Gonadotrophins for idiopathic male factor subfertility: a Cochrane systematic review
 Abdelhamid M. Attia, Hesham G. Al-Inany, and Michel L. Proctor

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

ABSTRACT

Objectives: To determine the effectiveness of gonadotrophins administration to men with idiopathic subfertility on spontaneous pregnancy rate and in assisted reproductive techniques.

Search strategy: We searched the all relevant databases. Searches were not limited by language. The bibliographies of included, excluded trials and abstracts of major meetings were searched for additional trials. Authors and pharmaceutical companies were contacted for missing and unpublished data.

Selection criteria: Truly randomized controlled trials where gonadotrophins were administered for the treatment of idiopathic male subfertility with reporting of pregnancy rates were included in the review.

Data collection and analysis: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials.

Main results: Five RCTs with 426 participants were included in the analysis. Compared to placebo or no treatment FSH showed a significantly higher overall pregnancy rate per couple randomized during treatment period (OR 1.8, 95% CI 1.03 to 3.17, NNT 14, 95% CI 8 to 100). Follow up of patients up to three months post-treatment also showed a significant difference in favor of FSH treatment (OR 1.92, 95% CI 1.15 to 3.20, NNT 11, 95% CI 6 to 50. However when patients were followed up for extended period over three months post-treatment results showed a non-significant overall pregnancy rate difference in favor of FSH treatment (OR 1.52, 95% CI 0.99 to 2.33). Compared to placebo or no treatment there was non-significant difference in pregnancy rates after IUI/IVF/ICSI per couple randomized either during the treatment period, during treatment and up to three months follow-up, when the follow-up period was extended to more than three months post-treatment. The spontaneous pregnancy rate per couple randomized showed a favorable and significant difference in the FSH group over placebo or no treatment. OR was 3.99, 95% CI 1.80 to 8.82, NNT 11, 95% CI 7 to 25.

Reviewers' conclusions: The number of trials and participants is not enough to draw final conclusions. However, analysis of the five included trials showed that in men with idiopathic subfertility treated with FSH there is a significant increase in the overall and spontaneous pregnancy rates per couple. This increased pregnancy rate is evident during the treatment period and within three months post-treatment. This increase is not significant in couples who undergo assisted conception.

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Rectal versus vaginal bromocriptine mesylate suppositories in hyperprolactinemic patients: an active comparator trial
 Atef M. Darwish, Ehsan Hafez, Ibraheem El-Gebali, Sahar B. Hassan, and Mohammad E. Ali

Departments of OB/GYN and Andrology, Faculty of Medicine and Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt

ABSTRACT

Objectives: to compare the clinical effectiveness, side effects and tolerability of rectal versus vaginal bromocreptine/pluronic F-127suppositories as compared to oral bromocriptine tablets for treating pathologic hyperprolactinemia.

Design: An active comparator randomized study.

Setting: A pharmaceutical phase at the department of Pharmaceutics, Faculty of Pharmacy, and a clinical phase at the Infertility out-patient Clinic of the department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University.

Materials and methods: A total of 69 female and 3 male patients with pathologic hyperprolactinemia. The 69 female patients were randomly divided into 3 groups. Group A comprised 22 patients who used rectal suppositories once daily for one month. Group B included 20 patients who used vaginal suppositories once daily for one month. Group C comprised 27 patients who received 2.5 mg bromocriptine tablets twice daily for one month. Serum prolactin (SP) was measured before and after therapy in all cases. The 3 males used the drug rectally daily for one month.

Main outcome measures: Decline of SP level after one month of therapy.

Results: The pharmaceutical phase of the study (group A and B) showed a higher but insignificant release rate constant (k) min-1 of the rectal than vaginal suppositories (0.60 vs. 0.51). In the clinical phase of all groups, there was an evident decline of SP levels after one month of therapy. Rectal application was associated with minimal local or systemic side effects. All the three males showed marked SP decline after therapy.

Conclusions: The approached bromocriptine suppositories containing pluronic F127 were proven to be effective in lowering SP whether used vaginally or rectally as compared to oral treatment. Rectal approach has minimal side effects, it is more convenient for patients who don’t accept to manipulate the vagina especially virgins, others fail to use the drug during menstruation, or during the postabortive or postpartum periods and those patients who believe that the drug may affect their fertility by interfering with sexual relationship. Furthermore, it can be used by intolerant hyperprolactinemic males. Its use as an alternative non-oral approach should be considered during counseling of patients in those formerly mentioned situations.

