Does triggering ovulation by 5000 IU of uhCG affect ICSI outcome?*
 Amany A.M. Shaltout, Mohamed S. Eid, and Amal A. Shohayeb

Dr Samir Abbas Medical Center,Jedda ,KSA; and Department of Obsterics and Gynecology, Cairo University.

ABSTRACT

Objective: To evaluate the effect of 5000 IU as compared to 10000 IU of uhCG on the outcome of  ICSI  cycles.

Study Design: A prospective randomized double blind clinical trial.

Setting: Dr. Samir Abbas Medical Center, Jeddah, KSA.

Material and methods: One hundred patients scheduled for ICSI were recruited for the study. Inclusion criteria included: age<35 years, BMI<30 kg/m² and basal FSH<10 IU/l. Patients were excluded from the study  if they had: PCOS, history of OHSS, or history of previous cancellation due to poor response. Long down-regulation using GnRHa, was  confirmed by serum LH levels <2 IU/l and serum E2 <50 pg/ml  after which stimulation with hMG was started and continued until one follicle was ≥18 mm and at least 2 other follicles ≥ 16mm with serum E2 level of ± 150 pg/ml per follicle. Two patients were withdrawn from the study before randomization ,1 had OHSS while the other had poor response. A total of 98 patients were then randomly divided into 2 groups: group I (n=50) received 5000 IU and group II (n=48) received 10000 IU uhCG via intramuscular route.

Main Outcome Measures : total number of oocytes retrieved, oocyte recovery rate, number of mature oocytes, fertilization and pregnancy rates , serum progesterone (P) on  day 6-7 post hCG and incidence of OHSS.

Results: There was no difference (mean± SD) between patients in group I and II regarding age (27.6± 4.1 versus 27.2±3.9),BMI (25.8±2.3 versus 25.6 ±2.2 kg/m²) and basal FSH (6.3±1.7 versus 6±1.8 IU/l) respectively. There was no significant difference between both groups regarding  oocyte recovery rate (87% versus 90%) ,total number of oocytes retrieved (7±3.5 versus 7.4±3), number of mature oocytes (5.6 ±3 versus 5.9±2.6) fertilization rate (71% versus 76%) and pregnancy rate ( 33.3% versus 35.4%), respectively. Serum P on day of oocyte retrieval  was (18.5±11.3 versus 19.8±11.5) while on day 6-7 post hCG it was (182.8±versus 177 ±108.9), with no significant difference between both groups. The incidence of OHSS was higher in group II : 4 patients (8.33%) as compared to only 1 patient (2%) in group I ;all were mild cases. However, this difference was not statistically significant.

Conclusion: Single dose of 5000 IU uhCG used for  triggering ovulation   is as effective as 10000 IU on the outcome of ICSI cycles with the added advantage  of reduced incidence of OHSS.

Key words: ovulation induction, hCG, ICSI

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

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Detection of Ureaplasma urealyticum and Mycoplasma hominis in endocervical specimens from infertile women by polymerase chain reaction
 Shahin Najar Peerayeh, and Mortaza Sattari

Department of Microbiology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

ABSTRACT

Objective: Ureaplasma urealyticum and Mycoplasma hominis are commonly found in the genitourinary tract as the causative agents of several sexually transmitted diseases, reproductive failure, and neonatal morbidity and mortality. We have used a polymerase chain reaction (PCR) for the detection of these mycoplasmas in endocervical samples from infertile women.

Materials and Methods: 377 endocervical swab samples were taken from infertile women. DNA was extracted by Cadieux method, and analyzed by PCR protocol with species-specific primers for U.urealyticum (urease gene) and M. hominis (16S rRNA gene).

Results: Of the 377 patients studied, 116(30.7%) were positive for U.urealyticum, M. hominis or both genital mycoplasmas. Of these 116 patients, 60 (51.7%) were PCR positive only for U. urealyticum, 31(26.7%) were PCR positive only for M. hominis and 25(21.5%) presented both organisms.

Conclusions: Because of the potential adverse effects of mycoplasmas on the success rate of highly specialized infertility treatment, and its causal roles in several maternal complications of pregnancy and in neonatal morbidity and mortality, the rapid detection of mycoplasmas by PCR in infertile women could be important and necessary. The increased sensitivity and shorter time requirement of PCR support its further development for the diagnosis of mycoplasmas infections.

