The Middle East IVF Registry for the year 2000
Ragaa Mansour

The Egyptian IVF-ET Center, Maadi, Cairo, Egypt

ABSTRACT

The International Committee for monitoring ART (ICMART) conducted a workshop in Cairo in order to disseminate tools for data collection and train people to develop national and regional IVF registries. All IVF centers in the Middle East were invited. The program was designed to provide an overview on the already existing national and regional registry models and also to formulate a plan of action to establish the Middle East IVF registry. One hundred and thirty nine infertility specialists representing 97 IVF centers from 14 countries in the Middle East participated in the workshop. The forms for data collection prepared by ICMART were distributed to all centers. Thirty two centers from 8 countries completed the forms for IVF results for the year 2000. In total, data were collected from 1,778 IVF cycles, 14,562 ICSI cycles, and 1030 frozen thawed cycles and 45 GIFT cycles. The clinical pregnancy rates per pick-up were 31.6% in IVF and 27.4% in ICSI. The singleton delivery rate was 67%, twin delivery rate was 27.4% and triplet or high order was 5.2%. The total number of babies born were 621 in IVF, 3,576 in ICSI, 165 from frozen thawed cycles and 14 from oocyte donation. Ovarian hyperstimulation syndrome occurred in 1.68% of all cycles.

(Back to index)

Oxidants and antioxidants in human fertility
Ashok Agarwal and Shyam S.R. Allamaneni.

Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohiot

ABSTRACT

Oxidants are highly unstable molecules that attack every chemical substance they come into contact. Oxidants modify the macromolecules both structurally and functionally. Body has defense mechanisms against oxidants in the form of both enzymatic and non-enzymatic antioxidants. Reactive oxygen species (ROS) are a group of oxidants formed during oxygen metabolism. ROS appears to be involved in the pathogenesis of many human diseases. In reproductive medicine, ROS have both physiological and pathological role in male and female reproduction. Oxidative stress develops when the generation of ROS overwhelms the scavenging capacity of antioxidants. Oxidative stress causes damage to spermatozoa, oocyte and embryos. It appears to play a role in both natural and in vitro fertilization and pregnancy. The patients with oxidative stress may benefit from the strategies to reduce oxidative stress and treatment with antioxidants.

Key words: Oxidants, antioxidants, infertility - male & female, spermatozoa, reactive oxygen species, free radicals

(Back to index)

Assisted hatching: routine or selective application in IVF
Bassam A. Elhelw, Moustafa M. El Sadek and Khaled M. El Nomrosy

Middle East Fertility Center, Dokki, Egypt, and Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt

ABSTRACT

The implantation rate of apparently normal embryos in IVF/ICSI programs has been reported to be 10% to 15% for day 2 or day 3 transfers and 23% to 25% for blastocyst transfers. The hatching process of blastocysts is still not completely understood. In vitro culture of mammalian embryos alters the architecture of their zona pellucida; in vitro derived embryos have thicker zonas, especially the inner layer of zona pellucida. A high proportion of morphologically normal blastocysts have hatching difficulties, and 54% fail to hatch after 8 days of in vitro culture. Assisted hatching was developed as a remedy for this type of implantation failure. Several techniques for assisted hatching have been introduced over the years including; drilling a hole in the zona pellucida, three dimensional partial zona dissection, thinning the zona pellucida, or total removal of the zona. These techniques can be performed chemically, mechanically, by using a LASER beam or a piezoelectric method. Although routine performance of assisted hatching on all embryos in IVF/ICSI patients is neither scientific nor appropriate, there is convincing evidence in the literature that assisted hatching increases the implantation capability of some of the embryos. The proposed indications for assisted hatching are advanced maternal age (³37 years), elevated basal FSH of women, 2 or more previously failed IVF attempts, embryos with thick zona pellucida (>15 mm), abnormal or poor embryo morphology and retarded developmental rate of the embryo.

