
Key words: abdominal ultrasound / embryo transfer
Delayed decidualization and
ultrastructural changes of mouse endometrium after mouse ovarian
hyperstimulation at the implantation time
Mandana Biegy, Mojdeh Salehnia & Taki Al-Tiraihi
Department of Anatomy, School of Medical Sciences, Tarbiat Modarres Univ. P O Box: 14115-111, Tehran, Iran.
ABSTRACT
Objective: The aim of this study was to determine the ultrastructural changes of mouse endometrium after ovarian hyperstimulation at the implantation time.
Design: Experimental study
Materials and Methods: Female NMRI mice 6-10 weeks old were superovulated by an intraperitoneal injection of 10 IU human menopausal gonadotropic hormone (hMG), which were followed by a second injection of 10 IU and human chorionic gonadotropic hormones (hCG) 48 later. Superovulated groups were rendered pseudopregnant by mating artificially. The stimulated and non-stimulated mice were sacrificed by cervical dislocation after 4 days of hCG injection. Samples were obtained from middle 1/3 part of the uterine horns fixed and processed for electron microscopic studies.
Results: Micrograph of treated groups after 4 days of hCG injection showed that an increase in the height and density of epithelium and stroma in comparison with control groups. The morphology of epithelium was pseudostratified columar. The number of fat droplets was increased in the basal and apical parts of glandular and surface epithelium. A lot of small pinocytotic vesicles were abundant in the sub apical membrane. Stromal cells arranged more compactly 4 days after hCG injection and the intercellular spaces were narrower than the others groups therefore decidualization were defective.
Conclusion: The ultrastructure of mouse endometrium was affected by ovarian induction and it may be influence on its receptivity.
Key Words: Endometrium, ovarian stimulation, ultrastructure, decidulization
Sex chromosome assessment for
prenatal diagnosis using circulating fetal cells and fluorescence in situ
hybridization
Mirvat El-Ansary, Hesham Al-Inany, Sahar Hussein & Mariam Farag
Departments of Clinical Pathology and Obstetrics and Gynaecology Faculty of Medicine, Cairo University, Cairo, Egypt
ABSTRACT
Objective: Detection of fetal cells in maternal circulation during pregnancy as a potential noninvasive mean of fetal diagnosis.
Design: Prospective study
Setting: Kasr El-Aini Hospital
Participants: Eleven pregnant healthy female with known fetal sex by ultrasound.
Interventions: maternal blood samples at gestational ages ranging from 10 to 26 weeks of gestation were analysed. Fetal cells were enriched among larger populations of maternal cells by density gradient centrifugation followed by immunomagnetic cell sorting of CD71 expressing cells. Fetal origin of the separated cells was confirmed by correlating the presence or absence of Y chromosome specific FISH with the true sex of the fetus.
Results: One hundred percent accuracy of fetal sex determination was achieved. Sensitivity and specificity as regards male detection were 100%. The mean number of fetal cells identified in our work by Y-chromosome specific FISH was 15.5 in 18ml of maternal blood.
Conclusion: FISH is feasible to analyze fetal cells in maternal peripheral blood and can be used for the analysis of Mendelian genetic disorders and fetal aneuploidies.
Key words: prenatal diagnosis, sex chromosome, FISH, fetal cells, noninvasive
Sonohysterography in the
evaluation of perimenopausal bleeding: can it replace hysteroscopy
Ahmed Aboul Nasr, Hesham Hamza, Hesham Al-Inany, Zakaria Aboul
Maaty & Sahar Thabet
Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
ABSTRACT
Objective: To evaluate the accuracy of sonohysterography in the assessment of the uterine cavity in patients with perimenopausal bleeding compared to hysteroscopy
Design: Prospective controlled trial.
Setting: Kasr El-Aini Hospital, Cairo University
Materials and Methods: thirty four women with perimenopausal bleeding were subjected to sonohysterography using saline medium for injection then examined by hysteroscopy under general anesthesia
Results: sonohysterography was found to have sensitivity of 63.6%, specificity of 92.8%, positive predictive value of 77.8% and negative predictive value of 86.7% and diagnostic accuracy of 84.6%, however, SHG gave more accurate diagnosis of submucous myoma with better estimation of the size of fibroid protruding in the cavity, +ve likelihood ratio for SHG was 8.8 and -ve likelihood was 0.39.
Conclusion: sonohysterography as a single investigation modality is feasible with reasonable accuracy and minimal discomfort to the patient.
