Non-hormonal therapies for the treatment of menopausal symptoms
 Bassam Elhelw

Middle East Fertility Center, Dokki, Giza, Egypt.

ABSTRACT

Hot flushes affect approximately 75% of postmenopausal women and are one of the most distressing symptoms that women experience as they enter the menopause.The treatment of hot flushes is a common clinical challenge. Hormone replacement therapy (HRT) effectively reduces vasomotor symptoms by 80-90%, however, many patients may be unable or unwilling to undergo hormonal treatment. Publication of the results of the Women’s Health Initiative (WHI) and the Million Women Study (MWS) has led to considerable uncertainties about the role of HRT among health professionals and women. The estrogen and progestin arm of the Women's Health Initiative and other recent reports suggest that HRT may increase the risk for coronary heart disease events, strokes, venous thromboembolism, and invasive breast cancer. Many expert groups recommend that combination hormonal therapy for the management of vasomotor symptoms should be limited to the shortest duration consistent with treatment goals and benefits versus risks for individual women. All of these concerns have generated interest in non-hormonal treatment of hot flushes. Such therapies, readily available for the menopausal patient could become a therapeutic nightmare -especially when taken without physician supervision. Data for these therapies are limited, and most of the studies have been conducted in women with a history of breast cancer. In this review we discuss the evidence underlying the commonly used non-hormonal therapies for hot flushes in terms of efficacy and safety.

Keywords: hot flushes, vasomotor symptoms, menopausal symptoms, complementary medicine, non-hormonal drugs.

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Anti zona pellucida antibodies in follicular fluid and outcome of ICSI
 Soheila Arefi, Mohammad Mehdi Akhondi, Mahmood J. Tehrani, AliReza M. Jarrahi, Mahnaz Heidari, Ahmad Ali Bayat, and Ali S. Tabaei

Avesina Research Institute, Tehran, Iran

ABSTRACT

Objective: To assess the correlation of the presence of AZA in the follicular fluids (FFs) of women who underwent ICSI, and etiology of infertility as well as multiple puncture of ovaries, and also the relation of presence of AZA with the results of ICSI, as the main outcome, to realize if ICSI can bypass the possible effect of AZA on reproduction.

Materials and Methods: In this prospective one year study, follicular fluids were evaluated from 96 infertile women, who referred to Avesina clinic for ICSI, including (19-40 years old, 31.5±5.1), that based on the etiology of infertility, 80 women were recognized with explained infertility whereas 16 were recognized with unexplained infertility. All FFs were evaluated by ELISA test.

Results: Twenty of samples (20.8%) were AZA positive. In patients with unexplained infertility, AZA antibody in follicular fluid, was significantly higher than the group with proven etiology of infertility (P value =0.001). Additionally in 20.4 % of patients, who had been punctured previously, AZA was detected in their FFs which are statistically similar to the patients who were punctured for the first time. In this regard, there were no significant correlation between the presence of AZA and the number of oocytes, embryos, fertilization rate and clinical pregnancy rates in patients who underwent ICSI.

Conclusions: The high incidence of AZA in infertile women, especially the ones with unexplained infertility has to be considered .The relation between the presence of AZA and repeated puncture of ovaries is still debatable. The clinical significance of AZA in follicular fluid in the outcome of in- vitro fertilization was suggested in some studies. Correlation between fertilization rate of AZA and the number of oocytes and positive AZA still remains controversial. However, it seems that microinjection could bypass the possible effects of AZA on fertilization, the number of embryos and clinical pregnancies. Determinations of AZA are highly recommended in evaluation of infertile couples especially in patients with unexplained infertility for making appropriate decision regarding the need for ICSI.

Key Words: Anti-zona antibody (AZA), unexplained infertility, Follicular fluid, Repeated IVF attempt, ICSI.

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Studying the effect of cognitive-behavioral counseling based on interacting cognitive subsystems on depression of infertile couples
 Parisa Nilforooshan, Ahmad Ahmadi, Mohammad Reza Abedi, and Mahdi Ahmadi

Faculty of education and psychology, university of Isfahan, Iran

ABSTRACT

Objectives: The main purpose of this research is studying the effect of cognitive - behavioral counseling, based on interacting cognitive subsystems (ICS) approach, on depression of infertile couples.

Design: The research is quasi experimental.

