Reproductive functions of progesterone
 Maha Al-Asmakh

Department of Health Science, College of Arts and Sciences, Qatar University, Doha, Qatar

ABSTRACT

Progesterone has a central role in reproduction, being involved in ovulation, implantation, and pregnancy.  Associated with this is the involvement of progesterone in regulation of uterine function during the menstrual cycle, by control of cyclical changes in proliferation and decidualization. Progesterone is essential for the development of decidual tissues, and if fertilization occurs, high circulating progesterone levels are important not only for facilitating implantation, but also for maintaining pregnancy by stimulating uterine growth and opposing the actions of factors involved in myometrial contraction.

Key Words: progesterone, progesterone receptors, Corpus Luteum, menstrual cycle, implantation, myometrial contractility.

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Fertility and fertility preservation techniques for breast cancer patients
 Fouzia Memon

Research Fellow, Newcastle upon Tyne NHS Foundation Trust, UK.

ABSTRACT

Breast cancer is not rare in younger women. There has been remarkable improvement in the survival rate due to progress in cancer treatment. Those treatments often cause premature ovarian failure due to massive destruction of the ovarian reserve. Early loss of ovarian function not only puts the patient at risk for menopause-related complications at a very young age but is also associated with loss of fertility. The purpose of this paper is to review the incidence of gonadal toxicity associated with adjuvant chemotherapy, fertility concerns, and the options to preserve fertility in young breast cancer survivors.

Key words: Breast cancer, premenopausal, reproduction, fertility preservation.

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Pregnancy outcome after multifetal reduction via early transvaginal embryo aspiration: Mansoura fertility care unit experience
 Hamed Youssef, Abd El Fattah Haroun Allam, Hatem AbuHashim, Emad Fawky, Hossam Goda ,and Mohamed Elshafei

Department of Obstetrics and Gynecology, and Fertility Care Unit, Faculty of Medicine, Mansoura University; and Department of Obstetrics and Gynecology, Faculty of Medicine, Benesuief University, Egypt.

ABSTRACT

Objective: To evaluate the pregnancy outcome after multifetal pregnancy reduction (MFPR) via early transvaginal embryo aspiration.

Design: Prospective clinical study

Material and Methods: The study included 30 patients with high-order multifetal gestations (more than 3 fetuses), Pregnancies included, before reduction: 22 quadruplet gestations (group 1) and 6 quintuplets (group 2), and 2 sextuplets (group 3). All pregnancies were reduced to twins. The primary outcome measures included procedure complications while the secondary ones were pregnancy outcomes.

Results: The procedure was successfully completed in all cases. Miscarriage occurred in 2/30 patients (6.6%). Preterm delivery occurred in 20/30 cases (66.6%). The incidence of early pregnancy complications and neonatal outcomes in reduced pregnancies were similar to that of the control group. However, the cesarean section rate of reduced twin pregnancies was significantly higher (P < 0.05).

Conclusion: Early transvaginal embryo aspiration is a safe, effective and simple operation. It is associated with reduced perinatal morbidity and mortality as well as minimal maternal complication.

Key words: High order pregnancy, multifetal embryo reduction, early transvaginal embryo aspiration.

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The effect of administration of metformin on lipid profile changes and insulin resistance in patients with polycystic ovary syndrome
 Mohamad Ali Karimzadeh, Maryam Eftekhar, Robabeh Taheripanah, Naeimeh Tayebi, Leili Sakhavat, and Fatemeh Zare

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

ABSTRACT

Objective: Polycystic ovary syndrome (PCOS) is one of the most common metabolism and endocrine disorders among women. The aim of the present study was to evaluate the effects of metformin on lipid profile changes, insulin resistance, body mass index (BMI), Ovulation and pregnancy rates in patients affected by PCO syndrome.

Materials and Methods: In this randomized controlled study, 200 women aged 20-35 years with PCOS were selected. Diagnostic criteria were based on the diagnostic criteria of PCO syndrome in Noterdam meeting in 2003. Samples of fasting peripheral blood were taken from all patients to test cholesterol, LDL, HDL, TG, FBS and Insulin before treatment. Patients were then divided randomly into two groups. In case group (n=100), metformin was prescribed three times a day (1500 mg daily) and in control group (n=100), placebo was administered in the same way. After three months, sample of blood was taken again in order to test the variance of the above mentioned parameters to compare with these amounts before test. Also, BMI was compared before and after treatment in both groups.

