Surgical complications of in vitro fertilization
 Abbaa Sarhan, and Suheil J. Muasher

Inova Fairfax Hospital, Department of Obstetrics and Gynecology, The George Washington University, Washington, D.C.; Department of Gynecology and Obstetrics, The Johns Hopkins University, Baltimore, Maryland; and Department of Obstetrics and Gynecology, Virginia Commonwealth University , Richmond, Virginia, USA

ABSTRACT

The incidence of complications arising from in vitro fertilization and oocyte retrieval is relatively low. Infections, bleeding, and ovarian torsion are the main complications discussed in this review. Physicians and patients need to be aware of these complications at all times during the treatment process. Early diagnosis and proper medical or surgical interventions will lead to a successful resolution in the majority of cases.

Keywords: Complications, surgery, in vitro fertilization.

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Current state of intrauterine contraceptive devices
 Hesham Al-Inany

Department of Obstetrics and Gynecology, Cairo University, Egypt

ABSTRACT

Background: Intrauterine contraceptive device (IUCD) is the most commonly used method of contraception in many countries. Despite the availability of many generations of IUDs with variable shapes and configurations, side effects and complications are frequent. We hypothesize that a modified IUD design with a fundal seeking effect will nullify the side effects and the complications of the currently available IUDs. Such a design will be at least as effective as the traditional copper devices without their well-known disadvantages. This simple modification of the IUD shape will add to the acceptability of this method even in communities with known preferences to other alternatives.

Keywords: Intrauterine contraceptive device, contraception,  family planning.

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The prevalence of circulating anti sperm antibody (ASA) in infertile population representing of all etiologies
 Amjad Hossain, Nazrul Islam, Subhash Aryal, and Amos Madanes

University of Texas Medical Branch, Galveston, Texas; The Midwest Fertility Center, Downers Grove, Illinois; University of Illinois at Chicago, Chicago, Illinois and The Midwest Fertility Center, Downers Grove, Illinois, USA

ABSTRACT

Objective: The clinical significance of anti-sperm antibody (ASA) in the etiology of infertility is slowly emerging. Both males and females can make antibodies that react with human sperm. The objective of this study is to investigate the prevalence of serum ASA in male and female patients at various age groups.

Materials and methods: A routine ASA screening was done on 680 patients registered for infertility treatment. The prevalence of ASA was estimated as percentage of ASA positive patients in different age and sex groups. The strength of the relationship of positive samples with the age and sex of the patients were tested by statistical analysis.

Results: A total of 39 (5.73%) out of 680 patients (336 male and 344 female) were ASA positive. Irrespective of the gender, the 2.5%, 6.82%, and 8.08% patients were positive in the age group of ≤30, 31-40, and ≥41 yr., respectively. The 4.36% female and 7.14% male were positive, the difference between the sexes is not statistically significant (p = 0.12). In female, 1.75%, 5.97%, and 4.35% whereas in male 3.48%, 7.61%, and 11.32% were ASA positive in ≤30, 31-40, and ≥41 yr. age group, respectively.

Conclusions:  Less than 10% infertile patient of all etiologies is positive by circulating ASA, and ASA prevalence probably increases with patient’s age.

Key words: Age, ASA, Female, Male, Sera

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Synchronization of antral follicles: a step further towards a friendly IVF Program
 Sherif Khattab, Iman Abdel Mohsen  Ismail Aboul Foutouh, Ashraf Ramadan, and Mohamed Moaz

Egyptian International Fertility center, Misr International Hospital, Cairo, Egypt

ABSTRACT

Objective: To evaluate the value of synchronization of follicles using luteal phase estradiol for a friendly IVF program.

Materials and Methods: A total of 108 infertile couples were included in a pragmatic trial. Group I (n=48) received Progynova 4mg/day for 10 days in the luteal phase preceding the ICSI cycle. Clomiphene citrate was started on the 2nd day of the cycle for five days, and hMG was administered on day 6 for 5 days. Group II (n=60) received the standard long protocol. The dose of hMG was then adjusted according to the ovarian response.

