Results of Assisted Reproductive Technology in 2001 generated from the Middle East IVF registry
Ragaa T. Mansour, and Ahmed M. Abou-Setta

The Egyptian IVF-ET Center, Maadi, Cairo, Egypt

ABSTRACT

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

Design: Retrospective analysis.

Materials and methods: The ‘World Report on ART’ forms, prepared by the International Committee for Monitoring Assisted Reproductive Technology (ICMART), were distributed to all IVF centers in the Middle East.

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

Results: Data was received from thirty centers, with a total of 16,293 reported cycles. ICSI constituted 86.14%, IVF constituted 8.26%, while the frozen-thawed embryo replacement cycles represented only 5.28% of the total number of ART cycles. As for standard IVF, the clinical pregnancy rate per aspiration and per transfer was 29.70 and 30.71%, respectively. For ICSI, the corresponding rates were 29.25 and 31.32%. The distribution of singleton, twin, triplet and high-order deliveries for IVF, ICSI, FET GIFT and OD combined was 64.1, 24.4, and 3.9% respectively. This gives a total multiple delivery rates of 28.3%. As a result of ART activities, 3,911 neonates were reported born. Complications of ART were mainly ovarian hyperstimulation syndrome, complicating 1.82% of cycles; the occurrence of bleeding in 0.21% and infection in 0.06% of all aspiration cycles.

Conclusions: This is the second consecutive report of the activities of the Middle East IVF registry for cycles initiated during the year 2001. The clinical pregnancy rates were comparable with the previous report. The multiple pregnancy rate is still high due to the transfer of >3 embryos. 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.  Even more efforts are needed to include centers that did not provide their data.

Key words: Middle East, IVF, ICSI, Registry data, ART results

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Biological and reproductive implications of stem cell research and therapeutics: prospects in the Middle East
 Noha A. Mousa, Mohamed A. Bedaiwy and Robert F. Casper

Reproductive Sciences Division, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada

ABSTRACT

Objective: To explore the potential ways in which stem cell research is linked to research and clinical aspects of Obstetrics and Gynecology practice. Moreover, to explore the possible applications most tailored to the needs and resources of the Middle East.

Design: Medical and biological databases were searched for references to stem cells.

Summary: Stem cells are undifferentiated cells that are capable of self-renewal and differentiation to more specialized cells. The discovery of different sources of stem cells enhanced research in this field substantially. Obstetrics and Gynecology is likely to have many points of intersection and cross talk with stem cell research either as a source or as a benefactor. Stem cell research could offer various solutions to gynecological tumors, perinatal pathologies, infertility management and placental development studies. The source of stem cells is mostly dependant on obstetrical-related supplies. Therefore, obstetricians and gynecologists should be aware of the significance of this research to their practice. This review is a aimed at exploring the possibilities of building a basis for stem cell research in the Middle East, with special emphasis on cultural and ethical issues, and resources in the area.

Key words: stem cell, stem cell markers, embryonic stem cells, umbilical cord stem cells, fetal stem cells, trophoblast stem cells, ovarian tumors, endometrial cancer, infertility, endometriosis, perinatal, epigenetic, progenitors.

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Proteomic analysis of uterine flushings from infertile women in the proliferative phase of the menstrual cycle with respect to estrogen level
 Hazem M. Al-Rumaih, David J. Gillott, Karen M. Price, and Gedis J. Grudzinskas

Department of Obstetrics and Gynaecology, St Bartholomew’s School of Medicine and Dentistry, Queen Mary College University of London, and Centre for Reproductive Medicine, St Bartholomew’s Hospital, West Smithfield, London, UK.

ABSTRACT

Objectives: To identify those proteins differentially expressed in the uterine cavity according to cycle day or estrogen level and to produce a two-dimensional protein map of proliferative phase uterine flushings.

Materials and Methods: Uterine flushings were obtained from 31 women undergoing evaluation for infertility prior to assisted reproductive technology treatment (ART). Five patients exhibiting the lowest estrogen (E2) levels were compared with the five patients having the highest values. The uterine flushings were subjected to 2D electrophoresis before the gels were silver stained, digitally captured and subjected to semi-quantitative computerized analysis.