Results: BMI was 28.81±3.18 and 29.49 ± 4.7 Kg/m2 before treatment in case and control groups respectively. This ratio changed after treatment to 28.45 ± 2.8 and 29.29 ± 4.8 Kg/m2 in case and control groups respectively (P-value>0.05). FSH/insulin ratio was 4.67±0.9 and 5.03±1.3 in case and control group respectively, while it changed after treatment to 6.07 ± 1.4 and 5.05 ±1.3 and this difference was significant in case group (P-value=0.0001),but it was no difference in control group. In case group, HDL level increased after treatment from 26.65±9.9 to 33.19± 9.9 MMoL/L (P-value=0.0001), and Triglyceride level decreased after treatment from 208.96±58.9 to 191.54±55.4 MMoL/L (P-value=0.004); whereas there was no change in control group.  LDL and cholesterol levels did not change in both groups. Ovulation rate and pregnancy rate were significantly higher in case group than in control group (86% vs. 20%) (P-value=0.003) and (40% vs. 11%) (P=0.021) respectively. In addition, Metformin had no significant effect on BMI in case group.

Conclusion: Treatment with metformin during 3 months causes not only the increase in ovulation and pregnancy rates but also the decrease in insulin resistance and lipid profile changes.

Key words: metformin, PCO syndrome, lipid profile, hyperinsulinemia

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Prevalence of factor V Leiden mutation and its relation with recurrent spontaneous pregnancy loss in a group of Syrian women
 Mohammad Motee Abbas Mohammad, Marwan Gamil Al-Halabi, and Fawza Mohammad Sharif Monem

Faculty of Pharmacy, and faculty of Medicine Damascus University, Damascus, Syria

ABSTRACT

Objective: The aim of our study was to investigate the prevalence of factor V Leiden and its relation with RPL in a group of Syrian women. 

Materials and Methods: The study group included 35 women with a history of recurrent pregnancy loss (two or more abortions before 20th week of gestation) were referred to Orient hospital for obstetrics, gynecology and assisted reproduction, Damascus, Syria, for investigation between December 2005 and July 2006. All women with known causes of pregnancy loss after convenient investigations were excluded. The control group included 45 healthy women from the same ethnic background, who had at least one successful pregnancy, and none of them had a history of fetal loss or complicated pregnancy. FVL mutation was screened by Real-time PCR method.

Results: The results show that 10 women out of 35 with RPL and 4 women out of 45 controls had FVL mutation (28.6 versus 8.9 %,P=0.022, Odds ratio 4.1, 95% CI: 1.16-14.4). From the 25 women who were primary RPL, eight patients had the factor V Leiden (32 versus 8.9%, P=0.014, OR: 4.8, 95%CI: 1.2, 18.17). From the 10 women who were secondary RPL, two patients had the factor V Leiden (20 versus 8.9%, P=0.30, OR: 2.5, 95% CI: 0.4-16.4). All patients and controls carrying the factor V Leiden were heterozygote.

Conclusion: Our results revealed that the prevalence of FVL was significantly higher in women with RPL in comparison with controls, particularly in the subgroup with primary RPL, and there is an association between factor V Leiden mutation and recurrent pregnancy loss.

Key Words: Factor V Leiden mutation, recurrent pregnancy loss, Prevalence, Syrian women

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The prevalence of sexual dysfunctions in infertile women
 Naeimeh Tayebi, and Seyed Mojtaba Yassini Ardakani

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

ABSTRACT

Objective: Sexuality is an important and integral part of every woman’s life. The aim of this study was to assess the degree of sexual dysfunction among infertile women and its correlation with age, duration of marriage and etiology of infertility in women.

Materials and Methods: 300 infertile women who were referred to IVF center for management of their infertility problem involved in this study after informed consent. They were asked to fill a questionnaire that contained three parts of demographic, infertility and sexual function items. Distribution of sexual dysfunction and its relationship to infertility and marriage duration were analyzed through SPSS software.

