Embryo biotechnology in reproductive medicine
 Karl Illmensee

Genesis Fertility Center, Patras, Greece

ABSTRACT

Mammalian embryo biotechnology with multiple applications in reproductive and therapeutic medicine has been summarized in this review article. Risk factors at the molecular, genetic and chromosomal level that profoundly influence the outcome of reproductive cloning have been included for serious considerations. Interspecies embryo cloning has turned out to be a unique bioassay to reveal the embryonic developmental capacities of various adult somatic cells. New approaches for in-vitro cloning of individual blastomeres (early embryonic cells) will lead to ES cells without destroying embryos. Novel attempts for embryo splitting have been presented with various implications for assisted reproduction. Predictive progress and prognostic views for human embryo biotechnology and patients' benefits are outlined for the near future.  Social and ethical issues concerning embryo biotechnology are being discussed in reference to public opinion polls or ethics committee guidelines.

Key Words: somatic cell nuclear transfer (SCNT), interspecies embryo cloning, embryo splitting, blastomere cloning, assisted reproductive technologies (ART)

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Luteal phase support in assisted reproduction: United Kingdom survey
 Ahmed S. Kassab, Gehan El-Bialy, H.Hashesh, Santanu Baruah, and Talha Al-Shawaf

Centre for Reproductive Medicine, St Bartholomew’s Hospital, London; Department of Obstetrics and Gynecology Royal Devon and Exeter Hospital and Department of maxillofacial surgery North Staffordshire University Hospital U.K.

ABSTRACT

Objective: Probing practices of luteal phase support in assisted reproductive technology (ART) centers in U.K.

Materials and methods: A question survey was conducted via the recognized centre by the HFEA (Human Fertilization Embryology Authority) registry for year 2005. Questions covered importance, optimal hormone for luteal support and optimal route and length of progesterone and human chorionic gonadotrophin (hCG) administration for women undergoing assisted reproductive technologies.

Main outcome measures: The main outcome measures were importance, optimal hormone, and optimal route, dose, length of progesterone, estrogen and hCG administration.

Results: 82 centers licensed for in vitro fertilization / Donor insemination (IVF/DI) acknowledge receiving the survey. Of those, 69 centers perform in vitro fertilization / intra cytoplasmic sperm injection (IVF/ICSI). 60 (87%) centers replied. Luteal support was very important in 65% and important in 31%. 97% used it in long down regulation protocol. The routine use of luteal support following controlled ovarian hyperstimulation (COH) with all stimulated cycles was 80.6%. HCG was behind the progesterone in its use in this survey. Cyclogest (progesterone pessaries) was the first choice of those selected as a preference in 55%. 92% of IVF/ICSI centers that responded to the questionnaire use cyclogest. The commonest dose used is 400 mg twice daily (BD). The other leaders are intramuscular progesterone (42%), hCG (38%), and vaginal progesterone gel (25%). The common practice is to start luteal support from the day of oocyte collection (48%) and 48% centers continue support until 12 weeks gestation.

Conclusion: Luteal phase support in ART is regarded as important by majority of specialist centre. Cyclogest is the most widely used luteal phase support.

Key words: ART, hCG, Luteal support, Progesterone, Survey.

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Serum-prostatic specific antigen level as a promising marker in infertile women with polycystic ovarian disease
 Mohamed A. Metawie, Taher El Sarafy, Sherif El-Kattan, Hamdy Azab and Magdy El-Biely

Department of Obstetrics and Gynecology, Department of Biochemistry, Suez Canal University, Egypt.

ABSTRACT

Objective: To evaluate value of serum prostatic specific antigen (PSA) as a marker for PCOS infertile women undergoing ovulation induction.

Design:  A prospective clinical trial

Setting:  Department of obstetric and gynecology, Suez Canal university.

Materials and Methods: Eighty four women (64 with PCOS, 20 normoovulatory as control) were evaluated clinically and by pelvic ultrasound.  Serum FSH, LH and Testosterone were estimated at 2nd day of menses while E2 and Progesterone were estimated at the midluteal phase using  highly sensitive ELFA technique ,TPSA was estimated at both 2nd day of menses and at the midluteal phase using the Immulite / Immulite 1000 system.

Results: The study group exhibited significant higher mean TPSA 2nd day (0.040 ng/dl) versus (0.003 ng/dl, P=0.031) in normal control group, and also significant higher mean TPSA midluteal (0.020 ng/dl) versus (0.002 ng/dl, P=0.022) as compared to control group. Subgroup analysis according to response showed that responders exhibited significant reduction in TPSA level midluteal (0.008 ng/dl) than that on 2nd day (0.011 ng/dl, P<0.001). 

Conclusion: the mean serum TPSA could be detected in high significant concentrations in the serum of PCOD infertile women with significant decreasing concentrations after induction of ovulation, thus TPSA can be used as a promising marker for ovarian response in infertile women due to PCOD.