Results: Nineteen protein spots were differentially expressed between the two groups. Seven protein spots appeared significantly more frequently in the low E2 group (p<0.05). Three proteins exhibited significantly higher mean expression in the low E2 group (p<0.05) and nine spots showed significantly higher mean expression in the high E2 group (p<0.05). Several spots that were upregulated in the high E2 group were identified as, Serotransferrin, Hemopexin precursor, Fibrinogen b-chain, a-1-antichymotrypsin and complement C4.

Conclusions: The identified proteins upregulated in the high E2 group are involved in iron transport, coagulation, tissue remodelling and complement activation. The relevance of these findings in relation to uterine processes in infertility is discussed.

Keywords: Endometrium/electrophoresis/proteomics/Infertility/In-vitro fertilization

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The effect of zona thinning size on implantation and pregnancy rates of ICSI-ET patients with advanced woman age
 Erdal Aktan, Aygul Demirol, Kaan Bozkurt, Dilek Ozer, and Timur Gurgan

Ozel Ege Tup Bebek Merkezi, IVF Center, Izmir; Clinic Women Health, Infertility and IVF Center, Ankara, and Hacettepe University, Faculty of Medicine, Dept of Ob&Gyn, Reproductive Endocrinology and IVF Unit, Ankara, Turkey

ABSTRACT

Objective: To find if the zona thinning size (in length) of the embryos transferred had any effects on the implantation and clinical pregnancy rates.

Design: A prospective randomized study

Setting: Infertility and Assisted Reproductive Techniques Centres.

Material methods: Sixty infertile women (≥38 years old) who underwent ICSI-ET procedures and accepted to join this study were enrolled. Women were assigned as one in 25 µm and the following in 50 µm zona thinning size groups consecutively, according to the order of the transfers. Thirty patients were assigned in each of the groups. Zona thinning procedure without perforating the zona was performed on the embryos before transfers, using a novel zona laser treatment system.

Main outcome measures: Implantation and clinical pregnancy rates.

Results: Implantation rates were 0.087±SD 0.160 and 0.099±SD 0.156 (p>0.05), and clinical pregnancy rates were 7/30 (23.3%) and 8/30 (26.7%) (p>0.05), in 25 and 50 µm zona thinning size groups, respectively.

Conclusion: Increasing the zona thinning length up to twice the commonly used size did not have any significant effects on the implantation and clinical pregnancy rates in women with advanced age who underwent ICSI-ET treatment.

Key words: Clinical pregnancy rate, implantation rate, hatching, zona thinning size, ICSI.

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Epidemiology and risk factors associated with laparoscopically diagnosed typical and atypical endometriosis among Egyptian women
 Atef M.Darwish, Hassanin, and Abou Sekkin I.A.

Departments of Obstetrics & Gynecology, Assiut and Al-Azhar Universities, Egypt

ABSTRACT

Objectives: To estimate the prevalence of typical and atypical (subtle) pelvic endometriosis as diagnosed by laparoscopy, and to define risk factors for this disease among Egyptian women.

Design: A prospective cross-sectional observational study.

Setting: Gynecologic Endoscopy Units, Assiut and Al-Azhar University Hospitals, Egypt.

Materials and methods: A total of 2493 patients submitted to video-assisted laparoscopy due to any indication. Diagnostic laparoscopy for evidence of typical or subtle endometriotic ovarian, tubal or peritoneal lesions. Biopsy from the lesion was frequently taken for histopathological evaluation.

Main outcome measures: Laparoscopic and histopathologic diagnosis of pelvic endometriosis. Correlating the different patient characteristics and the risk of endometriosis.

