Strategies for fertility preservation and gonadal protection during  gonadotoxic chemotherapy and radiotherapy
 Mohamed A. Bedaiwy

Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, and Mount Sinai Hospital, ON, Canada.

ABSTRACT

With the recent report of a pregnancy and delivery after autotransplantation of cryopreserved-thawed ovarian cortical strips, preservation of the reproductive potential resurfaced. There is a growing academic and public interest in exploring the available strategies for fertility preservation in patients at risk. This is due to the increasing incidence of cancer during the reproductive age. The overall survival and cure rates of reproductive age cancers are improving due to improvements in cancer therapy. Reproductive derangement is one of the major consequences of cytotoxic chemotherapy and radiotherapy. GnRh analogues concomitant therapy, laparoscopic ovarian transposition, oocyte cryopreservation, embryo cryopreservation and transplantation of cryopreserved-thawed ovarian tissue, are all strategies for fertility preservation in patients at risk. However, no evidence-based strategy is available yet. This article discusses the mechanisms of reproductive failure after gonadotoxic therapy and the currently available fertility preservation strategies.

Key words: chemotherapy/fertility preservation/ovarian failure/radiotherapy.

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Characteristics and possible function of pinopodes seen on the surface of the receptive human endometrium
 Anneli C. Stavreus-Evers

Department of Clinical Science, Division of Obstetrics and Gynecology Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

ABSTRACT

A synchronized development of embryo and endometrium is a prerequisite for a successful implantation. During the time of implantation, pinopodes appear on the endometrial surface. The precise function of these structural markers of endometrial receptivity is not known, but it is generally believed that they play a role in the implantation process. Further understanding of the function of these biomarkers and their role in embryo implantation could aid in better diagnosis and treatment of infertile couples in the future.

Keywords: Implantation window, pinopodes, endometrium.

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Out-patient hysteroscopy: findings and decision making for treatment of abnormal uterine bleeding in pre- and post-menopausal women
 Ashraf M. N. Refaie, Trevor Anderson and Sow S. Cheah

Department of Obstetrics and Gynecology, Erne Hospital, Cornagrade Road, Enniskillen, UK

ABSTRACT

Objective: To assess the feasibility of outpatient hysteroscopy for identifying abnormal findings in uterine cavities of pre- and postmenopausal women presented with abnormal uterine bleeding (AUB) and how can out-patient hysteroscopy affect the decision making for treatment.

Setting: Erne Hospital, Enniskillen, UK.

Materials and Methods: One hundred and twelve pre- and postmenopausal women presented with AUB. All patients had hysteroscopy as an out-patient procedure. Pipelle suction was used to obtain endometrium for histopathology. Ultrasonography was performed before the patient being seen in the out-patient hysteroscopy clinic.

Results: About half of the women in this study were shown to have normal uterine cavities. The most common abnormal hysteroscopic findings were the endometrial polyps (15.1%) and the submucous fibroids (11.3%). Other findings such as atrophy, hyperplasia and cancer were identified in 8.5%, 8.5% and 1.9% respectively. Sixty nine women (61.6%) with normal and atrophic endometrium went on medical treatment. Polypectomy, removal or insertion of intrauterine uterine contraceptive devices (IUCD) were performed in 14.3%, 3.6% and 4.5% respectively. Thermachoice ablation was performed in 8 patients (7.1%). Major surgical intervention in the form of abdominal hysterectomy was decided in 9% of cases.  

Conclusions: Out-patient hysteroscopy is a feasible technique in identifying abnormal uterine findings in cases of AUB in pre- and post menopausal women. Based on hysteroscopic findings, accurate diagnosis of the cause of AUB can be made and subsequently the appropriate decision regarding different treatment options can be chosen.

Key words: Hysteroscopy, ultrasonography, abnormal uterine bleeding.

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Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis
Amira Badrawi, Hesham Al-Inany, Mahmoud Hussein, Salah Zaki and Abdel Maguid Ramzy

Department of Obstetrics & Gynecology, Cairo University, and Nile Badrawi IVF unit, Cairo, Egypt

ABSTRACT

Objective: GnRH antagonists have been introduced into clinical practice as an attractive alternative to GnRH long protocol under the concept of a patient friendly medication. We wished to evaluate the cost effectiveness of a human menopausal gonadotropin (hMG) / GnRH antagonist flexible protocol versus a long GnRH agonist / hMG protocol.

Design: single center randomized controlled trial using sealed envelopes as a method for randomization.

Materials and methods:  One hundred women undergoing ICSI were randomized to receive either hMG/GnRH agonist long protocol (group I) or hMG/GnRH antagonist when follicle reaches 15 mm (group II).

