Assisted Reproductive Technology in Egypt, 2001: results generated from the Egyptian IVF registry
Ragaa T. Mansour, and Ahmed M. Abou-Setta

The Egyptian IVF-ET Center, 3, Street 161, Hadayek El Maadi, Cairo, 11431, Egypt

ABSTRACT

Objective: To summarize the results of ART procedures cycles initiated in Egypt during the year 2001.

Design: The 'World Report on ART' forms, prepared by the International Committee for Monitoring Assisted Reproductive Technology (ICMART), were distributed to all IVF centers in Egypt.

Materials and methods: All IVF centers in Egypt were invited to voluntarily participate.

Main outcome measures: The total number of standard IVF, ICSI, FET after standard IVF and ICSI cycles, incidence of clinical pregnancy, abortion, delivery, stillbirth and complications rates.

Results: Data was anonymously received from 16 centers, with a total of 6,757 reported cycles. ICSI constituted 91.4%, IVF constituted 4.4%, while the frozen-thawed embryo replacement cycles represented only 4.2% of the total number of ART cycles. As for standard IVF, the clinical pregnancy rate per aspiration and per transfer was 27.5 and 27.9%, respectively. For ICSI, the corresponding rates were 33.1 and 34.7%. The distribution of singleton, twin, triplet and high-order deliveries for IVF, ICSI and FET combined was 67.2, 29.1, and 3.6 respectively. This gives a total multiple delivery rates of 32.7%.  As a result of ART activities, 1,914 neonates were reported born. Complications of ART were mainly ovarian hyperstimulation syndrome, complicating 2.2% of cycles; the occurrence of bleeding in 0.27% and infection in 0.07% of all aspiration cycles.

Conclusions: This is the third consecutive report of the activities of the Egyptian IVF registry for cycles initiated during the year 2001. The clinical pregnancy rates were comparable with the previous reports. The multiple pregnancy rate is still high due to the transfer of >3 embryos. The practice of cryopreservation of embryos is still limited to only a few centers. OHSS is also high and therefore in the future preventative measures must be stricter. More efforts are needed to complete data on deliveries and perinatal mortalities.

Key words: Egypt, IVF, ICSI, registry data

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Enhancing research ethics capacity: implications for protection of research subjects, avoiding exploitation and achieving global health
Henry Silverman

University of Maryland School of Medicine, Baltimore, Maryland U.S.A.

ABSTRACT

Research sponsored by developed countries is increasingly being conducted in developing countries. While many celebrate the enhanced funding of foreign sponsors, others are concerned with the ethics of such research. Ethical issues usually center on the protection of the rights and welfare of human subjects involved in research. Another important issue involves avoiding exploitation by ensuring that developing countries receive a fair share of the benefits of foreign-sponsored research. A fair exchange of benefits between resource-rich and resource-scarce counties can help achieve global health. To ensure that research conducted in developing countries undergo proper ethical oversight and is responsive to the local context, measures to enhance research ethics capacity needs to be instituted in the developing world.

Key Words:  Research Ethics, International, Justice, Research Capacity

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Ultrasonically diagnosed polycystic ovaries in asymptomatic women with normal hormonal profile does not affect their fecundity
Amal Shohayeb,  Amany Shaltout, Adel Farouk, Mohamed Eid, Mona Mostafa, and Akmal Elmazny

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt

ABSTRACT

Objective: To evaluate the effect on fertility of ultrasonically diagnosed polycystic ovaries in asymptomatic women with normal basal hormonal profile.

Design: Case - control Study.

Stetting: Samir Abbas Medical Center.

Patient(s): Women with ultrasound appearance of polycystic ovaries and women with normal ovaries.

Intervention(s): Three dimensional ultrasound to evaluate ovarian volume and morphological features of polycystic ovaries.

Main outcome Measure (s): Time to pregnancy (TTP) of both groups.

Results: The TTP of women with polycystic ovaries was not significantly longer and they were not more likely to be subfertile than women with normal ovaries (6.7±3.2 versus 8.1±3.3 years respectively).

Conclusion: Without symptoms or endocrine disturbances of polycystic ovarian syndrome, polycystic ovarian appearance has shown not to have significant detrimental effect on fertility. Appearances alone are not indicative of the clinical or endocrine features associated with the syndrome, and additional diagnostic criteria should be considered

Key Words: Infertility, polycystic ovaries, polycystic ovarian syndrome, three dimensional ultrasonography.

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The role of intrauterine balloon after operative hysteroscopy in the prevention of intrauterine adhesions: a prospective controlled study
Mohamed I. Amer, Amre El Nadim, and Karim H. Ramzy

Department of obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.

ABSTRACT

Objective: To assess the efficacy of intrauterine Balloon in preventing intrauterine adhesions after operative hysteroscopy.

Setting: Ain Shams University Hospitals. 

Design: A prospective controlled study.