Results: The most common sexual dysfunction was orgasm disorder (83.76%) and the rate of sexual desire disorder, dyspareunia and vaginismus were 80.7%, 67.7% and 76.7% respectively. More than 50% of cases mentioned decreased frequency of coitus after diagnosis of infertility. Vaginismus and dyspareunia were more common in 20-24 years age group.

Conclusion: According to the high rate of sexual dysfunction in this study and almost the same rate in other studies, gynecologists should pay more attention to this important issue and encourage the patients to have an evaluation by a psychiatrist or psychologist

Keywords: Sexual dysfunction, infertility

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Prediction of pregnancy outcome by limulus amoebocyte lysate (LAL) test in non pregnant women with poor obstetric history
Mohamed Motawe, and Essam Abdullah

Department of Obstetrics and Gynecology, Department of Clinical pathology, Suez canal University, Egypt

ABSTRACT

Objective: to evaluate the prognostic value of Limulus Amoebocyte Lysate (LAL) Test in prediction of pregnancy outcome in women with poor obstetric history.

Materials and Methods: non pregnant females with history of abortions and or preterm labor were included. Measurement of bacterial endotoxin in menstrual effluent was done using the Limulus Amoebocyte Lysate (LAL) Test.  Sixty eight women got pregnant within a year; follow up of these women was done to assess the outcome of pregnancy and compared to results of LAL test.

Results: There was a statistically significant correlation between LAL test level and the occurrence of pregnancy (p < 0.05). Spontaneous preterm labor and abortion were 16.6% in samples with endotoxin ≤150 pg/ml while, they were 85.2% with endotoxin >150pg/ml.  Measurement of endotoxin level had a sensitivity of 79.3%, specificity of 89.2% for prediction of occurrence of preterm labor and abortion. It has positive predictive value of 85.2% and negative predictive value of 85.4% and overall accuracy of 85.3%.

Conclusion: Limulus Amoebocyte Lysate (LAL) Test in menstrual blood may be considered as a prognostic marker for pregnancy outcome in women with history of previous abortions and or preterm labor.

Keywords: pregnancy outcome, poor obstetric history, limulus amoebocyte lysate.

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Resistin as a predictor for ovarian response to clomiphene citrate in obese PCOS women
 Nadin Alaa, Olfat Noah, Ahmed Rizk, Enas Hamdy, and Hesham Al-Inany

Departments of Obstetrics and Gynecology, and Chemical pathology, Cairo University, Cairo, Egypt

ABSTRACT

Objective: to evaluate the value of resistin as a predictor of ovulation induction by clomiphene citrate in cases of PCOS.

Design: prospective, controlled clinical study

Setting: kasr Al-Aini Hospital

Materials and Methods: obese subfertile women with PCOS (BMI>30 kg/m2) received clomiphene citrate 50mg / 8hours from the third day of the cycle and for five days. Based on success of ovulation induction, women were divided into two groups: Group I who responded to CC and Group II: those who failed to respond to CC. Blood samples were collected on day 3 of the cycle and resistin, insulin and sugar were assayed .

Results: There was no significant difference between both groups regarding background characteristics, however, there was a significant difference regarding both BMI and resistin between both groups. Multiple linear regression showed a statistically significant value of resistin independent of that of BMI. The ROC curve showed a cut-off value of 4.78 for resistin with area under curve more than 78.9% and sensitivity 66.67% and specificity 82.4% to predict response to clomiphene citrate in obese PCOS women

Conclusion: in obese women, resistin may be of value in prediction of ovarian response to clomiphene citrate. This needs to be confirmed in further trials.

Key words: resistin, PCOS, obesity, clomiphene citrate

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Comparison of implantation and pregnancy rate using two methods of embryo selection: “Pronuclear morphology and embryo quality” and “embryo morphology alone”
 Robab Davar, Shamsi Beigi, and Mehrdad Soleimani

Research and clinical center for infertility, Shahid Sadoughi University of medical sciences and health services, Yazd, Iran

ABSTRACT

Objective: Despite many advances in the field of reproductive medicine, with <30% of embryos that are transferred ever resulting in clinical pregnancies. This study compared implantation and pregnancy rate in two methods of embryo selection.

