Chlamydia testing in infertility management
Jolande A. Land

Department of Obstetrics and Gynaecology, Research Institute Growth and Development (GROW), Academisch Ziekenhuis Maastricht, and Maastricht University, Maastricht, The Netherlands

ABSTRACT

In the majority of women, chlamydia infections occur during adolescence, and remain asymptomatic. These unrecognized and untreated infections may increase the risk for tubal factor subfertility at a later age. Since the association between chlamydia IgG antibodies in serum and  tubal pathology was noticed, chlamydia antibody testing (CAT) has been used in the fertility work-up as an inexpensive and non-invasive screening test for tubal factor subfertility. The predictive value of CAT is limited, however, and clinicians should be aware of factors known to affect the diagnostic accuracy of CAT (such as test and cut-off titre used, and definition of tubal factor subfertility).

Women who undergo uterine instrumentation (e.g. hysterosalpingography and laparoscopy with hydrotubation) are considered at risk for pelvic infections. In subfertile women, the incidence of active chlamydia infections is low (1-2%). But since the presence of viable chlamydia micro-organisms in their upper genital tracts cannot be excluded, prophylactic antibiotics before uterine instrumentation should be considered in all subfertile women, instead of endocervical screening for C. trachomatis and treatment of positive cases only.

Key words: Chlamydia trachomatis, Chlamydia antibody testing, tubal pathology, infertility, cervical screening, uterine instrumentation

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Intrauterine insemination
 Aboubakr M. Elnashar

Department of Obstetrics and Gynecology, Benha University Hospital, Egypt

ABSTRACT

Stimulated intrauterine insemination (IUI) should be the first choice treatment for mild male factor infertility, unexplained infertility or minimal to mild endometriosis. In mild male factor infertility, unexplained infertility, IUI is as effective as IVF & at 1/3 of the cost per pregnancy. In couples with the most severe semen defects, IUI in natural cycle should be the treatment of choice. In mild to moderate semen defects, mild ovarian hyperstimulation with IUI is recommended.  In endometriosis, simplified ultrlong protocol with IUI gives better chances of achieving pregnancy.  Ultrasonographic monitoring & human chorionic gonadotropin (hCG) induction of ovulation does not produce an increased pregnancy rate over urinary lutenising hormone (LH) monitoring of ovulation.  Double IUI showed no significant benefit over single IUI. Four cycles of IUI are enough.  Continued IUI is not recommended.

Key words: intrauterine insemination, infertility

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Generation of viable human embryos in a protein-free embryo culture (ART-7b) medium enhances clinical pregnancy rate and prevents disease transmission in assisted reproduction
 Jaffar Ali

IVF Unit, Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; and IVF Damansara, Damansara Specialist Hospital, Malaysia

ABSTRACT

Objective: To perform a clinical trial to evaluate human embryos generated in the protein-free medium (PFM).

Materials and methods: The quality of embryos generated in medium with (control; Medi-CultTM) and without protein (test; ART-7b) and their viability were compared.  Sperm was prepared in control or test media as appropriate. Effect of different antibiotic supplements in the PFM was investigated. The efficacy of the PFM following frozen-storage for 2 years was also determined. Investigations and clinical trial in the human were performed with approval of the hospital management.

Results: The fertilization rate and the quality of embryos (IVF and ICSI) in the test PFM were either statistically higher or similar in comparison to control medium containing protein. The clinical pregnancy rate from embryos generated in the PFM (with +ve fetal heart beat) was 54.7% (52/95) in women 39 years and below. The clinical pregnancy rate from embryos generated in frozen-thawed PFM or that supplemented with different antibiotics was similar to fresh test medium.

Conclusion: An efficacious PFM has been formulated which could be useful in the elimination of transmission of protein-bound pathogens and prions to IVF patients.

Keywords: albumin, day 2, embryos, PFM, ultra micro-droplet, ART-7b

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Testicular sperm extraction and cryopreservation in patients with non-obstructive azoospermia prior to ovarian stimulation for ICSI
Taha Abd Elnaser and Hamsa Rashwan

Andrology Department and Gynecology and Obstetric Department, Faculty of Medicine, Cairo University and Adam international clinic, Mohandeseen, Cairo Egypt.