Materials and methods: 50 women for whom operative Hysteroscopy were indicated, 20 (40%) with intrauterine adhesions (group A), 20 (40%) with uterine fibroids (group B) and 10 (20%) with uterine septa (group C). Each group was classified to two subgroups, subgroup (I) with balloon and subgroup (II) without balloon. Adhesion grade was compared for each patient preoperative and 6-8 weeks postoperative. Foley catheter balloon No 10 F inflated with 3.5 ml of saline with cutting its stem above the cervix, were left intrauterine in patients in subgroup (I).The balloon removed one week postoperative under paracervical anesthesia. Diagnostic Hysteroscopy was performed 6-8 weeks postoperative to evaluate for intrauterine adhesions in all groups.

Results: In group (A), 12 (60%) patients were in sub-group I, 8 (66.7%) developed no adhesions and 4 (33.3%) developed adhesions, 8 (40%) patients were in sub-group II, 3 (37.5%) developed no adhesions and 5 (62.5%) developed adhesions. for group (B), 15 (75%) were in sub-group I, from which 13 (86.7%) developed no adhesions and 2 (13.3%) developed adhesions and 5 (25%) patients were in sub-group II, from which 3 (60%) developed no adhesions, and 2 (40%) developed adhesions. In-group (C), 5 (50%) were in sub-group (I) from which 4 (80%) developed no adhesions and 1 (20%) developed adhesions, the other 5 (50%) in-sub-group (II), 3 (60%) developed no adhesions and 2 (40%) developed adhesions. These results are of clinical and practical importance, although it shows no statistical significance in each group separately (P value >0.05), but when comparing patients in subgroup I to those in subgroup II in the three groups (P value 0.04), it is statistically significant.

Conclusion: Intrauterine balloon application after operative Hysteroscopy is of great value in preventing intrauterine adhesions.

Keywords: Intrauterine balloon, Operative Hysteroscopy, intrauterine adhesions.

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Clomiphene-acetylcysteine combination as a new protocol to a friendly IVF cycle
Ahmed Y Rizk, Mohamed A Bedaiwy, and Hesham G. Al- Inany

Departments of Obstetrics and Gynecology, Benha University, Assiut School of Medicine, Assiut, and Cairo University, Egypt

ABSTRACT

Objective: N-acetyl-cysteine (NAC) has been shown to enhance the action of clomiphene citrate in ovulation induction. The objective of this study was to examine the use of NAC with clomiphene citrate for ovarian stimulation in assisted conception as a model for "Friendly IVF"

Design: pilot study

Materials and methods: Twenty infertile patients undergoing IVF/ICSI cycles were offered NAC, 1,200 mg/day from day 3-7 of the menstrual cycle with CC (100 mg /day) starting on day 3-7. hCG (10,000 IU) was given when leading follicle(s) were ³ 18mm followed by ICSI.

Main outcome measure(s): clinical pregnancy rate was the primary outcome and implantation rate, number of oocytes retrieved, fertilization rate were secondary outcomes

Result(s): response to CC stimulation with NAC co-treatment was evident by a number of mature follicles ranging from 2-7 at the time of hCG administration. Clinical pregnancy was achieved in 4 cycles (20%).

Conclusion(s): In this preliminary report, a potential benefit of NAC co-treatment with CC in young women undergoing IVF/ICSI cycles was demonstrated. This combination provides a cheap, effective way for ovulation induction in an IVF setting compatible with the concept of friendly IVF

Keywords: N-acetyl-cysteine; clomiphene citrate, Friendly IVF, ICSI, pregnancy

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Detection of endometrial pinopodes by scanning electron microscopy in hormone-controlled and stimulated cycles
Wafaa M. Aboul Enien, Fawzia M. Saleh, Hassan N. Sallam, Safinaz H. Safwat, and Mervat A. Mohamed

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

ABSTRACT

Objective: To assess the effects of clomiphene citrate (CC) and combined oral contraceptive pills (COP) on endometrial pinopode expression.

Design: Prospective study.

Setting: Department of Obstetrics and Gynecology and Department of Histology, Faculty of Medicine, Alexandria university.

Patients: Thirty volunteers with regular menstrual cycles were divided randomly into: group I (n=10) received COP, group II (n=10) received CC and group III (n=10) served as controls.

Interventions: Sequential endometrial biopsies obtained by a pipelle during the luteal phase.

Main outcome measures: Assessment of endometrial pinopodes by scanning electron microscopy (SEM).

Results: Ninety endometrial samples were evaluated under SEM. Fully developed pinopodes appeared in only one sample per cycle indicating their short life span and there were individual variations in the timing of pinopode expression in the same group. COP retarded the appearance of fully developed pinopodes (mean day = 22.4±0.7) whereas CC accelerated their appearance (mean day = 17.9±0.9) compared to controls (mean day = 20.4±0.5).