Key words: Assisted hatching, Zona pellucida, implantation, LASER, Zona drilling, Tyrode's solution

(Back to index)

Serum  β-hCG level: can it discriminate between unruptured and ruptured tubal ectopic pregnancies?
Selcuk Arslan, Gorkem Tuncay, Hakan Aytan and Omer Lutfi Tapisiz

Dr. Zekai Tahir Burak Woman Health Education and Research Hospital, Ankara, Turkey

ABSTRACT

Objective: To evaluate the predictive value of serum bhCG levels in discrimination of intact tubal pregnancies from ruptured tubal pregnancies.

Design: Prospective cohort study.

Setting: A training hospital; Turkey

Patients: Consecutively seen patients from September 1998 to December 2002 with tubal ectopic pregnancies confirmed by laparoscopy and or laparatomy.

Results: 189 patients with tubal ectopic pregnancies were included in the study. 151 cases were confirmed by laparoscopy and or laparatomy. 39 patients had tubal rupture and active bleeding. 121 patients were found to have intact tubes. There was a positive correlation between serum bhCG levels and the size of ectopic pregnancies (p<0.001). The mean size of ectopic pregnancies in the ruptured group was 32.8 SEM 1.7 and 44.1 SEM 3.1 in the ruptured group (p<0.001). However, no significant correlation was found between serum bhCG levels and the tubal status (p=0.917).

Conclusion: There is no correlation between serum bhCG levels and the tubal status in the tubal ectopic pregnancies, so preoperative serum bhCG levels cannot be used in prediction of tubal integrity.

Key words: Ectopic pregnancy, preoperative serum bhCG level, tubal integrity.

(Back to index)

A prospective comparative study between 3D ultrasonography and traditional 2D ultrasonographic assessment of ovarian tumours
Dalia Youssef, Mona Aboulghar, Khaled Abdel Malek, Ahmad El-Halwagy, Bahaa El-Din Hammad and Essam Aboul Foutouh

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

ABSTRACT

Objective: to evaluate the value of 3D ultrasonographic examination of adnexal masses compared to 2-dimensional ultrasound.

Design: prospective clinical study

Setting: Kasr El-Aini hospital, Cairo University

Materials and methods: One hundred women with postmenopausal bleeding were subjected to two dimensional ultrasound and 22 women with ovarian masses were further examined by 3-D ultrasonographic evaluation. Then the findings were compared to histopathological examination of tissue specimens. Data obtained were then analyzed

Results: malignant lesions were found in 7 cases; benign lesions in 13 cases and non-neoplastic lesions in 2 cases (PID and endometrioma). Out of the seven malignant cases; five were cystadenocarcinoma. At cut-off points of 9 and 7 for 2D and 3D respectively achieved 85% sensitivity and 80% specificity

Conclusion: 3D ultrasonography has the potential to be a supplement to 2D ultrasonography and might be useful in identifying malignant ovarian tumors. Large scale studies are needed to confirm our findings

Keywords: 2D ultrasonography, 3D ultrasonography, ovarian cancer, tumors

(Back to index)

Can serum prostate-specific antigen be a promising marker for patients with polycystic ovary syndrome and hirsutism
Ansam A.Al Bayatti, Summer H. Al-Samak and Awatif J. Al Bahar

Department of Biochemistry, College of Medicine, University of Baghdad; Al- Elwyia Teaching Hospital -Al-Kindy Collage of Medicine, University of Baghdad, Baghdad, Iraq and Al Wasal-Hospital, Dubai, AUE

ABSTRACT

Background: Total prostatic specific antigen (TPSA) is a glycoprotein that is secreted from the prostate in males and from paraurethal glands and breast in females.

Objective: To evaluate the total prostate specific antigen (TPSA) in females with hirsutism and PCOS. In order to shade a light on its relation with FSH, LH, Prolactin (PRL), testosterone (testo) and estradiol (E2) as well as to hirsutism score and menstrual cycle disturbance.

Setting: College of Medicine, University of Baghdad and Al-Alwia Hospital, Iraq.