Results: Laparoscopically, 469 patients (18.8%) were diagnosed to be endometriosis.  Of those, typical and atypical endometriosis were diagnosed in 220 patients (8.8%) and 249 patients (9.98%) respectively.  Laparoscopy was indicated as a part of infertility work-up in 2017 patients (80.9%), for chronic pelvic pain in 304 patients (12.2%), and other indications in 172 patients (6.9%). Endometriosis was diagnosed in 182 (38.8%), 219 (46.6%), and 68(14.5%) patients in the 3 groups respectively. Biopsy was taken from 367 cases (78.2%) and significantly correlated with laparoscopy (P=0.001, OR=0.8, 95% CI (0.4 -1.5). Concerning risk factors, only decreased patient’s age (less than 30 years), low parity, and urban residence were significantly correlated with endometriosis. ORs were 0.8, 0.8, and 0.9 with 95% CI of 0.7-3.4, 0.4 -1.6, and 0.4 - 1.2 for the 3 risk factors respectively.   

Conclusions: Pelvic endometriosis is a common frequently underestimated health problem in Egypt. It is correlated with patient’s age less than 30 years, low parity and urban residence. It should be considered in infertile women and patients with pelvic pain specially those with prior pelvic surgery. Being more commonly diagnosed, subtle endometriosis deserves large sample-sized studies of its impact on women’s health and fertility.

Keywords: endometriosis, laparoscopy, epidemiology, Egypt

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Insulin resistance and upper-body obesity in polycystic ovary syndrome
 Ansam A. Al-Bayatti

Department of Biochemistry, College of Medicine, University of Baghdad, Iraq

ABSTRACT

Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting 5-10% of premenopausal women. 50-90% characterized by insulin resistance. Obesity is common among patient with PCOS.

Objective: To investigate insulin resistance (IR) and β - cell function (βF) in upper - body obese women with PCOS.

Materials and Methods: 51 Iraqi women with PCOS and 25 healthy age-matched controls were recruited in cross-sectional study from infertility clinic population. PCOS patients were divided into 2 groups according to waist-to-hip ratio (WHR); either > 0.85 (upper body obesity) or ≤ 0.85 (lower body obesity). Fasting insulin, glucose, free testosterone (free T) were measured. Homeostatic model assessment values of IR (HOMA-IR) and percent β-cell function (HOMA - %β cell) were calculated. Statistical analyses used were student-t test, analysis of variance (ANOVA), Pearson Correlation coefficient (r) as appropriate.

Results: Patients with PCOS and Controls differed significantly in all parameters studied, except fasting glucose, FSH (p < 0.05). 60% of obese PCOS had upper – body obesity were found to be more insulin resistance and have higher β cell function than those with lower – body obesity who in turn were more insulin resistance than control women (p<0.0005 by ANOVA). In PCOS, upper – body obesity were correlated positively and significantly with (HOMA-IR), (HOMA - %β cell) and free T. (r=0. 371,p=0. 002;r=0. 383,p=0. 001;r=0. 254;p=0. 027 respectively). 76.5% of patient with PCOS had IR from whom 65% had upper – body obesity.

Conclusion: About seventy four of patients with PCOS had insulin resistance. Upper- body obesity aggravates insulin resistance and hyperandrogenism of patients with PCOS and modulates β-cell function

Key words: polycystic ovary syndrome, insulin resistance, upper - body obesity.

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Use of low-dose human chorionic gonadotropin (hCG) for final follicular maturation in ovulatory women treated by intrauterine insemination
 Razeih Dehghani-Firouzabady, Maryam Asgharnia, Naeimeh Tayebi, and Seyyed Mehdi Kalantar

Research and Clinical Center for Infertility, Yazd Medical Sciences University, Iran

ABSTRACT

Objective: To evaluate follicle growth and maturation supported by daily late follicular phase low-dose human chorionic gonadotropins (hCG) administration following pre-stimulation with clomiphene citrate(CC) and human menopausal gonadotropin (hMG) in comparison with a sequential CC and hMG regime only.