Results: Two cases had premature LH surge in group II. Fifteen cases (30%) got pregnant in the first group as compared to 12 cases (24%) in the second group. The difference was statistically non-significant. The mean cost of medications per cycle was estimated to be $608 (3740 Egyptian Pounds) in the hMG/antagonist group, while it was $680 (4180 E.P) in the long GnRH agonist protocol treated group. This difference was statistically. However, the total cost per pregnancy was $6531 (40166 EP) in the hMG/antagonist protocol and $5008 (30800 EP) in the GnRH-a/hMG protocol which is statistically significant.

Conclusion: the use of the hMG/antagonist protocol is not a cost effective strategy although it provides short and simple stimulation protocol.

Keywords: GnRH antagonist, Flexible, agonist, ovarian stimulation, ICSI

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The difficulties encountered with embryo transfer and the role of catheter choice in clinical pregnancy success rates in an IVF cycle
 Cem Fıçıcıoglu, Evrim Aksoy, Nihal Dolgun, Belgin Devranoğlu, Seval Tasdemir, Ayça Cubukçu and Şafak Tavukçuoğlu

Zeynep Kamil Women and Children's Hospital Reproductive endocrinology and Infertility division and Ferti-Jin ART center, Istanbul Turkey.

ABSTRACT

Objective: The aim of the study was to compare the clinical pregnancy rates of soft catheters and catheters with stylet in according to the difficulty levels of transfer.

Setting: Zeynep Kamil Women and Children's Hospital Reproductive endocrinology and Infertility division and Ferti-Jin ART center.

Materials and methods: The total number of 1158 embryo transfers performed are examined retrospectively. The embryo transfer performances are divided into three groups as easy, moderately-difficult and difficult. 827 transfers were in the easy group, 284 were in moderately-difficult group and 47 were in the difficult group.

Results: The pregnancy rates were % 41.4, % 36.2, and % 17, respectively. There were statistically significant difference between group 1 and group 3, p<0.05 and between group 2 and group 3, p<0.05. There were no statistically significant difference between group 1 and group 2, p>0.05.

Conclusions: In case of the failure of the embryo transfer by soft catheter by detected in mock transfer, it may be replaced by catheter with stylet to achieve the transfer. But the success of IVF is the highest in the easy-transferred and soft catheter used group. In moderately difficult group, it is possible to improve the clinical pregnancy rates by choosing catheter with stylet but not in diffucult transfer goup. Therefore examining the cervical canal, "trying mock transfer and deciding which catheter is to be used", before the transfer is very useful.

Key words: IVF-ET, Embryo transfer

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Biochemical markers for prediction of pregnancy outcome in cases of recurrent pregnancy loss
Amal Darwish, Nabil Ghorab, Hazem El-Ashmawy, Manal Kamal and Ahmed Soliman

Department of Obstetrics and Gynecology, Cairo University, Galaa Teaching hospital, Cairo, Egypt

ABSTRACT

Objective: To predict pregnancy outcome by studying the relation between serum bHCG, progesterone and CA125 and the occurrence of miscarriage in the first trimester, in cases with history of recurrent pregnancy loss.

Design: Prospective controlled trial.

Setting: Kasr- El-Aini Hospital and Galaa Hospital.

Materials and methods: Serum bHCG, progesterone and CA125 levels in twenty pregnant women with history of recurrent pregnancy loss were compared to 20 pregnant women with no history of abortion, and to another group of women (No=20) who failed to complete the 1st trimester of pregnancy during the study.

Results: Serum B-hCG showed a sensitivity of 100%, a specificity of 50%, a PPV of 50% and a NPV of 100%. serum progesterone showed a sensitivity of 25%, a specificity of 78%, a PPV of 36% and a NPV of 67%, While serum CA125 showed a sensitivity of 10%, a specificity of 65%, a PPV of 13% and a NPV of 59%.

Conclusion: the value of CA125 in recurrent abortions is still unclear and cannot be recommended on routine basis. On the other hand b-HCG is 100% sensitive with a 50% NPV as a single serum measurement for the prediction of pregnancy outcome.

Keywords: Recurrent pregnancy loss, abortion, CA125, B-hCG, progesterone

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Three dimensional endometrial volume versus endometrial thickness measurement in prediction of IVF/ICSI outcome
 Mona M. Aboulghar, Hesham G. Al-Inany, Mohamed A. Aboulghar, Gamal I. Serour, Ragaa T. Mansour, Yehia M. Amin, and Ahmed M. Abou-Setta

The Egyptian IVF & ET Center, Maadi

ABSTRACT

Objective: To investigate the role of estimating endometrial volume and it's correlation with endometrial thickness, on the day of hCG, in prediction of IVF outcome. 