Materials and Methods: Thirty five females with age range of 19-28 years and a mean of 25.3±2.3 years, suffering from PCOS and hirsutism that was classified according to Ferriman and Gallway scale, in approach, hair growth was judged in each of 11 androgen sensitive areas. Group I: score 4-8 consisted of 10 patients; Group II: score 8-12 consisted of 13 patients; and Group III: score 12-16 consisted of 12 patients. All patients with score above 16 were excluded from this study as well as patients with amenorrhea. They were evaluated clinically and by Sonar as well. FSH, LH, PRL, Testo and TPSA were estimated during second to third day of the cycle, while E2 and P were estimated during the midluteal phase using highly sensitive technique ELFA. Twenty fertile apparently healthy females with normal regular menstrual cycles without hirsutism were considered as control. Their age range 18-29 years with a mean of 25.5±2.8 years.

Results: TPSA mean SD was 2.67±0.37 ng/ml in hirsute females with PCOS which was significantly higher than control with a mean ± SD equal to 0.11±0.07 ng/ml (p<0.05). LF level was significantly higher in those patients, thus LH, FSH ratio 2.3±0.87 which was significantly higher in those patients (p<0.05) in comparison to control group. On the other hand P and E2 hormones during midluteal phase were significantly low in them with values 6.59±1.96 ng/ml and 87.55±21.61 pg/ml respectively (9<0.05). All other parameters including testo were more or less similar to control group. There was no significant correlation between TPSA and testo while the more the hirsutism score was the higher the TPSA level.

Conclusion: Serum TPSA level could be detectable in the serum of hirsute patients with PCOS by using ELFA technique, thus it could be a promising marker for such condition. It was noticed that the more the hirsutism score the higher the TPSA level.

Keywords: PCOS, TPSA, hirsutism, ELFA

(Back to index)

3D power Doppler; a possible new predictor for ovarian hyperstimulation syndrome in PCOS: hormonal correlation

Dr. S. Abbas Medical Center (IVF unit), Jeddah, KSA and Department of Ob. Gyn., Cairo University, Cairo, Egypt.

ABSTRACT

Objective: An attempt for prediction of severe OHSS using 3D power Doppler scan of ovarian stromal blood flow in PCOS patients and correlating the findings with serum estradiol (E2).

Design: Prospective-observational study.

Materials and methods: Twenty- two infertile, PCOS patients were included; all were fulfilling the criteria of PCOS and were under gonadotrophins stimulation for IVF or ICSI. Serum E2 and 3D power Doppler were done for each patient on the day of hCG injection. Serum E2 for patients included was (³ 3000 pg/ml), as E2 > 7000 pg/ml is the cut-of figure for cancellation in our center. 3D power Doppler scans, using Voluson 530-3D, were done by the same operator who was blind to the serum E2. Reconstructed 3D vascular image for the ovarian stromal blood flow was recorded and resistance index (RI) was also measured.

Results: Two patterns of 3D vascular images were detected; each pattern was mostly confined to certain level of serum E2.  "Reassuring pattern"; (Pattern 1), regular branches, minimal coils, mild dilatation and RI (0.55 - 0.61); was detected in 15(71%) patients. Serum E2 associated was 3000 - 5000 pg/ml in 12 (57%) patients. Of interest, 3(14%) patients with E2 9000 - 11000 pg/ml, showed this pattern; one (37 years), second (BMI = 29.5 kg/m2), and third (associated endometriosis). OHSS was not observed with this pattern. "Aggressive pattern"; (Pattern II), irregular branches, several angles and coils, marked dilatation and RI (0.48 - 0.52); was detected in 7 (29%) patients. Serum E2 associated was > 5000 - 7000 pg/ml. OHSS was developed in 3 (14%) patients, 2 moderate and one severe.

Conclusion: 3D power Doppler scan for ovarian stromal blood flow reflects the degree of neovascularization "angiogenesis ", which stays behind the pathogenesis of OHSS. So, it could be used as a possible new predictor for OHSS in PCOS patients complementary to serum E2. Moreover, it might be used for reassurance against the development OHSS in certain PCOS patients (age > 35, BMI > 27 kg/m2 and associated endometriosis) even with very high serum E2 level, but this observation needs further extended studies.

Key words: OHSS, PCOS, power Doppler, 3D-US.