Keywords: prostatic specific antigen, infertility, PCOD, Immulite

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Comparison of the effects of cabergoline and bromocriptine in women with hyperprolactinemic amenorrhea
 Ahmed J Al-Husaynei, Isam H. Mahmood and Zena S. Al-Jubori

Al-Batool Teaching Hospital for Obstetrics and Gynecology, and Department of Pharmacology, College of Medicine, University of Mosul, Iraq

ABSTRACT

Objective: There are relatively few reports in the world comparing the beneficial and adverse effects of bromocriptine and cabergoline in the treatment of hyperprolactinemic patients and there is also lack of such studies in Iraq. Therefore, this study sets out to compare the efficacy and safety of cabergoline with those of bromocriptine in women with hyperprolactinemic amenorrhea in Mosul city.

Design: Randomized, 8 - week period comparative trial.

Setting: Al-Batool Teaching Hospital for Obstetric and Gynecology and the department of pharmacology, college of medicine in Mosul city.

Materials and methods: One hundred and thirty women with hyperprolactinemic amenorrhea participated in the study. Women were treated with either cabergoline (0.5 mg weekly) or bromocriptine (2.5 mg twice daily) administered randomly for 8 weeks. Amenorrhea and galactorrhea and serum prolactin levels were assessed at baseline and at the end of the trial.

Main Outcome measures: The efficacy of both treatments was assessed with the occurrence of menses, absence of galactorrhea and normalization of serum prolactin levels.

Results: Amenorrhea persisted in 9 women of the cabergoline-treated women and 20 of the bromocriptine-treated women. Galactorrhea disappeared in the cabergoline group and persisted in 12 of the bromocriptine group. Normoprolactinemia was achieved in 87.7% women treated with cabergoline and in 67.7% of women treated with bromocriptine.

Conclusions: Cabergoline and bromocriptine are effective in the treatment of hyperprolactinemic amenorrhea .Cabergoline has the advantage over bromocriptine in terms of both efficacy and tolerability and therefore it is preferred in the treatment of hyperprolactinemic amenorrhea.

Key words: Hyperprolactinemia, amenorrhea, galactorrhea, bromocriptine, cabergoline.

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The levels of bacterial contamination of the embryo transfer catheter relate negatively to the outcome of embryo transfer
 Ismail Aboul Fotouh and Mirvat Gaber Al-Inany

Departments of  Obstetrics and Gynecology and Clinical Pathology, Cairo University, Cairo, Egypt

ABSTRACT

Objective: To determine the prognostic value of presence and level of bacterial contamination on the pregnancy outcome in patients undergoing embryo transfer following IVF/ICSI.

Design: Prospective, cross-sectional observational study

Materials and methods: Twenty-five consecutive patients undergoing an embryo transfer cycle as a part of their IVF/ ICSI treatment were included. Cervical mucus samples were taken immediately prior to embryo transfer and the tips of the post-transfer catheters were examined for bacterial contamination, and their levels were recorded.

Results: The presences of bacterial contamination in the cervical and catheter tip samples showed a weak correlation between finding gram positive and gram negative bacteria on the cervical sample and the catheter tip. Multiple linear regression analysis demonstrated that the presence of bacterial contamination was not significantly associated with the pregnancy rate.

Conclusion(s): The presence of bacterial contamination of catheter tips during embryo transfer is evidently limited, and does not significantly affect the cycle outcomes.

Key words: Bacterial contamination, Vaginal flora, Embryo transfer, Assisted Reproduction

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The predictive value of pronuclear morphology screening on embryo development and pregnancy outcome in ART cycles
 Mohammad Ali Khalili, Vida Razavi, Farahnaz Mardanian and Navid Esfandiari

Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Fertility and Infertility Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; and Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.

ABSTRACT

Objective: To evaluate the predictive value of zygote pronuclear (PN) morphology on embryo development and pregnancy outcome in in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles.

Materials and Methods: PN morphology of embryos resulted from 35 IVF and 35 ICSI cycles were evaluated. The cause of infertility for IVF and ICSI patients were tubal and male factor of infertility, respectively. After PN assessment using Z-scoring, the zygotes were incubated individually in drops of culture media and evaluated blindly. Embryo transfer (ET) took place either on day-2 or day-5.

Results: Significant differences were noticed between Z1 and Z4 scoring embryos. The Z-scoring system was useful in predicting day-2 and -5 embryo survival and development. There was a direct correlation with Z1 and grade A embryo formation, also between Z2 and blastocyst development in both IVF and ICSI cycles. The pregnancy rates in IVF and ICSI were 25.7% and 22.9%, respectively. Day-2 ET derived from Z1 and Z3 zygotes, and day-5 ET resulted from Z1 and Z2 zygotes were involved with high pregnancy rates.

Conclusion: PN morphological assessment can predict further embryonic development and pregnancy outcome in ART cycles. The Z-score could be of a helpful tool in the selection of embryos both in cellular and blastocyst stage for transfer to achieve high pregnancy rates.

Key Words: pronuclear morphology; zygote scoring; IVF; ICSI; cleaving embryo; blastocyst.