Methods: Endometrial volume and endometrial thickness were measured in women undergoing an IVF/ICSI cycle, on the day of HCG, using the 3 D transvaginal ultrasound probe (Sonoace 9900 Medison -Kretz, Korea). Patients were divided according to endometrial volume calculated into 3 subgroups; < 2ml, 2-4ml, and >4 ml, as well as according to endometrial thickness into 3 groups; <8mm, 8-12mm and >12mm. Pregnancy rates were compared between all groups.

Results: The study included 103 women with no significant difference in background characteristics between all subgroups. The pregnancy rates between the three groups of endometrial volume; <2ml, 2-4ml, and >4 ml was; 42%, 36% and 48% respectively. 

Pregnancy rates between the three groups of endometrial thickness were 25%, 40% and 50 % for <8mm, 8-12 and >12mm respectively. There was no significant difference in pregnancy rates between all groups in relation to both endometrial volume and endometrial thickness.

Conclusion: Endometrial volume on day of hCG is not a better predictor than endometrial thickness for determining outcome of IVF/ICSI cycles.

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Effect of late coasting used in the prevention of ovarian hyperstimulation syndrome on oocyte quality
Amany Shaltout, Amal Shohayeb, Adel Faruk, Mohamad Eid, Mona Mostafa and Ashraf Eldaly

Samir Abbas Medical Center, Jeddah, KSA.

ABSTRACT

Objective: To detect the effect of late coasting on oocyte quality.

Design: Retrospective study.

Setting: Samir Abbas Medical Center

Materials and methods: Patients where estradiol level was over 4000 pg/ml and late coasting was used as a method to prevent OHSS, and patients where estradiol level was over 4000 pg / ml  but no coasting was done

Main outcome measure(s) : Oocyte quality.

Results: number of mature oocytes was identical in both groups,however the significant difference was in the oocyte recovery rate which was higher in the control group (120) than in the coasting group(92)

Conclusion(s): Oocyte quality is not affected after using coasting as a method for prevention of OHSS. Effect of late coasting used in the prevention of ovarian hyperstimulation syndrome on oocyte quality

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Role of oocyte morphology on fertilization and embryo formation in assisted reproductive techniques
Mohammad A. Khalili, Mahdieh Mojibian and Abdul-Munaf Sultan

Fertility & Infertility Research Center, Isfahan University of Medical Sciences, Isfahan and Department of Obstetrics & Gynecology, Yazd University of Medical Sciences, and Dr. Mojibian Hospital, Yazd, Iran; and ART Center, Qatar Women's Hospital, Qatar

ABSTRACT

Objective: To assess the influence of MII oocyte morphology on the fertilization outcome and embryo development in ART cycles. Since, age may affect the quality of oocyte, the role of women's age was also evaluated following IVF or ICSI cycles.

Materials and Methods: 200 MII oocytes from 30 IVF and ICSI cycles were evaluated. The morphology of oocytes that were fertilized in IVF cycles (IVF+) was compared with failed fertilization (IVF-). The oocytes were similarly categorized in the ICSI procedure (ICSI+ and ICSI-). The criteria for morphological evaluations were: a. normal oocytes showed clear cytoplasm with homogenous fine granularity; b. granular oocytes, dark with granularity either homogenous in whole cytoplasm or concentrated in the central portion of the oocyte; c. cytoplasmic inclusions comprised vacuoles presumed to be of endocytotic origin; d. dark zona pellucida (ZP), e. fragmented polar body (PB) of different sizes; f. non-spherical shape of oocyte; and g. wide previtelline space (PVS). Embryo transfer took place 48 h after insemination/ injection. The statistical significance of the data was analyzed using chi-square and Fisher's exact tests.

Results: A total of 67 and 78 oocytes were fertilized in IVF and ICSI cycles, respectively. 46.3% and 35.9% of fertilized oocytes were shown with normal morphology in IVF and ICSI cases, respectively. The rates of grade A & B embryos were significantly higher in oocytes with normal morphology (P<0.05). The mean number of embryos transferred was similar in IVF and ICSI groups (3.3±0.4 versus 3.0±0.9). In IVF+ and ICSI+, fragmented PBs were the highest rates of single abnormality with 11.9% and 14.1%, respectively. Also, multiple abnormalities were observed in 21.0% and 48.5% of oocytes in IVF+ and IVF-, respectively (P<0.001).  15.4% and 31.8% of the oocytes from ICSI+ and ICSI- were presented with more than one abnormality. Refractile bodies were the highest type of single abnormality (18.2%) in ICSI- group.

Conclusions: In both IVF and ICSI, the highest rates of fertilization and embryo formation took place in oocytes with normal morphological features that were retrieved from young patients. The most single morphological features involved in failed fertilization were refractile body in ICSI and ooplasm granulation in IVF cases. The data suggest that oocyte quality plays a major role in fertilization process and embryo development in ART program.

Key Words: Oocyte morphology, Human Embryo, IVF, ICSI, Infertility

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