Vitrification: will it replace the conventional gamete cryopreservation techniques?
 Yasser Orief, Askan Schultze-Mosgau, Konstantinos Dafopoulos, and Safaa Al-Hasani

Department of Obstetrics and Gynecology, Shatby maternity hospital, Faculty of Medicine, Alexandria University, Egypt, and  Department of Obstetrics and Gynecology, Medical University of Lubick, Germany

ABSTRACT

The radical strategy of vitrification results in the total elimination of ice crystal formation, both within the cells being vitrified (intracellular) and in the surrounding solution (extracellular). The protocols for vitrification are very simple. They allow cells and tissue to be placed directly into the cryoprotectant and then plunged directly into liquid nitrogen. To date, however, vitrification as a cryopreservation method has had very little practical impact on human-assisted reproduction. This may be due to the wide variety of different carriers and vessels that have been used for vitrification. Second, many different vitrification solutions have been formulated, which has not helped to focus efforts on perfecting a single approach.

On the other hand, the reports of successfully completed pregnancies following vitrification at all pre-implantation stages is encouraging for further research and clinical implementation.

Keywords: vitrification, ,cryopreservation, cryoprotectants.

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The effects of different gonadotropin releasing hormone analogues in IVF cycles
 Cem Fiçicioğlu, Tayfun Kutlu, Seval Taşdemir and Leyla Altuntaş

Zeynep Kamil Women and Children's Hospital, Reproductive Medicine-Infertility & IVF unit, Istanbul.

ABSTRACT

Objective: To compare Triptorelin, Leuprolide acetate and Nafarelin sodium in women undergoing controlled ovarian hyperstimulation for in vitro fertilization cycles.

Settings: Zeynep Kamil Women and Children's Hospital Reproductive Endocrinology - Infertility - IVF Center.

Material and Methods: Sixty patients were haphazardly distributed for each GnRH-a group. GnRH-a was administrated, starting on the 21st day of menstrual cycles for the long protocol: Triptorelin (Decapeptyl, 0.1 mg) as 0.1 mg/day SC, leuprolide (Lucrine, 5 mg flacon) as 0.5 mg/day SC and nafarelin (Synarel, 2 mg/mi nasal spray) as 200 micrograms to each nostril with a daily total dosage of 800 micrograms. The responses from each group were compared on the basis of duration of stimulation, total dosage of gonadotropin, E2 values on day 5, the down regulation duration, cyst formation, E2 values on the 1st day of stimulation and HCG, progesterone values and endometrial thickness on the HCG day, the number oocytes picked up, fertilization rates, the number of transferred embryos, pregnancy and implantation ratios.

Results: Evaluating Triptorelin (T), Leuprolide (LA) and Nafarelin (NA) groups respectively, E2 values on the 1st day of menstrual cycles, measured to confirm the down regulation for each GnRH-a, were 24.67 pg/ml, 21.23 pg/ml, 29.62 pg/ml (p<0.05); the total gonadotropin usage (ampoules) were 47.15 ± 12.97, 39.45 ± 13.97, 36.72 ± 13.14 (p<0.05); the number of retrieved oocytes were 9,89 ± 5,98, 10,50 ± 3,69 and 9,19 ± 5,31 (p>0,05); the fertilization rates were 89%, 100% and 100% (p>0.05). The implantation and pregnancy rates, the two major parameters of the study were 5% and 15% in T, 16.5% and 40% in LA, 14.8% and 38.8% in NA groups respectively (p>0,05).

Conclusions: Even though the success rates in Triptorelin group were somewhat lower, the results of every GnRH-a group were statistically similar; but to reach the same outcome we had to use more gonadotropins in this former group. Cost-effectivity analysis of the three GnRH-a makes Leuprolide and Nafarelin better choices than Triptorelin. However, we must state that our study has two major limitations to give a concrete conclusion, namely the study was not randomized and the number of patients was very small.

Key words: Assisted reproductive techniques, GnRH-a, controlled ovarian hyperstimulation, Triptorelin, Nafarelin, Leuprolide acetate.

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Three dimensional sonohysterography versus standard hysterosalpingography in infertile women
Abdel Meguid Ali, Mohamed Aboul Kassem, Shamel Moustapha Hefny and Badr Kair-Allah Amin

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

ABSTRACT

Objective: to compare three-dimensional hystero-salpingo contrast sonography (3D-Sonohysterography) versus X-ray sonohysterography (XHSG) in the initial assessment of infertile women

Design: Prospective clinical trial

Setting: Kasr El-Aini Hospital, Cairo University

Materials and Methods: Fifty infertile women underwent 3D hysterosalpingography and standard hysterosalpingography. The decision of doing either of the two tests was independent of the results of the other test. Every patient was herself control.