Key words: Bromocriptine, pluronics, oral, rectal, vaginal.

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Outcome of twin ICSI pregnancy compared with spontaneous conceived twin pregnancy: a prospective, controlled, observational study
Mamdoh Eskandar

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

ABSTRACT

Objectives: to evaluate the relationship between the type of conception and progress of pregnancy and delivery

Settings: Abha Maternity Hospital and the Saudi Center for Assisted Reproduction

Design: A prospective cohort study from January, 2004 to January, 2006

Materials and methods: 35 ICSI twin pregnancies and 73 spontaneously conceived twin pregnancies were followed up. The primary outcome was gestational age at delivery, secondary outcome were maternal and neonatal complications and mode of deliveries

Results: There was a trend toward preterm labor with ICSI twins than with naturally conceived twins but no significant difference between both groups regarding neonatal weight, Apgar score (A/S) and weight of the placenta. In addition, the post-natal/ neonatal period was similar in both groups. There was no difference in maternal outcomes in both groups.

Conclusion(s): When compared to naturally conceived twins, ART-conceived twins are more or less similar to those conceived naturally. A trend towards increased preterm labor should be further investigated in larger studies

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Clomiphene citrate response in PCOS patients with abnormal lipid profile and impaired glucose tolerance test
Maida Y. Shamdeen, and Luma A. Mohammad

Mosul medical college, and Albatool Maternity Teaching Hospital, Mosul, Iraq

ABSTRACT

Objective: To assess the clomiphene citrate(CC) response to 200mg in women not responding to 150mg for ovulation induction in PCOS women with abnormal lipid profile and impaired glucose tolerance test, and to assess the postprandial triglyceride response to high fat meal in PCOS women

Design: controlled clinical study.

Setting: infertile PCOS women attending infertility centre in Al-Batool maternity Teaching Hospital.

Materials and methods: 50 infertile women with PCOS, who failed to respond to 150 mg clomiphene citrate (CC) fore 4cycles (25 non-obese and 25 over weight) were given 200mg of CC, and 25 healthy women as controls, were selected. Assessment for; Clinical, anthropometric measurement, fasting serum glucose, fasting lipid profile, oral glucose tolerance test, postprandial triglyceride, cholesterol, high and low density lipoprotein, hormonal assay, and ovarian ultrasound.

Results: Both obese and non-obese PCOS women with CC resistant (CCr) to 150mg when 200mg is used had a significant higher waist-to-hip ratio than controls at P≤0.05. PCOS women had higher levels of fasting, and 2-hour postprandial blood sugar (2h PPBS) and high-density lipoproteins (HDL) levels in a significant difference at P≤0.05. High-density lipoprotein was significantly lower in PCOS women than controls at P≤0.05. Clomiphene citrate response (CCR) was significantly less in PCOS groups with impaired glucose tolerance (IGT) 33.4% than those with normal blood sugar (BS) (81.8%), and higher in women with type 2 diabetes mellitus (DM) as (100%) were (CCr). CCr was more in PCOS women with abnormal lipid profile compared to normal (71.4% in abnormal triglyceride (Tg), 78.2% in abnormal cholesterol (Ch) and 67.7% with abnormal HDL.

Conclusion: PCOS women with IGT test; non-insulin dependent DM and abnormal lipid profile had more CCr in ovulation induction, than those with normal blood sugar and lipid profile. PCOS women had postprandial hypertriglyceridemia that is related to high waist-to-hip ratio, and insulin resistance regardless of obesity.

Key words: PCOS, clomiphene citrate, abnormal lipid profile, impaired glucose tolerance.

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Comparing gonadotrophin-releasing hormone agonists or gonadotrophin-releasing hormone antagonists in poor responder in IVF
Fatma Aletebi

Department of Obstetrics and Gynaecology, King Abdulaziz University,  Jeddah, Saudi Arabia.

ABSTRACT

Objective: The use of GnRH antagonist versus GnRH agonist in poor responder for patient undergoing ovarian hyper-stimulation and in vitro-fertilization was compared.