(Back to index)

Multiple intravenous oxytocin injection may yield sperm in azoospermic men scheduled for TESE
Ahmed Y. Rezk, Hesham Al-Inany and Mohamed Bedaiwy

Departments of Obstetrics and Gynecology, Benha University; Cairo University and Assuit University, Egypt

ABSTRACT

Objective: The aim of the present trial is to evaluate the value of multiple IV injection of oxytocin in cryptospermic men scheduled for TESE/ICSI

Design: a prospective clinical trial

Materials and methods: Twenty eight infertile cryptospermic men were injected with 1.0 IU oxytocin IV daily for four successive days. Last injection was 20 minutes before collecting semen sample by masturbation. Data were then compared to their semen analysis one week before oxytocin injection (every case was its own self control).

Results: Motile spermatozoa were found in semen in 8 participants (28.6%). Number of sperm identified ranged between 1-5 motile sperm. Motility ranged from shaking movement to progressive movement. In cases where sperm showed any indication of movement, it was used for ICSI. TESE were performed in other subjects who yielded zero sperm. No difference in Blood pressure and pulse were recorded pre- and one hour post- injection. However, 5 cases complained of tension headache and hot flushes.

Conclusion: Multiple dose oxytocin injection in azoopermic men prior to ICSI may yield some spermatozoa, hence saving some cryptospermic men doing TESE.

Key words: oxytocin, azoospermia, cryptozoospermia, TESE

(Back to index)

Clinical, ultrasonographic and endocrine predictors of ovarian response to clomiphene citrate in normogonadotropic anovulatory infertility
Wafaa M Aboul Enien, Nadia A Barghash and Fayrouz S Mohamed Ali

Department of Obstetrics and Gynecology, and Department of Medical Biochemistry, Faculty of Medicine, Alexandria University, Egypt.

ABSTRACT

Objective: To identify screening characteristics involved in the prediction of anovulation after clomiphene citrate (CC) medication.

Design: Prospective follow-up study

Setting: Infertility Clinic, University Department of Obstetrics and Gynecology and Department of Medical Biochemistry, Faculty of Medicine, Alexandria.

Materials and Methods: 60 patients presenting with oligomenorrhea or amenorrhea and infertility. Clinical, ultrasonographic and endocrine screening took place before initiation of CC medication. Endocrine screening included serum assays for LH, FSH, fasting insulin, glucose, leptin, inhibin B, testosterone and androstenedione.

Results: 22 patients (36.6% of the total group) did not ovulate. Age, body mass index (BMI), ovarian volume, Doppler indices of ovarian stromal blood vessels, the LH/FSH ratio serum insulin, leptin, inhibin-B, testosterone and androstenedione differed significantly between CC responders and non-responders. However, forward stepwise multivariate analyses revealed a final prediction model for CC resistant anovulation including BMI, serum insulin and androstenedione.

Conclusions: Data suggest that obesity, hyperinsulinaemia and hyper- androgenaemia are crucial factors involved in ovarian dysfunction that prevent response to CC.

Keywords: Clomiphene citrate, infertility, ultrasound, anovulation, leptin, insulin, inhibin-B.

(Back to index)

Lack of an effect of interferon a-2b on endometrioma cellular respiration
Shawky Z. A. Badawy, Violeta Cuenca and Abdul-Kader Souid

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

ABSTRACT

Objective: To explore the effect of INF a- 2b on oxygen consumption of endometrioma cells in culture.

Design: Oxygen consumption is evaluated by the use of phosphorimeter, which measures oxygen concentration in solution.

Patients: A sample of endometrioma from patients who had undergone surgery for such disease, was cultured to develop cell lines for this study.

Results: INF a-2b (at 4,000 units/ml) inhibited the proliferation of endometrioma cells in culture.  The curves that describe [O2] in the cell suspensions as function of time, were linear, indicating that the kinetics were zero order.  INF a-2b had unnoticeable effect on the cellular oxygen consumption.

Conclusion: INF a-2b treatment does not target the energy converting mechanism in the mitochondria.  Its antiproliferative effect may be related to inhibition of intracellular DNA.