Conclusions: Advanced endometrial maturation and early pinopode expression in stimulated cycles may reflect shifts in the window of receptivity, resulting in ovo-endometrial asynchrony and limiting implantation success.

Keywords: Endometrium, pinopodes, clomiphene citrate, combined oral contraceptive pills, scanning electron microscopy.

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Characteristics of polycystic ovary syndrome with and without insulin resistance and the role of insulin sensitizing drug (metformin) in its management 
Ashraf M. N. Refaie, Gehan A. K. Ibrahim, and Saad Al Oash

Departments of Obstetrics and Gynaecology, Internal Medicine, and Clinical Pathology, Zagazig University, Egypt

ABSTRACT

Objectives: To define the clinical and biochemical characteristics in polycystic ovary syndrome (PCOS) patients with and without insulin resistance (IR); and to evaluate the role of metformin as an insulin sensitizing drug in infertile IR PCOS patients with regard to both reproductive and metabolic functions.

Materials and Methods: Fifty five PCOS women with an initial complaint of infertility. Other presentations include obesity, hirsutism and acanthosis nigricans (AN). According to fasting glucose/insulin (G/I) ratio, the patients were classified into two groups; group I: IR PCOS and group II: non-IR PCOS. The patients in both groups I & II were given Clomiphene citrate (CC) for 5 days from 2nd day of the period for six months. Group I was subdivided according to treatment protocol into: group Ia who received metformin daily in addition to (CC) and group Ib who received CC only. Body mass index (BMI), Ferriman-Gallwey score and (G/I) were calculated. Fasting glucose (G), fasting insulin (I), follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), progesterone (P), total cholesterol (TC) and triglyceride (TG) were also measured. The clinical and biochemical parameters were assessed initially and at end of treatment.

Results: Thirty four of the 55 PCOS patients had IR (62%). Obesity, hirsutism and AN were common association in group I. LH, LH/FSH and T were significantly lower in group I compared with group II (P <0.05). Ovulation rate was improved in group Ia and became similar to group II while group Ib was more resistant to ovulation induction with CC. Pregnancy rates were also higher in group Ia and group II Vs group Ib but not to a significant level. After 6 months of treatment with metformin + CC, there was a significant improvement in ovulation rate, LH, LH/FSH, T, FI, BMI, TG and TC levels in group Ia compared with pre-treatment levels (P >0.05). All post-treatment parameters in group Ia were also significantly improved compared with those in group Ib (P >0.05).

Conclusion: IR-PCOS patients are more likely to be obese, hirsute and have AN. They are also more resistant to ovulation induction with CC. They tend to have lower LH, LH/FSH and T levels. Metformin improves the response to ovulation induction with CC as well as the pregnancy rates in IR-PCOS. It also appears that metformin may be of help in improving the other metabolic parameters related to IR syndrome so it may retard or prevent the long-term complications of this syndrome.

Key words: Polycystic ovary, insulin resistance, insulin sensitizing drugs

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Pharmacological effects of low-dose of aspirin on Corpus Luteum functions in mature cycling female mice
Adnan S. Al-Janabi, Ahmad M. A-lzohyri, and Fouad K. Al-Rubayai

Institute of the Embryo Research and Infertility Treatment, College of Medicine, University of Baghdad, IRAQ.

ABSTRACT

Objective: To investigate long-term effect of aspirin in low-dose on the corpus luteum functions and its hormonal changes associated with ovarian and uterine structural changes.

Design: Prospective study.

Setting: Institute of the Embryo Research and Infertility Treatment- University of Baghdad.

Materials and methods: In the treatment group, 24 mature cycling female mice underwent subcutaneous administration of aspirin at a dose level of (7.5mg/Kg b.w)twice daily at the beginning of diestrous phase of the estrous cycle. In the control group, 24 mature cycling female mice underwent subcutaneous administration of a placebo(distilled water) twice daily at the beginning of diestrous phase of the estrous cycle.

Main outcome measure: Uterine and ovarian morphological changes, uterine and ovarian weight changes, serum level of (FSH,LH&Progesterone) and ovarian and uterine structural changes.

Results: There was statistically significant increase in progesterone level, number of corpora lutea, diameter of granulosa cells. and a significant decrease in gonadotropins (FSH/LH) , number of growing follicles, uterine weight, endometrial living cell height, endometrial and myometrial thickness, diameter of endometrial glands.

Conclusion(s): long-term administration of a low-dose of aspirin to mice at the beginning of diestrous phase, causes the following changes: significant decrease in uterine weight with development of hemorrhagic spots on the external surface of uterine horns of only those animals that receive treatment for 30 days, and a significant decrease in serum level of both gonadotropins (FSH/LH) associated with significant increase in progesterone level, number of corpora lutea, diameter of granulosa cells, congestion in the uterus, ovary and prolongation of the luteal phase in all 4 periods of treatment.

Keywords: Low-dose aspirin, Long-term treatment, uterine morphology, ovarian morphology.

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