Materials and methods: A prospective controlled randomized trial. Sixty infertile women who were considered suitable for intrauterine insemination (IUI) were recruited. All of the patients received 100mg dose of CC for 5 days (Day 3-7 of their cycle) with hMG from day 8. Then the patients were assigned to two groups. Thirty patients received low-dose hCG (250 IU/day, group A) when a leading follicle greater than 14mm in diameter was detected in serial transvaginal ultrasound. Thirty patients (group B) continued only hMG. In both groups, hCG (10/000 IU IM) was given when the leading follicle diameter reached 18-20mm.

Results: The mean age, BMI, duration and cause of infertility were similar in both groups. Group A had significantly more follicles above 14mm (p = 0.035) and significantly fewer follicles below 14mm by the end of the stimulation compared with group B (p = 0.045). A significantly higher in serum estradiol (E2, pg/ml) on the day of hCG administration was observed in group A (368.5±40 vs. 194.2±10 in group B, p = 0.015). There was no difference in the endometrial thickness between the groups (10.3 ± 2.3, group A vs. 10.5 ± 2.8, group B). There were significantly more chemical and clinical pregnancies in group A (26% vs. 10%, p = 0.02). No pregnancy miscarried and there were two twin pregnancies in group A and one in group B. Two of the pregnancies in group B developed moderate forms of ovarian hyperstimulation syndrome (OHSS) and none in group A.

Conclusions: The use of micro-dose HCG after gonadotropin therapy in the late follicular phase is better at achieving pregnancies than a conventional regimen.

Key words: Ovarian stimulation, low-dose human chorionic gonadotropin (hCG), intrauterine insemination (IUI)

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Expression of estrogen and progesterone receptors in the human endocervix
 Ayman Al-Hendy, Hui Qun Wang, and John A. Copland

Departments of Obstetrics & Gynecology and Internal Medicine, and Sealy Center for Environmental Health & Medicine, University of Texas Medical Branch, Galveston, Texas, USA.

ABSTRACT

Objective: To determine the messenger RNA and protein expression, as well as distribution of estrogen receptors (ER) and progesterone receptors (PR) in the endocervix compared with the endometrium.

Setting: Volunteers in an academic research environment

Materials and methods: Twelve volunteer patients undergoing total hysterectomy for benign indications. Patients did not receive any hormonal or GnRH analogues treatment prior to surgery. Hysterectomy samples were collected from volunteers. Tissues (endometrium and endocervix) were collected. Samples were transferred immediately to the research area and analyzed using Western blotting, reverse transcription-polymerase chain reaction (RT-PCR), and immunohistochemistry.

Main Outcome Measures: Protein and mRNA expression of ER-α, ER-β, PR-A, and PR-B in endocervix compared with endometrium.

Results: In both Western blot and RT-PCR, we detected ER- α, PR-A, and PR-B mRNA and proteins in every sample. The ratio between PR-A and PR-B was about 2:1 in both the endometrium and endocervix regardless of menstrual cycle phase. In immunohistochemistry, these three receptors were detected in the lining and glandular epithelium, and to a lesser degree in the stromal layer. Estrogen receptor- β was minimally expressed in the glandular epithelium in immunohistochemistry sections with identical distribution of these receptors in the endocervix and endometrium.

Conclusions: Further research is needed to elucidate the differential response of endocervix to steroid hormones.

Keywords: Endocervix, estrogen receptors, progesterone receptors. 

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Ongoing pregnancy after re-vitrification of cleavage stage embryos
 Özmen B, Schultze-Mosgau A, Schöpper B, Griesinger G, Diedrich K, and Al-Hasani S

Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Saudi Arabia

ABSTRACT

Cryopreservation of gametes and embryos leads to increased cumulative pregnancy rates along with restored costs of artificial reproduction techniques (ART). Vitrification, a novel method, is now being widely used in ART laboratories due to high survival rates along with low cost and simplicity. However the safety and outcome of repeated vitrification procedure has not been clearly determined in human embryos. In this report an ongoing pregnancy after re-vitrification and transfer of cleavage stage embryos was described.      

Key Words: Cleavage; repeated; vitrification; pregnancy.

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