Materials and Methods: In this study, 23 patients underwent ovarian hyperstimulation with recombinant FSH followed by the use of GnRH antagonist (Cetrorelix) 0.25mg during the late Follicular Phase. These patients were compared to 20 patients who underwent controlled ovarian hyper-stimulation with recombinant FSH proceeded by GnRH agonist (short protocol).

Results: There was no significant difference between the two groups for mean-age, duration of infertility or base line FSH, number of ampoules of gonadotrophin used, number of mature oocyte retrieved, estradiol concentration on the day of injection of human chronic gonadotrophin HCG, fertilization rate and number of embryo transferred. The clinical pregnancy rate in the antagonist group appear to be high but not significantly different (12% compared to 10%).

Conclusion: The addition of GnRH antagonist to ovarian stimulation protocol may be used for poor responder. Further randomized clinical studies with large sample size required to elicit significant differences.

Keywords: GnRH agonist, GnRH antagonist, IVF, poor responders

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Difficult embryo transfer: the impact of propofol anesthesia
 Ahmed M. Abou-Setta, Ragaa T. Mansour, Hesham G. Al-Inany, Gamal I. Serour, Mohamed A. Aboulghar, and Mohamed El-Wassify

The Egyptian IVF-ET Center, Cairo, Egypt.

ABSTRACT

Background: Difficult embryo transfers (ET) requiring general anesthesia are occasionally encountered in clinical practice. Little evidence is present in the literature as to the success rates when compared with difficult transfers not requiring anesthesia.

Objective: To evaluate the impact of using Propofol anesthesia during difficult embryo transfers on the implantation and clinical pregnancy rates.

Design: Retrospective patient chart review.

Materials and methods: Women undergoing ICSI cycles in the Egyptian IVF-ET center, from January 2000 – December 2002, and having difficult ET requiring general anesthesia (Group I = 99 women) were included. A matching group of women with difficult ET, without anesthesia (Group II = 99 women) were used as a control.

Results: There were no significant differences in the patient demographics (e.g. age, period of infertility, number of oocytes retrieved, fertilization rate, embryo quality, number of embryos transferred. Moreover, there was no significant differences in implantation (Group I = 19.15%, Group II = 20.86%) or clinical pregnancy rates (Group I = 36.36%, Group II = 33.33%).

Conclusion: The use of propofol general anesthesia during difficult embryo transfer does not seem to improve the implantation and pregnancy rates. Even though, prospective randomized trials are needed to confirm these findings.

Key words: Propofol, Embryo transfer, Assisted Reproduction, ICSI, IVF

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Comparison of laparoscopic drilling by diathermy and laser for ovulation induction in clomiphene citrate-resistant women with polycystic ovary syndrome
 Abbas Aflatoonian, Maryam Asgharnia, and Naeimeh Tayebi

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

ABSTRACT

Objective: The aim of the present study was to compare the effectiveness of laparoscopic ovarian drilling (LOD) with monopolar diathermy and CO2 laser on the serum levels of hormone and pregnancy outcome in clomiphene citrate (CC) resistant infertile women with polycystic ovarian syndrome (PCOS).

Materials and Methods: Thirty women underwent laparoscopic ovarian diathermy (group A) and thirty women underwent laparoscopic ovarian laser (group B). Serum levels of LH, FSH, Testosterone and Progesterone, menstrual cycles' regularity, ovulation and Pregnancy rates were compared between the two groups.

Results: In this study, there was no significant difference in the main demographic, clinical and endocrinological characteristics between two groups. The percentage of women with PCOS resumed regular menstrual cycle in group A and B was 73% and 76% respectively (P-value=0.5). There was no significant difference in hormonal profiles (LH, FSH, Testosterone and Progesterone) between two groups. Similarly, there was no statistically difference in the total ovulation rate between two groups (40% vs.43.3% in group A and B respectively). Finally, there was no significant difference in the pregnancy and miscarriage rate in women with CC resistant PCOS undergoing diathermy compared with laser therapy.

Conclusions: Both laparoscopic ovarian diathermy and laparoscopic ovarian laser have good effects on ovulation induction in PCOS women but none of these two methods had any obvious advantages over another method.

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