Results: There was no significant difference between both groups regarding age, duration of infertility and body mass index. Group I showed a statistically significant reduction in duration of stimulation, dose of hMG (16.4 ± 4.7 vs. 40.9 ± 7.9), and number of oocytes retrieved (4.8 ± 2.6 vs. 16.2 ± 7.5), but it also showed a significant increase in cycle cancellation (8.3%). Even so, there was no significant difference in clinical pregnancy rate/ transfer (33.3% vs. 40%) between the two groups.

Conclusion: This approach is both simple and effective and it may prove to be an attractive alternative to the standard GnRH agonist long protocol.

Key words: friendly IVF, clomiphene citrate, ICSI, male infertility

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Polycystic ovarian syndrome: the correlation between the LH/FSH ratio and disease manifestations
 Abdulrazak H. Alnakash, and Nada K. Al-Tae'e

Institution of Infertility Treatment and Embryo Research, Department of Obstetrics and Gynecology, Alkindy Medical College,  Baghdad University, Iraq

ABSTRACT

Objectives: to study the correlation and association among LH / FSH ratio, BMI and clinical manifestations of Polycystic Ovarian Syndrome (PCOS).

Setting: Institution of Infertility Treatment and Embryo Research.

Study design: A cross sectional descriptive study.

Materials and Methods: One hundred and seven infertile women with PCOS were included according to their menstrual history (Amenorrhea or oligomenorrhea) and/or presence of hirsutism. All of them were subjected to vaginal ultrasound to confirm the presence of polycystic ovary. Body Mass Index (BMI) assessed to be included in the correlations. Blood collected twice (4-5 days interval) from each attendant to measure their serum FSH, LH & mean LH/FSH ratio obtained. The resulted data were arranged in tables and subjected for statistical study using correlation analysis.

Results: The characteristics of women recruited, showed that 59.81% of them were 25-32 years old, and 63.55% of them were over weight or obese (BMI>25). Besides the infertility, the commonest second complaint was hirsutism (64.49%) While oligomenorrhea is prevalent in 43.93%, amenorrhea in 22% and only minority (6.56%) have regular menses. The relationship between study variables as assessed by correlation analysis revealed no statistical significant correlation among LH/FSH ratio, BMI and other manifestations (hirsutism and oligomenorrhea).

Conclusion: No significant statistical correlation is found between LH/FSH ratio, BMI, menstrual pattern and hirsutism. This disproves the traditional concept about PCOS which regards that the heavier the patient is the higher the LH or the worst manifestations.

Key words: PCOS, BMI, Hirsutism

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Three-dimensional ultrasonography in the evaluation of the uterine cavity
 Mohamed M. Momtaz, Alaa N. Ebrashy, and Ayman A. Marzouk

Department of Obstetrics and Gynecology, Kasr El Aini Medical School, Cairo University

ABSTRACT

Objective: To evaluate the use of three-dimensional transvaginal ultrasound (3D TVS) in the assessment of uterine cavity pathology and uterine congenital anomalies.

Materials and methods: One hundred and twenty three patients were studied. All cases were subjected to 2D TVS, 3D TVS and hysterosalpingography (HSG). Hysteroscopy / Laparoscopy were done for all patients to whom ultrasound and radiology results were compared.

Results: Out of 123 cases studied, 102 were found to have: a. uterine cavity anomalies (n=38, Group I), b. uterine myomas, and c. polyps (n=52, Group II) and intrauterine adhesions (n=12, Group III). In Group I, sensitivity, specificity and predictive values were higher for 3D TVS compared to 2D TVS or HSG but comparable to both techniques combined. Also, the positive and negative likelihood ratios were strong and comparable for 3D TVS and 2D TVS + HSG. In Group II, 3D TVS showed highest sensitivity, specificity and predictive values which were similar to 2D TVS + HSG but higher than each technique alone. In Group III, all tests showed low sensitivity and positive predictive value. The negative likelihood ratio was poor for all methods.