Results: Tubal patency by 3D hysterosalpingography was 83% patent and 17 % blocked as compared to hysterography. The full contour of the uterine cavity was depicted in 80% by standard HSG and 100% of cases by 3D HSG.

Conclusion: Three-dimensional hystero-salpingo contrast sonography (3D-Sonohysterography) provides a good alternative to conventional X-ray HSG for tubal factor evaluation and gives an outline of the uterine cavity. It is feasible with minimal invasiveness, avoidance of exposure to X-rays; the possibility of being performed as an outpatient procedure

Keywords: sonohysterography, Hysterosalpingography, infertility

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Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome
 Maida Yousif Shamdeen and Maha Amer Saber

Al-batool Maternity Teaching Hospital, infertility center, Iraq

ABSTRACT

Objective: To determine the prevalence of glucose intolerance and parameters associated with risk in polycystic ovary syndrome (PCOS) patients.

Design: case control study

Setting: Al-batool Maternity Teaching Hospital, infertility center.

Materials and methods: From October 2001 to October 2002, one hundred women with, aged 18-44years met conventional clinical criteria for PCOS, and had ovarian sources of androgen excess, were compared with 60 control women of similar weight and age. Anthropometric measurement the weight, height, and waist: hip measurements and body mass index (BMI) were assessed; two groups were identified, over weight BMI 25 kg/m² and obese as BMI 30kg/m². Fasting serum glucose (FSG), Oral glucose tolerance (OGT) and serum fasting testosterone were done. Patients were divided into three groups: (non diabetics, diabetics and impaired glucose tolerance).

Results: the prevalence of glucose intolerance was significantly higher in PCOS than the controlled group, the risk of glucose intolerance and diabetes was increased with the age, obesity, and the first degree relatives.

Conclusions: PCOS women are at significantly increased risk for impaired glucose tolerance and type 2 diabetes mellitus at all weight and at young age.

Key ward: PCOS, Insulin resistance, type 2 diabetes mellitus, impaired glucose tolerance.

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Outpatient minihysteroscopy and conventional hysteroscopy: a comparative study
 Gamal A. Kassem,  Wael H. El-Brombly and Ahmed M. El Huseiny

Hysteroscopy Unit, Department of Obstetrics and Gynecology, Zagazig University, Egypt

ABSTRACT

Objective: to compare the success of 3.5-mm minihysteroscopy to conventional 5-mm hysteroscopy as outpatient procedure.

Design: prospective non-blinded randomized study.

Setting: hysteroscopy unit in a university hospital

Materials and methods: seven hundred forty patients with different gynecologic problems referred for outpatient diagnostic hysteroscopy. Patients were randomized to 5-mm conventional (group I) or 3.5-mm minihysteroscopy (group II).

Main outcome measures: need for cervical dilatation, degree of pain, need for diazepam for sedation, occurrence of vasovagal attacks, duration of procedure and failure rate.

Results: cervical dilatation under local anesthesia was required in 27 (7.3%) and 5 (1.4%) patients of group I and II respectively (p < 0.001). Eighteen (4.9%) patients in group I experienced the procedure with almost no pain versus 82 (22.2%) patients in group II (p < 0.001). Two hundred thirty eight (64.3%) patients experienced it as discomfort versus 261 (70.5%) patients in group II (p = 0.07). One hundred eight (29.2%) patients reported it as painful in the group I versus 25 (6.8%) in the group II (p < 0.001). Six (1.6%) in the group I experienced it as very painful versus 2 (0.5%) patients in group II (p = 0.28). Diazepam was required in 10 (2.7%) and 1 (0.3%) patients of group I and II respectively (p = 0.006). Vasovgal attack was observed in 5 (1.4%) and 1 (0.3%) patients of group I and II respectively (p = 0.2). Mean time of the hysteroscopy was significantly shorter in group II than that of group I (84±5 versus 155±9 seconds, p < 0.001). Failure of the procedure occurred in 17 (4.6%) and 10 (2.7%) patients in group I and II respectively (p = 0.16).

Conclusion: Outpatient 3.5-mm minihysteroscopy is more successful than 5-mm conventional one. It is less painful and can be conducted in shorter time. It is safe procedure with low failure rate.