Key words: Ureaplasma urealyticum, Mycoplasma hominis, infertility, PCR

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N-acetyl-cysteine in anovulatory women: The impact of postcoital test
 Gamal Youssef, Abdel Meguid Ali, Nadine Alaa, Basma Makin, Mohamed Waly, and Ahmed Abou-Setta

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

ABSTRACT

Objective: N-acetyl-cysteine (NAC), a mucolytic drug with insulin sensitizing properties, has been proved useful as an adjuvant therapy in subjects with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC).  The objective is to determine the possible beneficial mucolytic effect of NAC on patients with poor post-coital tests.

Design: Prospective, controlled pilot study.

Materials and methods: Thirty-nine women diagnosed with CC-resistant PCOS, aged 17 – 42 years undergoing therapy for infertility were included. All women were given NAC (1.2 g/d) and with CC 100 mg/d for 5 days starting at day 3 of the cycle.  They were divided according to the results of their priori post-coital test into:  good post-coital test (Group I: N=11) and poor post-coital test (group II: N=28).

Main Outcome Measure(s): Clinical pregnancy rate (CPR).

Result(s): There were no demographic differences (i.e. age, period of infertility, weight, previous use of CC) between the two groups, nor differences in the cycle characteristics (i.e. cycle length, ovulation induction, number of follicles produced). In addition, there was no statistical difference between the two groups pertaining the clinical pregnancy rate (P = 0.24).

Conclusion: The sample size of the present study is not large enough to withdraw firm conclusions, but we may assume that the effect of NAC as an adjuvant to CC appears not to be related to its mucolytic effect.

Key Words: N-acetyl-cysteine, polycystic ovary syndrome, clomiphene citrate resistance, post-coital test, pregnancy

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Comparison of the use of letrozole and clomiphene citrate in regularly ovulating women undergoing intrauterine insemination
 Robab Davar, Maryam Asgharnia, Naeimeh Tayebi, and Abbas Aflatoonian

Research and Clinical Center for Infertility, Shahid Sadoughi University, Yazd, Iran.

ABSTRACT

Objective: To compare the effects of letrozole 5mg and clomiphene citrate (CC) 100mg on total follicle number, endometrial thickness, hormone levels, pregnancy, miscarriage and OHSS rate in women undergoing superovulation and I.U.I.

Material and methods: This study was done as a prospective randomized trial in Research and Clinical Center for Infertility (Shahid Sadoughi University) and Mother Hospital, Yazd, Iran. In this study, 115 patients with unexplained and mild male factor infertility were studied. Patients were randomized, using a computer-generated random table into two groups which were treated with 5 mg of letrozole daily (60patients, 60 cycles) or 100mg of CC daily (55 patients, 55 cycles) from day 3-7 followed by FSH on day 8 of the cycle. Then data were analyzed using student's T Test and chi- square.

Results: The mean age and duration of infertility in both groups were similar. There was a significant difference in the total numbers of follicles during stimulation between two groups (5.45± 4.3 in CC group vs. 3.28± 2.5 in letrozole group) (p-value= 0.01). No significant difference was found in the endometrial thickness between two groups (letrozole group= 6.9±2.5, CC group= 7.6±1.8) .The mean level of LH (IU/L) and FSH (IU/L) in both groups were similar. (P-value of hormone levels between two groups were respectively: 0.33 and 0.47), but there was a significant difference in mean estrogen (pg/ml) levels between the groups (220.28±150.5 in letrozole group vs. 867.34±240.6 in CC group) (p-value=0.018). The mean number of used gonadotropin ampoule was the same in both groups. Chemical pregnancy rate per cycle was 8.3% in the letrozole group and 5.5% in the CC group. Clinical pregnancy rate per cycle was 6.6%in the letrozole group and 1.8% in the CC group (p-value= 0.6).Two out of the three pregnancies in the CC group and one out of the five pregnancies in the letrozole group resulted in a miscarriage. One twin pregnancy occurred in the letrozole group and none in the CC group. Ovarian hyperstimulation syndrome (OHSS) has not occurred in any group.