Design: randomized double blind clinical trial

Materials and Methods: Research and clinical center for infertility, Yazd, Iran

Subject: In this randomized double blind clinical trial, 95 patients referring to the Yazd Research and Clinical Center for Infertility for IVF or ICSI treatment were included from March to December 2004. These patients randomly allocated in two groups. (A & B) In group A (Case), embryo selection was done by pronuclear morphology and embryo quality while in group B (Control), this process was done by embryo morphology methods alone. Oocytes were classified according to their quality. According to cause of infertility ICSI or IVF was done. Finally ≤ 4 embryos with best quality were selected and transferred to uterus.

Main outcome measures: Implantation rate, Pregnancy Rate

Results: In case group, 419 and in control group, 444 oocytes were collected. In case group 129 embryos and in control group 151 embryos were transferred. Number and percent of clinical pregnancies was 14 (31.11%) and 9 (18%) and implantation rate was 18 (13.95%) and 12 (7.94%) in case and control groups.

Conclusion: Until to achievement of better methods and confirmation of blastocystic transferring, we can use from this method in Infertility center.

Keywords: implantation, pronuclear morphology, pregnancy

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Ultrasonographic observations following unilateral and bilateral laparoscopic ovarian diathermy in infertile women with clomiphene citrate resistant polycystic ovarian syndrome.
Ebtisam S. Al-Mizyen, and Jurgis G. Grudzinskas

Department of Obstetrics and Gynecology St Bartholomew's and The Royal London School of Medicine and Dentistry, London, Queen Mary's Hospital, Roehampton, The London Bridge Fertility, Gynecology and Genetics Centre, London, UK

ABSTRACT

Objective: To evaluate the changes in ovarian volume and the reproductive outcome after unilateral (UOD) and bilateral (BOD) laparoscopic ovarian diathermy in infertile women with Clomiphene Citrate resistant PCOS.

Material and Methods: The ovarian volume in both groups was measured by transvaginal ultrasonography preoperatively and up to 10 days after laparoscopic ovarian diathermy and examined in relation to the subsequent clinical course.

Results: Of the ten patients who underwent UOD, seven clinical pregnancies were achieved in five women. Of the ten patients who underwent BOD, seven clinical pregnancies were achieved in six women. BOD was seen to be followed by a statistically significant decrease in mean ovarian volume ten days post-operatively; whilst there were no changes in mean ovarian volume following UOD, resulting there was a decrease in ovarian volume in two women whose right ovary (ipsilateral) was diathermied and three women in the contralateral ovary.

Conclusion: Although such changes were not consistently seen following UOD, the clinical outcome was similar in both groups.

Key words: unilateral vs. bilateral laparoscopic ovarian diathermy; polycystic ovarian syndrome; ultrasound

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Ongoing twin pregnancy after transfer of vitrified oocyte injected with sperm recovered from cryopreserved testicular tissue
 Mohamed Youssry, B. Schöpper, A Schultze-Mosgau, S Von Otte, G Griesinger, Klaus Diedrich, and Safaa Al-Hasani

Department of Obstetrics and Gynecology, University of Schleswig – Holstein, Lübeck, Germany. Department of Obstetrics and Gynecology, University of Alexandria, Alexandria -Egypt.

ABSTRACT

Cryopreservation of human gametes and embryos has become an essential part of assisted reproduction. It is now possible to cryopreserve gametes and embryos at their different stages of development. It allows patients undergoing chemotherapy or radiotherapy to preserve their fertility, and helps to attain all benefits from the costly ovarian superovulation therapies prior to assisted reproductive techniques (ART). Owing to the extremely high survival and pregnancy rates, vitrification is now being widely used in ART laboratories in addition to its low cost and simplicity as an optimal cryopreservation procedure for human oocytes and embryos. Here, we would like to report an ongoing twin pregnancy after Vitrification/warming of oocytes which were injected by ICSI with patient’s husband spermatozoa retrieved from cryopreserved testicular tissue and transfer of day three cleavage stage embryos was.

Key words: Vitrification; oocytes; embryos.

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