Key words: minihysteroscopy, conventional hysteroscopy, pain, acceptability.

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A prospective comparative study of 3-D ultrasonography and hysteroscopy in detecting uterine lesions in premenopausal bleeding
 Fouad Abo Haemila, Dalia Youssef, Mohamed Hassan, Ahmed Soliman and Maha Mossad

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

ABSTRACT

Objective: to compare the accuracy of 3D ultrasound in identifying endometrial and intramyometrial lesions in comparison to hysteroscopy.

Settings: Kasr El-Aini Hospital.

Materials and methods: Three dimensional ultrasonography was done followed by hysteroscopy for all cases (number =70). Data obtained were compared and analyzed to estimate the accuracy of 3D ultrasound.

Results:  Compared to hysteroscopy, 3DUS has a sensitivity of  63.2% specificity of 80.8% , positive predictive value of 54.6% and negative predictive value of 85.7% , accuracy of 76.1.

Conclusion: Three dimensional ultrasound can be used in diagnosing uterine focal lesions with results comparable to hysteroscopy. Further research is needed to show whether this increased diagnostic capability of 3D ultrasound could be the option of choice before surgery.

Key words: Three-D ultrasound, hysteroscopy, uterine lesions, premenopausal bleeding.

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Reduction of early postoperative pain after diagnostic laparoscopy with local bupivacaine: a randomized placebo controlled study
 Ashraf M. N. Refaie and Mowafy M. Khatab,

Departments of Obstetrics and Gynaecology, and Anesthesia, Zagazig University Hospital, Zagazig, Egypt

ABSTRACT

Objective: To evaluate the effects of preincisional infiltration and intraperitoneal instillation of bupivacaine on early relief of pain after diagnostic laparoscopy.

Design: Randomized, placebo, controlled-double blind study

Setting: University teaching hospital.

Materials and methods:  Sixty three women with unexplained infertility, for whom diagnostic laparoscopy was performed under general anesthesia. Preincisional infiltration at the trocar sites and intraperitoneal instillation of bupivacaine were used in the patient group (group I) which included 32 patients, and same volumes of physiologic saline were given at the same sites to control group (group II) which included 31 patients. Modified McGill pain intensity score was used to assess the postoperative pain.

Main outcome measures: Pain scores at 1,2 and 3 hours postoperatively, percent of patients who needed further analgesia, percent of patients discharged 2 hours after the procedure and time to first analgesia.

Results: Pain scores at 1, 2 and 3 hours postoperatively were significantly lower for group I than group II (P < 0.05).  The percent of patients who needed further analgesia was significantly lower in group I compared with group II (P < 0.05). The percent of patients discharged 2 hours after the operation also was significantly higher in group I than group II (P <0.05%). The time to first analgesia was significantly longer in group I (P <0.05).

Conclusion: Bupivacaine infiltration into the trocar sites and instillation into the peritoneal cavity is beneficial for patients undergoing diagnostic laparoscopy. The effect of these drugs is temporary, but they can significantly decrease early postoperative pain and reduce the need for additional analgesics. Most important, the rate at which patients can be discharged from the hospital only 2 hours after surgery is increased significantly.

Key words: Diagnostic laparoscopy, postoperative pain relief, local anesthetics

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A prospective comparative study to assess the accuracy of MRI versus HSG in tubouterine causes of female infertility
 Khaled Abdel Malek,  Mohamed Hassan,. Ahmed Soliman, Heba El-sawah and Amr Osama Azab

Departments of Obstetrics and Gynecology, and  Radiodiagnosis, Cairo University, Cairo, Egypt

ABSTRACT

Objective: To evaluate the role of magnetic resonance imaging versus hysterosalpingography during investigating infertile women due to uterotubal causes of infertility

Setting: kasr EL-Aini Hospital

Materials and methods: All infertile women were subjected to both hysterosalpingography and MRI. Laparoscopy was performed to confirm different findings, being considered the gold standard for diagnosis.

Results: MRI was superior to HSG in diagnosing uterine anomalies (accuracy 100% vs. 96%), but failed to diagnose any case of intrauterine adhesions or peritubal adhesions.

Conclusion: In infertile women with suspected uterine anomalies, magnetic resonance imaging is the study of choice because of its high accuracy and detailed elaboration of uterovaginal anatomy. Laparoscopy and hysteroscopy are reserved for women in whom interventional therapy is likely to be undertaken.

Key words: hysterosalpingography, magnetic resonance imaging, laparoscopy, infertility

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