Key words: Endometrioma, Interferon a-2b, O2 consumption

(Back to index)

Peritoneal fluid leptin and interleukin-15 in pelvic endometriosis
Mohamed Abd El-Salam, Gamal Kenawy, Ashraf El-Mashad and Mamdooh Abadeer

Obstetrics and Gynecology, and Medical Biochemistry Departments, Benha Faculty of Medicine, Zagazig University, Egypt

ABSTRACT

Objective: This study investigated the relation between peritoneal fluid (PF) leptin and interleukin-15 (IL-15) concentrations and the severity of pelvic endometriosis.

Design: Peritoneal fluid samples were collected from 40 women with endometriosis and 15 women without endometriosis as controls.

Setting: The Department of Obstetrics and Gynecology, Benha Faculty of Medicine, Zagazig University.

Intervention: Peritoneal fluid samples were collected during laparoscopy. Quantitative measurement of PF leptin and IL-15 was done by enzyme immunoassay.

Results: The mean ranks of PF leptin and IL-15 were significantly higher in women with endometriosis compared to controls (p = 0.001 and 0.004, respectively). PF leptin and IL-15 levels were significantly different in the various stages of endometriosis. The PF leptin in stages I and II was significantly higher than stages III and IV. In addition, significantly higher concentrations of IL-15 were found in stage I than stage III and IV. A significant negative correlation was found between PF leptin levels and the stage of endometriosis (r = -0.578, p < 0.001). Moreover, a significant negative correlation was found between IL-15 and the stage of endometriosis (r = -0.425, p < 0.001). Furthermore, a significant positive correlation was found between PF leptin and IL-15 levels in endometriosis group (r = 0.381, p < 0.05).

Conclusion: This work demonstrated that PF leptin and IL-15 concentrations were elevated in women with endometriosis particularly in the early stages of the disease. This could suggest a role for leptin and IL-15 in the pathogenesis of peritoneal endometriosis and development of endometrial peritoneal implants.

Key Words: Endometriosis - Peritoneal fluid - Leptin - Cytokines- Interleukin-15

(Back to index)

The effect of intramural fibroids on the outcome of IVF
Mona M. Aboulghar, Hesham G. Al-Inany, Mohamed A. Aboulghar, Gamal I. Serour and Ragaa T. Mansour

The Egyptian IVF-ET Center, Maadi, and Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt

ABSTRACT

Objective:  To evaluate the effect of fibroids on outcome of IVF and study value of myomectomy prior to IVF.

Design: Prospective controlled study.

Setting: Private IVF center, The Egyptian IVF ET Center, Maadi, Cairo.

Materials and methods: One hundred and eighty four patients were included. Sixty three patients with intramural fibroids were counseled for either myomectomy or no treatment prior to IVF and decision left to the patient. Group A, N=19 were treated by myomectomy, Group B, N=44 had no myomectomy. Group B were subdivided into B1, N=11 with fibroid at a distance < 5 mm from the endometrial lining and B2, N=33 at a distance of > 5 mm.  Group C, N= 100 were an age-matched group of infertility patients. Group D included 11 submucous fibroids and 10 fibroid polyps that were all treated by hysteroscopic resection.

Main outcome Measures: Size and distance of intramural fibroid to endometrial lining were recorded. Outcome of IVF was compared between fibroids at a distance > 5 mm and < 5 mm from endometrial lining. As well as outcome between group that performed myomectomy and that which did not undergo myomectomy.

Results: Pregnancy rates achieved in the three groups A, B and C were; 50%, 27.5% and 36% respectively. This was found to be non significant. In subgroup B1 there was one pregnancy (9%) as compared to 10 pregnancies in subgroup B2 (30%). The difference was non significant. Following hysteroscopic resection 2 out of 6 patients with submucous fibroids and 6 out of 10 patients with fibroid polyps became pregnant after IVF.

Conclusions: The distance between the intramural myomas and the endometrial lining did not affect the IVF outcome. An insignificant tendency towards improvement of IVF outcome was found in myomas at more than 5 mm from endometrial lining.

Keywords: Fibroid, myomectomy, endometrial cavity, Sonohysterography, IVF

(Back to index)