Materials and methods: The sample consists of 30 infertile couples who are placed randomly in the experimental and the control group. Both groups were assessed in two stages, pre- test and post-test, by Beck Depression Inventory. The time laps between pre-test and post-test was 6 weeks. The experimental group was exposed to counseling based on ICS approach in six sessions.

Results: The study indicates that counseling based on interacting cognitive subsystems is effective in decreasing the depression of infertile couples in the experimental group than the control group (p<0.0001) and its effect is considerably higher on women than men (p=0.009).

Conclusion: Cognitive-behavioral counseling based on interacting cognitive subsystems approach is effective in decreasing infertile couples’ depression and it would be better to consider it as a part of therapy along with biological therapies related to infertility.

Key words: Cognitive-behavioral counseling, Interacting cognitive subsystems, infertile couples, depression.

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Diclofenac for analgesia in assisted conception: a prospective cohort study
 Mashael Al Deery, Kamal Jaroudi, Saad Al Hassan, Rima Bazzi, Abdulaziz Al Shahrani, and Khalid Awartani

Division of Reproductive Medicine, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia

ABSTRACT

Objective: To assess the effectiveness of diclofenac in pain experience following oocyte retrieval under conscious sedation.

Setting: Assisted reproductive unit (ART) in a tertiary care referral centre.

Design: Prospective controlled non-randomized study.

Materials and Methods: One hundred and thirty six infertility patients undergoing IVF or ICSI treatment where included. All patients received pre-ovum pickup (OPU) conscious sedation in form of alfentanil 0.5 mg IV, in addition the treatment group (n=81) received 100 mg diclofenac per rectal 30 minutes pre OPU, the control group (n=55) had no pre OPU diclofenac.

Main outcome Measures: Pain score measurement performed at 30 minutes, one, two, and 12 hours post OPU.

Results: Average pain score in the treatment group was significantly lower than that of the control group at each measured time interval.

Conclusion(s): Pre OPU Diclofenac is an effective medication for reducing post procedure pain experience.

Key Words: Analgesia, ART, Diclofenac, IVF

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Transvaginal hydrolaparoscopy: an advance or a gimmick!
 Amr El-Shalakany, Abdel-Megeed Ismaeel, Mohamed Sayed Ali, and Hanaa Ahmed Mahmoud

Department of Obstetrics & Gynecology, Ain Shams University, Abbassia, Cairo, Egypt.

ABSTRACT

Objective: Transvaginal Hydrolaparoscopy (TVHL) is the recent modification of a well known gynecological procedure culdoscopy used for exploration of the pelvic cavity that takes advantages of micro-endoscopic technology and uses aquafloatation for inspection of the tubo-ovarian structures. This is a case series to evaluate the feasibility, procedure performance and complications of Transvaginal Hydrolaparoscopy.

Materials and Methods: The study was conducted at the Ain Shams University Maternity Hospital in Cairo. Twenty two women were included in the study being referred for diagnostic fertility investigation or for performing benign hysteroscopic surgery (e.g., myomectomy, septum resection) for infertility or recurrent miscarriage reasons. Transvaginal hydrolaparoscopy was carried out in all participants under general anaesthesia.

Results: Entry into the peritoneal cavity was successful in 21 out of 22 (95.5%) cases. The mean duration of the TVHL procedure was 15.6 ±3.2 minutes with a time range from 12 to 19 minutes. The pelvic inspection was excellent in 10 (45.5%), satisfactory in 3(13.6%), unsatisfactory in 7 (31.8%), and failed in 2 (9.1%). In 3 women traditional laparoscopy was performed in the same setting. There were no difficulties in inspecting the posterior wall of the uterus and the uterine contour in all women with septate or bicornuate uterus (n=7) to guide the procedure of septum resection.  TVHL detected pelvic pathological findings in 12 (54%) women (4 endometriosis, 3 polycystic ovaries, 2 peritubal adhesions, 3 hydrosalpinx). Tubal patency was tested by transcervical dye hydrotubation with methylene blue in 5 (22.7%) cases only (4 of them had normal patent both tubes, 1 case had bilateral tubal obstruction).

Conclusion: Transvaginal hydrolaparoscopy may allow limited detailed exploration of the tubo-ovarian structure in some infertile patients. The procedure can be combined with hysteroscopy and dye hydrotubation. Visualization is restricted to the posterior part of the uterus and can judge the uterine contour effectively. However, the whole pelvic inspection process is inferior to that achieved by conventional laparoscopy.