Conclusions: The use of 3D TVS is a valuable non-invasive method for assessment of uterine cavity pathology and is more useful than HSG and 2D TVS combined in cases of uterine anomalies, submucous myomas and polyps. However, its value in the assessment of intrauterine adhesions is limited.

Keywords: Uterus, uterine cavity, evaluation, ultrasound, three-dimensional, 3D, sonography

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Pharmacological effects of low- dose of aspirin on ovulation rate in mature cycling female mice
 Adnan S. Al-Janabi, Ahmad M. Al-Zohyri, and Fouad K. Al-Rubayai

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

ABSTRACT

Objective: To determine the effects of low-dose of aspirin on ovarian response, uterine and ovarian blood flow supply, and ovulation rate in mature cycling female mice.

Design: Mature cycling female mice treated with aspirin on the first day of proestrous phase.

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

Materials and methods: Mature cycling female mice treated subcutaneously twice/day with Aspirin (7.5mg/Kg.b.w)on the first day of proestrous phase. In the treated six groups (6 mice/ group) underwent subcutaneous administration of aspirin at a dose level of (7.5mg/Kg b.w) twice daily at proestrous phase of the estrous cycle. In the control six group (6mice/ group) underwent subcutaneous administration of a placebo (distilled water) twice daily at proestrous phase of the estrous cycle

Main outcome measure(s): Uterine and ovarian morphological changes, uterine and ovarian weight changes, number of ova and serum (FSH, LH and E2) levels.

Results: There were statistically significant differences between the treated group and the control group, respectively, in the Ovarian weight (3.14 ± 0.03 versus 2.58 ± 0.06), number of ova (6.00 ± 0.37 versus 11.17 ± 0.40).

Conclusion(s): Short-term administration of a low-dose of aspirin to mice at proestrous causes the following changes: significant increase in ovarian weight with an increased congestion in the uterus and ovary. A significant decrease in ovulatory rate with no effect on serum gonadotropins and estradiol levels.

Key wards: Low-dose aspirin, uterine and ovarian morphological changes, and ovulation rate.

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Oral versus rectal route of misoprostol administration: a randomized controlled trial
 Farid I. Hassan, Mohamed K. Mostapha, Mahmoud Abdel sattar, Emad Marouf, and Shokry Abdel Azim

Department of Obstetrics and Gynecology, Al-Hussein Hospital, Al-Azhar University, Cairo, Egypt

ABSTRACT

Objective: to compare between the efficacy of oral versus rectal misoprostol in the treatment of incomplete abortion.

Design: prospective controlled trial. Patients were allocated to intervention using alternate sequence

Setting:  Al-Hussein Hospital, Al-Azhar University

Materials and methods: one hundred women with retained products of conception were divided into two groups: G1: fifty women received misoprostol 200 µg misoprostol/4 hs rectally and G2; fifty women received it orally. Follow up and side effects were recorded

Results: There was no significant difference between both groups regarding their background characteristics, response to misoprostol, need to do D&C or side effects. the dose of 200ug misoprostol every 4 hours (orally and rectally) for a maximum of 3 doses was not only effective in complete evacuation but also had low incidence of side-effects especially vomiting diarrhea and bleeding

Conclusion: misoprostol whether by oral or rectal route seems to be an effective as a non invasive method for evacuation of the uterus in women with retained products of conception.

Keywords: Misoprostol, incomplete abortion 

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Single dose methotrexate for treatment of ectopic pregnancy: risk factors for treatment failure
Mamdoh Eskandar

Department of Obstetrics and Gynecology and Reproductive Medicine, King Khalid University, College of Medicine, Abha, Saudi Arabia

ABSTRACT

Objective: To identify risk factors for single dose methotrexate (MTX) failure among patients treated for ectopic pregnancies.