ABSTRACT

Objective: To compare between freshly retrieved and cryopreserved testicular sperm obtained from patients with non-obstructive azoospermia (NOA) undergoing intracytoplasmic sperm injection.

Design: Retrospective analysis of 168 TESE / ICSI cycles.

Setting: Adam international clinic. Giza, Egypt.

Materials and methods: One hundred sixty patients with documented NOA underwent microdissection TESE and either cryopreservation of the retrieved sperms (107) or concomittent ICSI at the same time (53), ICSI was planned later for the group who underwent crypoperservation. Comparison between the two groups in terms of fertilization, implantation, clinical pregnancy and abortion rates was done

Results: fifty four cycles were performed using freshly retrieved testicular sperm and 114 cycles were performed with cryo-thawed testicular sperms. The fertilization, implantation, pregnancy and abortion rates were 59.2%, 22%, 50% and 3.7% respectively for the first group versus 58.7%, 22% 45% and 16.3% for the second group respectively. No statistically significant differences were found in any of these parameters between the 2 groups (P > 0.05). Also, testicular histopathology did not affect ICSI outcome significantly between the 2 groups regardless of the degree of impairment of spermatogenesis.

Conclusion: cryo-thawed testicular sperm from NOA patients has the same fertilizing potential in ICSI programs, as the freshly retrieved sperm in those patients, TESE/cryopreservation has many advantages over TESE/ICSI in patients with NOA, So it should be considered as the first line in the therapy of those patients.

Key words: Cryopresevation, ICSI, non-obstructive azoospermia, TESE, testicular biopsy.

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Acanthosis nigricans as skin manifestation of polycystic ovaries syndrome in primary infertile females
Khalifa E. Sharquie, Ansma Al-Bayatti, Awatif . Al-Bahar and Qais M. A. Al-Zaidi

Departments of Dermatology and Venereology, and Biochemistry, College of Medicine, University of Baghdad, Baghdad, Iraq

ABSTRACT

Objective: The present work is to record the frequency of Acanthosis Nigricans (AN) among patients with Polycystic Ovaries Syndrome (PCOS), and to observe the frequency of PCOS among patients with AN. and to study the association between AN & PCOS

Materials and methods: The present study consisted of two groups of patients; the first group included thirty-two primary infertile females. Their ages ranged from 18-33 years with a mean ｱ SD of 25.8 ｱ 7.2.  The second group included twenty unmarried females with benign AN. Their ages ranged from 16-48 years with a mean ｱ SD of 18.55ｱ3.73. 15 (75%). All patients are assessed by clinical examination, sonar and hormonal profile. The diagnosis of AN is mainly clinical by observation of hyperpigmented verrucous plagues with a velvety texture symmetrically distributed in the intertriginous areas and oral and anogenital mucosa. The diagnosis was confirmed by histopathological examination.

Results: The first group with primary infertility and PCOS. had AN. In 68.75%, while the second unmarried group who are complaining from AN. Showed the features of PCOS. in 75% of patients

Conclusion: This study showed a close association between PCOS and AN. So AN should be considered as an important skin marker and major feature of PCOS

Key word: Acanthosis Nigricans, Polycytic Ovaries Syndrome, Primary Infertility

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Transvaginal ultrasound appearance of the ovary in infertile women with oligomenorrhea: association with clinical and endocrine profiles
Ahmed Aboul Nasr, Hesham Hamzah, Zakaria Abou El Maaty, Hesham Gaber & Omniah Azzam

Department of Obstetrics & Gynecology, Cairo University, Cairo, Egypt

ABSTRACT

Objective: to assess the morphological findings of the ovary based on transvaginal ultrasound in infertile oligomenorrheic women and their predictivity for endocrine signs of polycystic ovary syndrome

Design: prospective controlled trial

Setting: Kasr El-Aini Hospital

Participants: Fifty women were recruited and divided into two groups: Group I: 30 patients suffering from primary or secondary infertility with oligomenorrhea. Group II: 20 apparently normal parous women non-hirsute, non-obese, with normal menstrual rhythm and normal serum concentration of LH as control.