Keywords: sonohysterography, hysteroscopy, perimenopausal bleeding, fibroid, polyp, cancer
Natural cycle ICSI in low
responders
Hisham Ali Saleh, Ashraf Abou-Ali, Hoda Abd Elhamid & Mervat
Sheikh El-Arab
Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, and Miami IVF/ICSI center, Alexandria, Egypt
ABSTRACT
Objective: To evaluate natural cycle ICSI in previous low responders.
Design: Prospective cohort study.
Materials and methods: 25 natural cycles in 17 patients with poor response in at least two previous cycles, were monitored by serial sonography, and serum LH, and E2 assay. Oocyte retrieval was performed 35hours after hCG in eligible patients, and standard ICSI was performed on retrieved MII oocytes.
Results: OR was attempted in twenty cycles (80%). Successful oocyte recovery was achieved in 13 of them (65%). Sixteen (16) oocytes were obtained as three patients had secondary follicles. Fifteen (15) of the recovered oocytes were MII, and were injected. Successful fertilization and cleavage occurred in 11 cycles, and failed in two (87%) ending in 11 transfer. Pregnancies occurred in five patients, one of them was chemical and four ended in live births (36% per transfer, 20% per attempted retrieval, and 16% per started cycle).
Conclusion: Natural cycle ICSI is a low cost alternative with reasonable success rate in women with previous low response to stimulation due to low ovarian reserve.
Key Words: natural cycle/ ICSI/ poor responder.
Local anesthesia with conscious intravenous
sedation for laparoscopic tubal sterilization: experience in a suburban center
in Egypt
Elsayed A. Etman & Amr E. Etman
Misr Spinning and Weaving Co. Hospital, El-Mahalla El-kobra, and Menoufia School of Medicine, Menoufia, Egypt
ABSTRACT
Objectives: To evaluate the advantage of using local anesthesia with conscious sedation in laparoscopic tubal sterilization.
Design: Retrospective clinical study
Design classification: Canadian taskforce classification III
Setting: One-day surgery center
Patients: One thousand patients seeking tubal sterilization.
Intervention: Laparoscopic tubal sterilization using Fallope ring.
Results: 97% of patients undergoing laparoscopic tubal sterilization under local anesthesia with conscious sedation stated that pain during application of Fallope rings was mild and tolerable. The mean operative time was 15 ｱ 3 minutes. Direct trocar insertion was done in 100 cases. No air embolism, vessel injuries, blood transfusion or death resulted from such procedure.
Conclusions: Local anesthesia with conscious sedation for laparoscopic tubal sterilization with the use of room air is an easy and safe method. It has also been associated with short operative time, easy recovery with fewer burdens on the women or nursing staff.
Keywords: Tubal sterilization, Fallope ring, local anesthesia, laparoscopy, room air, direct trocar insertion
Methotrexate versus laparoscopic surgery for
the management of unruptured tubal pregnancy
Mohamed Tawfik El-Sherbiny, Ibrahim Hussein El-Gharieb & Ismael
Mohamed Mera
Departments of Obstetrics and Gynecology, Damietta General Hospital, El-Sherbiny Hospital, Damietta; El-Mataria Teaching Hospital, and Al-Azher University, Cairo, Egypt.
ABSTRACT
Objective: To evaluate the efficiency and safety of systemic methotrexate (MTX) as an alternative to laparoscopic surgery for the treatment of unruptured tubal pregnancy.
Design: Randomized clinical trial.
Setting: Two governmental hospitals and two private centers.
Subjects: Fifty-eight clinically stable women with unruptured tubal pregnancy as diagnosed by transvaginal sonography (TVS), serum b-human chorionic gonadotropin (b-hCG) < 10,000 IU/L, and a tubal pregnancy < 4 cm. diameter.
Intervention: Patients eligible for the study were randomly allocated to 2 groups: Group I included 26 patients who received 50 mg/m2 intramuscular MTX to be repeated if there was less than 15% decline of b-hCG by day 7. They were compared to 32 women managed by laparoscopic surgery using the same technique and instruments (Group II). Patients of both groups were followed up for one year.
Main outcome measures: Treatment success was defined as the drop of b-hCG to £ 5 IU/L without the need for laparoscopy in Group I or MTX in Group II. Outcome measures also included the frequency of preservation of the tubes, subsequent ipsilateral tubal patency, and future pregnancy within one year.