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A randomized trial of letrazole versus clomiphene citrate in induction of ovulation in patients with polycystic ovary syndrome
 Adel F. El Bigawy, Usama M. F. Fouda and Hala A.E. Wahab

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

ABSTRACT

Objective: The aim of this study was to compare the effect of letrazole (2.5mg) and clomiphene citrate (150mg) on ovulation in patients with polycystic ovary syndrome.

Design: Prospective randomized trial.

Setting: University teaching hospital.

Materials and Methods: Sixty four consecutive patients with polycystic ovary syndrome were recruited. Thirty four patients (70 cycles) were given clomiphene citrate and thirty patients (64 cycles) were given letrazole. Both drugs were given orally on days 3-7 of menses. Letrazole, clomiphene citrate, ovulation induction, timed intercourse.

Main outcome measures: Number of follicles, endometrial thickness and pregnancy rates.

Results: The mean age, body mass index, and duration of infertility in both groups were similar. Ovulation occurred in 78% of the cycles (50 /64) in letrazole treated group and 73% of the cycles (51/70) in clomiphene citrate treaded group. The endometrial thickness was significantly higher in letrazole group, the number of mature follicles was significantly lower in the letrazole group. Pregnancy rate per cycle was 16% in the letrazole group and 13% in the clomiphene citrate group.

Conclusion: Aromatase inhibitor letrazole is as effective as clomiphene citrate in induction of ovulation in patients with polycystic ovarian syndrome, and may have a role as first line treatment for anovulatory patients with polycystic ovary syndrome.

Key words: letrozole, clomiphene citrate, polycystic ovary, ovulation, conception

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Medical management of ectopic pregnancy with high HCG levels: a case series
 Leili Safdarian, Elaheh Mossayebi and Bita Badehnoosh

Department of obstetrics and gynecology, Shariati Hospital ,Tehran University of Medical Sciences, Tehran, Iran

ABSTRACT

Objective: To evaluate the efficacy of medical management of ectopic pregnancy with  high HCG levels .

Design: Case series.

Setting: A teaching hospital in Tehran University.

Materials and Methods: Selecting 6 patients with unruptured ectopic pregnancy and HCG levels above 12000 IU/L to be managed medically.

Results: All patients were managed successfully.

Conclusion: In selected patients with high pre-treatment HCG levels medical management may be successful and that high HCG level is not a contraindication for medical management by itself.

Keywords: Ectopic pregnancy, HCG level, Medical management

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Fresh versus cryopreserved testicular spermatozoa in men with nonobstructive azoospermia undergoing ICSI
 Mohamed Khaled Moustapha and Shedeed Ashour

Dr Erfan And Bagedo General Hospital, Jeddah, Saudi Arabia; Al Azhar University and Cairo University, Cairo, Egypt

ABSTRACT

Objective: To compare the outcome of intracytoplasmic sperm injection (ICSI) with fresh and frozen-thawed testicular spermatozoa in patients with nonobstructive azoospermia.

Design: single center clinical trial

Materials and methods: Forty seven men with nonobstructive azoospermia in whom testicular sperm was found after testicular sperm extraction were enrolled (25 cases using fresh biopsy and 22 using frozen –thawed biopsy).

Main outcome measure(s): fertilization rate; mean number of embryos transferred per cycle, embryo implantation, clinical pregnancy

Result(s): There was no statistically significant difference between both groups regarding their background characteristics. There was an improved pregnancy rate with fresh versus cryopreserved testicular (P=0.053). No significant difference regarding other parameters was found.

Conclusion: In men with non obstructive azoospermia, fresh sperm extraction may yield better results than frozen biopsy.

Keywords: testicular biopsy, ICSI, nonobstructive azoospermia

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GnRH agonist long protocol versus short protocol in women 40 years or more undergoing ICSI: a multicenter study
 Hamed Youssef, Walaa El Deeb, Osama Shawky, Mohamed Metawe and Hossam Goda

Departments of Obstetrics and Gynecology, Mansoura University, Alexandria University, Cairo University, and  Suez Canal University, Egypt

ABSTRACT

Objective: to compare results of GnRH agonist long protocol vs. short protocol in women forty years or older undergoing ICS cycles

Setting: multicenter comparative trial

Materials and methods: Participants & Interventions: a total of 531 women ranging between 40-47ys were included in this study. Two hundred eighty five women received long protocol while two hundred forty six women received short protocol. All women had FSH less than 20 before start of treatment. Standard ICSI program was done and follow up for all cases. Women with previous poor response were excluded from the study.

Results: In total, among 531 participants, clinical pregnancy was achieved in one hundred and one women (19%) and miscarriage rate was (32%) mainly in the first eight weeks. There was a wide variation in regarding both protocols (long protocol achieved pregnancy rate of 26.6 % while short protocol achieved only 10.2% pregnancy rate (P <0.001). No cases of severe OHSS were reported. Cost of drugs were significantly reduced with the short protocol (P =0.031)

Conclusion: this multicenter study shows that long protocol of GnRH agonist was better than short protocol in women with age of forty or above.

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