Key words: Hydrolaparoscopy, vaginal

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Intrauterine insemination: pregnancy rate and its associated factors in a university hospital in Iran
 Zahra Rezaie, Ozra Azmodeh, and Neda Heydari Hamadani

Mirza Koochak Khan Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Objective: To determine pregnancy rate and its associated factors in Intrauterine Insemination (IUI) in a University ART center in Tehran, Iran.

Materials and Methods: A retrospective descriptive study was conducted on all available records of infertile patients (200 cases) who had undergone IUI treatment for their infertility problems in Mirza Koochak Khan ART center, between 1999 and 2000. The necessary data were collected and then analyzed with Chi-square test with a significant level of 0.05.

Results: 200 infertile couples did 575 IUI cycles. Pregnancy rate was 19.5% per couple and 6.8% per cycle (39 cases). The pregnancy rate in couples with secondary infertility was significantly higher than those with primary infertility (47.4% vs. 8.4%, P<0.0001) and patients with more than 60% normal sperm morphology (NSM) had higher pregnancy rate than those with less than 60% NSM (24.3% vs. 7.7%, P=0.0052). Pregnancy rate tended to increase when the number of large follicles increased at the time of IUI (From 6.7% in 1-2 oocytes to 15.7% in >5 oocytes, P=0.0095). As the numbers of IUI treatment cycles increased, the success rate per cycle decreased. There was a significant difference in pregnancy rate according to kind of drug used for ovarian stimulation. Pregnancy rate was 11.5% with HMG, compared to 7.2% with clomiphene citrate and HMG (P=0.052). Pregnancy rate with twice IUI per cycle was significantly higher than those who had one IUI per cycle (24.1% versus 11.8%, P<0.05). The highest pregnancy rate was seen in 21-30 years old patients (46.5%) and the lowest in women with more than 36 years of age, while no pregnancy occurred in patients less than 20 years of age. The frequency of twin pregnancy and low birth weight infants was 25.6% (10 subjects) and 14.3% (7 subjects) respectively.

Conclusion: It seems that IUI provides better results in patients with secondary infertility, with >60% NSM and with >5 large follicles at the time of treatment. Pregnancy rate does not increase with increasing the number of treatment cycles and ovarian stimulation with HMG is associated with relatively higher pregnancy rate.

Key words: IUI, pregnancy rate, infertility, ovarian stimulation.

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Luteal phase support in in-vitro fertilization
 Shamma Thwaini Al Inizi,Magdy Asaad, and Juergen Schick

Department of Obstetrics and Gynecology, Fertility clinic, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates (UAE).

ABSTRACT

Objective: To compare the clinical pregnancy rate after the use of human chorionic gonadotropin (hCG) injections (Profasi, Serono Pharmaceuticals), to that after the use of oral Duphaston (Duphaston, Solvay Pharmaceuticals B.V., Weesp, The Netherlands) , or vaginal Cyclogest (Cyclogest, Cox Pharmaceuticals, Barnstaple, Ex32 8NS, England) used for luteal phase support in in-vitro fertilization-embryo transfer (IVF-ET) cycles using gonadotropin- releasing hormone agonist.

Study design: A retrospective cohort study.

Setting: Tawam Hospital Fertility Clinic (a tertiary referral center) in the United Arab Emirates.

Materials and methods: A total of 305 consecutive IVF/ET cycles from 1st of January to 31st of May 2000 were included in the study. All women were < 40 years of age. 201 women were treated with hCG (66%) at a dose of 1,500-2,500 IU intramuscular (IM) given every second or third day for three to five doses.  44 women were treated with oral Duphaston (14.4%) given at a dose of 40mg/day and 60 were given vaginal Cyclogest  pessaries  (19.6%) at a dose of 400mg twice daily, until the date of the pregnancy test. Student t test was used for statistical analysis to measure significance.

Main outcome measures: Clinical pregnancy rate.

Results: The use of IM hCG for luteal phase support in IVF-ET cycles was associated with similar clinical pregnancy rate compared with vaginal Cyclogest pessaries and oral progesterone (Duphaston) (24.9%, 28.3% and 25% respectively), (P=1.000and P= 0.359).

 Conclusion: There is no significant difference in clinical pregnancy rate when different modalities of luteal phase support medications are used in IVF-ET cycles like hCG, oral Duphaston and vaginal Cyclogest. This conclusion is affected by the small number of studied cycles and the study design being retrospective.

Key words: luteal phase support, clinical pregnancy rate.

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