Design: Retrospective cohort.

Materials and methods: Seventy women diagnosed with an ectopic gestation treated with MTX. After a single dose, 66 (94.3%) patients experienced ectopic resolution, three (4.3%) patients needed a second dose of MTX, and one (1.4%) patient had a subsequent tubal rupture.

Main outcome measure(s): Predictive variables for failure of single dose MTX, including human chorionic gonadotropin (hCG) value, fetal sac size, patient age, parity and history of previous miscarriages.

Result(s): Ectopic pregnancies that failed to resolve following a single dose MTX were associated with increased maternal age, history of spontaneous abortions, larger sac sizes (>3.4 cm), and higher β-HCG levels (>2000 mIU/mL). Multiple regression analysis demonstrated that the size of the embryonic sac was the most important variable in failures of single dose methotrexate treatment.

Conclusion: Size of gestational sac and the pre-treatment level of HCG should be considered as independent risk factors for treatment failure of single dose methotrexate treatment.

Key words: Ectopic pregnancy, methotrexate, human chorionic gonadotropin, embryonic sac size, tubal rupture.

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Subfertile couples with inv (9) (p11q13): Report of two cases
 Nasrin Ghasemi, Seyed Mehdi  Kalantar, Abbas Aflatoonian, and Naeimeh Tayebi

Departments of Medical Genetics and Obstetrics and Gynecology; Infertility Research and Clinical Center, Yazd Shahid Sadoghi Medical Sciences University, Yazd, Iran.

ABSTRACT

This paper reports two cases of inversion chromosome 9 in one of partners from two sub fertile couples. The first case was the woman with idiopathic recurrent spontaneous abortion in the first trimester of her pregnancy, which referred to genetic counseling clinic. Cytogenetic examination showed that her karyotype was 46 XX, inv (9) (p11q13), and her husband’s karyotype was normal (46 XY). The second couple referred for idiopathic infertility to genetic counseling clinic. The woman's karyotype was normal (46XX), but she did not have any pregnancy in 5 years of marriage. Her husband's karyotype was 46XY, inv (9) (p11q13).  His semen analysis showed low motility, but sperm count and morphology was normal. The abnormal karyotype of these cases, 46 XX, inv (9) (p11q13) and 46 XY, inv (9) (p11q13) could be acknowledged as a reason of infertility during evaluation of unknown infertile couple.

Key words: Inversion chromosome 9, recurrent spontaneous abortion, idiopathic infertility

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Successful pregnancy and delivery following IVF treatment in a patient with endometrial polyp diagnosed by saline infusion sonohysterography at oocyte retrieval
Ahmed S. Kassab, Ariel Zosmer, Clair Gillott, Amanda Tozer, and Talha Al-Shawaf

Centre for Reproductive Medicine, Barts and The London NHS Trust, Kenton and Lucas wing, St Bartholomew’s Hospital, London EC1A 7BE., UK

ABSTRACT

Background: There is lack of consensus regarding the management of patients diagnosed with endometrial polyp in assisted reproductive technology (ART) cycles. Saline infusion Sonohysterography (SIS) may provide more precise identification of endometrial pathology without need for hysteroscopy, cycle cancellation or cryopreservation of all embryos.

Case: A 38 year-old woman with endometrial polyp diagnosed by saline infusion sonohysterography (SIS) during controlled ovarian hyperstimulation (COH) which necessitated the intervention where diagnosis was confirmed after oocyte retrieval. Several options were discussed with patient who opted for fresh embryo transfer that resulted in normal pregnancy and delivery.

Conclusion: Normal pregnancy and deliver can be achieved in the presence of an endometrial polyp during IVF. Performing SIS near the time of embryo transfer did not prevent implantation.

Key words: sonohysterography /endometrial polyp/ implantation

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