Interventions: All women were examined by transvaginal sonography, assessed for dody mass index and hirsutism. Blood withdrawal was performed for hormone estimates.

Main Outcome measures: Ovarian follicle number, volume, stromal width, cross sectional area, roundness index and uterine width / ovarian length. Estimates of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone were performed.

Results: All the ultrasonographic criteria for PCOS diagnosis showed highly statistically significant difference between the study and control group (P =0.0001). The hormonal characteristics in the form of high LH, LH/FSH ratio >3 and high testosterone showed statistically significant difference between study and control group (P<0.05). Polycystic ovaries could be observed in 20% of normal control population. About half of the patients in the study group were hirsute. There was statistically significant difference between hirsute and non-hirsute subgroups as regards the ultrasonographic criteria (P<0.05) but not the hormonal ones. There was no statistically significant difference between obese and non-obese patients in the study group as regards all ultrasonographic criteria except for increased cross sectional area (P=0.025) The mean stromal width as a single test and mean stromal width and/or mean roundness index as a combined test appear to be the most valuable sonographic parameters as screening test to predict endocrine abnormalities characteristic for PCOS diagnosis.

Conclusion: A wide spectrum of ultrasonographic ovarian findings can be demonstrated in PCOS, extending from apparently normal to markedly enlarged cystic ovaries. In addition some women show sonographic signs of PCO without hyperandrogenemia, others are hyperandrogenemic without clinical symptoms and without typical sonographic PCOS signs. Amongst all sonographic signs abnormal ovarian stroma alone or in combination was the most sensitive one in prediction for endocrine profiles.

Keywords: Oligomenorrhea, PCOS, infertility, transvaginal ultrasound. Hyperandrogenaemia.

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Comparison of embryo development in sibling  oocytes cultured in two different sequential media
Necati Findikli, Semra Kahraman, Ersan Donmez, Semra Sertyel, Sureyya Melil and Moncef Benkhalifa

ART, Reproductive Endocrinology & Genetics Center, Istanbul Memorial Hospital, Istanbul, Turkey

ABSTRACT

Objective: To compare the efficiency of two different sequential media for the cultivation of sibling embryos until the blastocyst stage.

Design: A prospective analysis was conducted on 113 ART cycles with the indication of severe male factor infertility in Istanbul Memorial Hospital ART and Genetics Unit. Setting: After insemination, oocytes were randomly divided into two groups and cultured with either ISM1/ISM2 or G1.2/G2.2 sequential media until embryo transfer. Embryo development parameters were recorded for every embryo on consecutive days of preimplantation embryo development, growing in each set of culture media.

Results: 16.7±6.4 MII oocytes were retrieved. Out of 1434 MII oocytes injected, 1044 were fertilized (72.8%). There was no statistically significant difference in the rate of fertilization (p>0.05). Also, there was no difference in embryo development on the second day of cultivation. On the 3rd day of cultivation, the mean number of blastomeres was significantly higher in embryos cultivated within ISM1 (p<0.01). There was no statistically significant difference among the two groups in terms of blastulation rate.

Discussion: Both G1.2-G2.2 and ISM1-ISM2 sequential cultures are equally effective for in-vitro cultivation of embryos until the blastocyst stage. Our results show that both commercial media can be used as valuable and efficient alternatives to each other for sustaining blastocyst development in extended embryo culture programs. ISM1 may be preferred when blastomere biopsy for preimplantation genetic diagnosis is planned as more embryos with 7-8 blastomeres can be available with the use of ISM1.

Key Words: Human embryo development, sibling oocytes, sequential media, severe male infertility

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Letrozole induction of ovulation in clomiphene citrate resistant polycystic ovary syndrome: responders and non-responders
 Aboubakr Elnashar, Hany Fouad, Magdy Eldosoky and Naser Abelgafar

Benha University Hospital Clinic, Benha, Egypt.