Results: Among women of Group I, the success rate was 84.6%, not significantly different from that of Group II (87.5%). However, the mean period till serum b-hCG level decreased to £ 5 IU/L was significantly longer in Group I as compared to Group II (30.5 versus 12.4 days, p<0.001). Ipsilateral tubal patency was conserved in 75% of Group I versus 72.7% of Group II. Intrauterine pregnancy occurred in 61.5% of Group I and 60% of Group II. Complications of treatments were observed in 11.5% of Group I and 9.3% of Group II. All these differences were not proved to be statistically significant.
Conclusion: Single dose of systemic methotrexate was well tolerated and could be recommended as an alternative to surgery for treatment of unruptured tubal pregnancy.
Keywords: Ectopic pregnancy, methotrexate, laparoscopic salpingostomy, and laparoscopic salpingectomy.
Analysis of fetal sex and RhD gene in fetal
cells DNA from maternal blood by polymerase chain reaction
Ahangari G., Zeinali S., Ebrahimi M., Mohsani F. & Saremi A.T.
Department of Molecular Medicine and Immunology, National Research Center for Genetic Engineering and Biotechnology; Reproductive Immunology Lab, Sarem Community Hospital and Medical Center; Department of Biotechnology, Pasture Institute of Iran; Department of Surgery, Medical university of Iran, and Department of Fertility and Sterility, Sarem Community Hospital and Medical Center, Tehran, Iran
ABSTRACT
Objective: The Purpose of this study was to determine fetal nucleated red blood cells (NRBCs) among enriched maternal peripheral blood and to evaluate the effectiveness of enriching NRBCs using nested-PCR methods.
Material and methods: We obtained approximately 30ml blood from 53 pregnant women. The mononuclear cells were isolated with ficole. To remove unwanted maternal white blood cells, magnetic beads coated with antibodies against CD45 and CD14 were used as negative selection. Positive selection methods based on using antibody against CD71 and Dynal magnetic were employed to enrich fetal nucleated erythrocytes. DNA was extracted from fetal cells by a standard phenol-chloroform procedure. Nested PCR specific for a region of the amelogenine gene was used for Sex (X and Y) determination as well as for RhD gene.
Results: The most interesting data obtained by isolation of the nucleated fetal erythrocytes. At the DNA level in order to detect fetal sex and RhD PCR was performed to identify fetal sex and RhD in maternal blood circulation in 27 (51%) out of 53 cases.
Conclusion: These results suggest that identification of fetal cells sex and RhD in the maternal blood circulation is possible.
Keywords: Non-invasive Prenatal Genetic Diagnosis, RhD antigen, Fetal Sex, Fetal cells in maternal blood, Nucleotide erythrocytes.
Embryo transfer under propofol anaesthesia: the impact on
implantation and pregnancy rate
Hesham G. Al-Inany, Mohamed Wasseef, Mohamed A. Aboulghar,
Ragaa T. Mansour, Gamal I. Serour & Ahmed M. Abou-Setta
The Egyptian IVF-ET Center, Cairo, Egypt
ABSTRACT
Objective: to evaluate the possible impact of using Propofol anesthesia during embryo transfer on the implantation and pregnancy rates
Design: retrospective study
Methods: Women undergoing IVF/ICSI cycles in the Egyptian IVF-ET center and having general anesthesia for ET due to pre-operative anxiety (Group I =202 women). A matching group of women with easy ET without anesthesia during the same period of time (Group II = 341 women) were used as a control.
Results: There was no statistically significant difference in pregnancy rate between the two groups (45.1%, and 48.1%). There was no statistically significant difference in implantation rates between the two groups (19.6%, and 23.7%). Multiple pregnancy rate was not significantly different between the groups (34.1%, and 37.4%)
Conclusion: the use of propofol general anesthesia during embryo transfer does not seem to have an unfavorable impact on the implantation and pregnancy rates.
Key words: Propofol, Embryo transfer, Assisted Reproduction, ICSI, IVF
Primary bladder endometriosis as detected by 3D-ultrasound
Mohamed Eid, Emad Soliman & Amany Tayae
Dr. Samir Abbas medical center (IVF unit), Jeddah, KSA and Department of Obstetrics & Gynecology, Cairo University, Egypt.
ABSTRACT
We report here a case of primary bladder endometriosis with no previous history of uterine surgery detected by 3D-ultrasound which clearly defined the mass as a full thickness detrusor lesion. Cystoscopy-guided biopsy from the lesion and pathological examination proved bladder endometriosis.
Key words: adenomyosis / bladder endometriosis / 3D-ultrasound