Conclusions: In spite of comparable pregnancy rate in clomiphene citrate and letrozole group, C.C. in these patients could be prescribed because of its lower cost.

Keywords: letrozole, clomiphene citrate, superovulation, I.U.I

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Cytomegalovirus and the expression of immunological markers in reproductive failure
 Wafaa Aboul Enien, Amal  Azzam, Tarek Karkour, Nashwa Abou Khedr, and Nagwa Rizk

Department of Obstetrics and Gynaecology, and Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

ABSTRACT

Objective: To assess the relation of cytomegalovirus (CMV) infection and serum interleukin 10 (IL-10), tumor necrosis factor-a (TNF-a) and soluble intercellular adhesion molecule 1 (sICAM-1) with reproductive failure.

Design: Prospective study.

Setting: Department of Obstetrics and Gynaecology, Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University.

Subjects: Twenty patients with unexplained infertility, twenty recurrent aborters and twenty fertile controls.

Interventions: Serum concentrations of IL-10, TNF-a, sICAM-1 and anti-CMV IgG and IgM antibodies were measured by ELISA.

Main outcome measure: Reproductive failure.

Results: Levels of serum IL-10 and sICAM-1 were significantly lower in unexplained infertility and recurrent miscarriage patients compared to controls (P < 0.00001, P < 0.0001 respectively). In contrast, levels of TNF-a were significantly higher in patient groups compared to controls (P < 0.00001). There were no significant correlations between the three biochemical parameters in each of the three studied groups. Moreover, there was no significant difference in the incidence of IgG and IgM anti-CMV antibodies between groups.

Conclusions: Serum IL-10, TNF-a and sICAM-1 are immunomodulatory factors which may play an essential role in the pathophysiology of reproductive failure. However, CMV infection does not seem to be a major abortion related factor.

Keywords: Cytomegalovirus, interleukin-10, tumor necrosis factor-a, intercellular adhesion molecule-1, reproductive failure.

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Evaluation of the effect of the adoption of ultrasound guidance for embryo replacement on the pregnancy outcome for multiple providers
 Mohamed A. Bedaiwy

Departments of Obstetrics and Gynecology, Assiut University Hospital, Assiut, Egypt; The Cleveland Clinic Foundation, Cleveland, Ohio; University of Toronto and Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.

ABSTRACT

Objective: To evaluate the clinical effects of adopting the policy of transabdominal ultrasound–assisted embryo transfer on outcomes of in vitro fertilization–embryo transfer (IVF-ET) in comparison to the “clinical touch” method of transcervical embryo transfer by 3 different providers.

Design: A cohort study in a university-based IVF practice.

Materials and methods(s): Four hundred sixty-two sequential patients who underwent transcervical transfer of fresh embryos 1-year before (group I) and 1-year after (group II) the adoption of US guidance were included. The clinical touch and the US guided embryo transfers were performed by 3 experienced physicians. On selected days, at time of embryo transfer, transabdominal ultrasound was performed to guide catheter placement depth approximately 1.5 cm from the uterine fundus. The presence of at least one gestational sac on ultrasound was compared in the two study groups. Additionally, the clinical pregnancy rate (presence of fetal cardiac activity observed on ultrasound), and the implantation rate (number of gestational sacs identified on ultrasound per number of embryos transferred) between groups was evaluated. Characteristics of the two cohorts were analyzed to verify similarities between the treatment and control groups, including age of recipient, and difficulty of transfer, the use of a tenaculum, and the quality and number of embryos transferred.

Result(s): US guidance did not reduce the time of the ET procedure. In addition, it did not reduce the percentage of bloody catheters at the end of the procedure. More importantly, no statistical difference was seen in the presence or number of gestational sacs following embryo transfer either before or after the adoption of the transabdominal ultrasound guidance for all 3 providers.

Conclusion(s): Providers’ performance has not improved by the adoption of US guidance. There is no other additional advantage for using transabdominal ultrasound to perform embryo transfer. Although there is a trend towards a higher pregnancy if US guidance is adopted, in experienced hands, the “clinical touch” method of embryo transfer yields equivalent results to transabdominal ultrasound–guided embryo placement.

Key Words: IVF-ET, Embryo transfer; transabdominal ultrasonography

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