ABSTRACT

Objective: To evaluate the efficacy of Letrozole in induction of ovulation in cases of CC-resistant PCOS and to compare between Letrozole responders and non-responders.

Design: Prospective trial in infertility patients treated with CC

Setting: Benha University Hospital Clinic, Egypt.

Patient(s): Forty-four infertile women with anovulatory PCOS who failed to ovulate with CC.

Intervention(s): Letrozole was given in a dose of 2.5 mg/day from day 3 to day 7 of the menstrual cycle. When the dominant follicle reached a diameter > 18 mm, HCG 10.000 U was given and timed intercourse was advised.

Main outcome measure(s): Occurrence of ovulation, endomertial thickness, cervical score & pregnancy rate

Results:  On the day of HCG administration, the mean number of follicles ³ 18mm was 1.21, the mean endometrial thickness was 10.2 mm and cervical mucus score was 11.42. Ovulation occurred in 24 cases (54.6%) and pregnancy in 6 cases (25%). There was no significant difference between Letrozole responders and non-responders as regards the age, period of infertility, BMI, waist circumference, LH, FS H or LH/FSH ratio.

Conclusion(s): Induction of ovulation with Letrozole in CC-resistant PCOS is not dependent on age, period of infertility, BMI, waist circumference, menstrual pattern, hirsutism, LH, FSH or LH/FSH ratio. Further studies are necessary to confirm these results.

Key Words: Letrozole, clomiphene citrate, PCOS, ovulation, infertility

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Histological evaluation and In situ localization of apoptosis in fresh and cryopreserved ovarian tissue
 Mohamed A. Bedaiwy and Mahmoud R. Hussein

Departments of Obstetrics and Gynecology, Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio; department of Obstetrics and Gynecology, and Pathology Department, Assiut School of Medicine, Assiut, Egypt.

ABSTRACT

Objective: To study the feasibility of using combined morphology and terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) for apoptosis detection and the impact of cryopreservation on this process.

Materials and methods: We conducted this investigation using a porcine animal model. Bilateral oophorectomy was performed in eight sows. The ovarian tissues were divided into two parts; one part was immediately fixed while the other was cryopreserved.  The cryopreserved specimens were subsequently thawed and then fixed. All the specimens were sectioned, fixed and stained with H&E. The ovarian follicles were counted, histologically categorized as healthy and atretic and evaluated for the presence of apoptosis. Then, in situ examination of apoptosis was performed using TUNEL assay. 

Results: In the cryopreserved tissues: 1) the count of the primordial follicle was significantly reduced as compared to freshly- fixed samples (4.9±5.3 vs. 7.2±5.4, p=0.03 respectively) and 2) the mean values of apoptosis were insignificantly higher when compared to the freshly-fixed group (p=0.74). Moreover: 1) apoptosis was found in the atretic, but not in the healthy follicles (primordial, primary and  secondary); 2) the nuclei of the granulosa cells, but not those of theca or stromal cells, were TUNEL positive; 3) some cells with histological features of necrosis and apoptosis were TUNEL negative, and 6) The distribution of apoptosis was not different between cryopreserved tissue and freshly fixed tissue.

Conclusions:  the presence of apoptosis in the atretic follicles may suggest its involvement in follicular atresia; and 2) combined histology and TUNEL assay may be a useful method for detection of apoptosis.

Key words: Apoptosis/ovarian cryopreservation/Morphology/TUNEL assay.

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Heterotopic pregnancy following induction of ovulation in PCOS
Mohamed Addar

Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Saudi Arabia

ABSTRACT

A case of successful intrauterine pregnancy diagnosed after surgical removal of a ruptured ectopic pregnancy in a patient subjected to induction of ovulation for PCOS. Heterotopic pregnancy is a problem with increasing incidence that needs high alertness to avoid serious complications.

Key Words: Ectopic pregnancy, induction of ovulation, heterotopic pregnancy

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