Vitrification as a tool to preserve women fertility
 Kareem El-Nahas, Tamer El-Nahas, Klaus Diedrich, & Safaa Al-Hasani

National Research Center, Cairo, Egypt Schleswig Holustein, Lübeck University, Germany.

ABSTRACT

In recent years, preservation of fertility in women has been recommended. Thus, cryopreservation of human gametes, embryos and ovarian tissue has become an essential part of assisted reproduction. This approach limits the number of embryos transferred, while supernumerary oocytes and/or embryos can be used in subsequent treatment cycles. Furthermore, cryopreservation reduces the potential risk of hyperstimulation syndrome. Cryopreservation is carried out by two techniques; the slow freezing method, and the more recent rapid procedure called vitrification technology. Recently due the success and simplicity of vitrification, the balance between those two methods has been changed in advantage of vitrification. The use of slow freezing method has become controversial due to its difficulties, expense and respective low success rates in artificial reproduction. Therefore, vitrification seems to win the battle and will be the cryopreservation method of the future.

Keywords: Fertility preservation, vitrification, slow freezing, cryopreservation.

(Back to index)
 

Low cost / accessible assisted reproductive technology in developing countries: dream or reality?
 Willem Ombelet

Genk Institute for Fertility Technology, Department of Obstetrics and Gynecology, Genk, Belgium

ABSTRACT

Background: The majority of childless couples are residents of developing countries. When compared to Western societies, negative consequences of childlessness are experienced to a greater degree in these countries. Sexually transmitted diseases and pregnancy-related infections with tubal block are the most common causes of infertility. This means that most cases of infertility in developing countries are only treatable with assisted reproductive technologies (ART) which are either unavailable or very costly. In this opinion paper we try to make a proposal of simplified, safe and low-cost ART.

Materials and Methods: Using PubMed, Excerpta Medica and EMBASE we didn’t succeed to identify relevant papers on the issue of simplified IVF. Subsequently a search for papers in which simplified techniques of the different steps on IVF were studied, including the preparation of oocytes, the monitoring of the cycle, the IVF procedure itself, the laboratory phase, the luteal support and the prevention of complications was performed.

Results: Mild stimulation using clomiphene citrate and/or very low dose gonadotrophins seems to be a safe and effective option concerning ovarian preparation. The set-up of an IVF clinic can probably be organized without very expensive equipment. Cheap catheters and needles are as effective as more expensive ones. Different strategies for a safe and effective laboratory phase and methods of preventing complications are described.

Conclusion: Although prevention is better than cure, for reasons of social justice we believe that it is justified and possible to implement simplified, safe and effective methods of ART in resource-poor countries.

Keywords: developing countries, infertility, low cost ART, politics, simplified infertility treatment.

(Back to index)

Effect of follicle size on in-vitro maturation of oocytes
 Samy Mahmoud Ismail

Departments of Obstetrics and Gynecology, King Fahd University Hospital, King Faisel University, Dammam, KSA; Al Mana General Hospital, Khobar, KSA; Faculty of Medicine, Al Azhar University, Cairo, Egypt and Campus Benjamin Franklin - University Hospital, Homboldt University, Berlin, Germany.

ABSTRACT

Objective: To study the effect of follicle size, on oocytes maturation, fertilization, cleavage and pregnancy rates in women with polycystic ovary syndrome.

Study design: Five hundred germinal vesicles (GV) were collected to study the effect of follicle sizes on in vitro maturation outcomes. 

Material and Methods: Fifty PCOS patients were randomly allocated to study the effect of two follicle sizes (8-10mm and 11-13mm) on oocytes maturation, fertilization, cleavage, and pregnancy rate. 

Results: Increase follicular size showed significant (P<0.05) increase on the rate of maturation, fertilization, cleavage, and clinical pregnancy. Oocytes retrieved from 11-13 mm follicles showed higher rates of maturation, fertilization, cleavage, and pregnancy, than those retrieved from 8-10 mm follicles. The above parameters increased from 48 to 70%; from 54 to 76%, from 64 to 68%, and from 11 to 22.5%, respectively.

Conclusion: The results suggested that oocytes recovered from follicles with 11-13 mm in diameter provided higher maturation rates and a better subsequent developmental competence than those retrieved from smaller follicles of 8-10 mm diameter.

Keywords:  Oocytes, IVM, ICSI, fertilization, pregnancy

(Back to index)

A prospective comparative study to assess receptor polymorphism in women with polycystic ovary syndrome versus normo-ovulatory women
 Hesham Al-Inany and Abeer Mohyi

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

ABSTRACT

Objective: to examine the associations of polymorphisms of ß3-adrenergic receptor and glycogen synthetase gene with obesity and insulin resistance in women with polycystic ovary.

Design: prospective controlled trial

Setting: Faculty of medicine, Cairo University

Participants & Methods: Subfertile women with PCOS, n=43 (group I) were compared to matched age group of normoovulatory women (control group II (n=20). Both groups were further subdivided according to Body mass index (BMI) into obese and non obese participants. Ultrasound examination and blood sampling were done and fasting blood glucose, insulin resistance, total cholesterol, and triglycerides were estimated. Trp64Arg polymorphism of the ADRB3 and A1A2 polymorphism of the GS gene were determined by PCR-RFLP analysis.

Results: The frequency of Trp64Arg variant was significantly higher in obese PCOS women (24%) compared with obese control group (0%); P = 0.044. A major effect of the Trp64Arg variant on insulin resistance (HOMA-IR) could not be demonstrated. On the other side, all women were normal for the glycogen synthetase gene (A1A1) whether obese or non obese, whether PCO or normoovulatory. Association between polycystic ovary and polymorphism of ADRB3 gene was found to be of high significance [Odds Ratio = 10.03 95% CI = 2.73 to 36.72] P= 0.00054. An association between Trp64Arg genetic variant and obesity in PCOS women was demonstrated.

Conclusion: Polymorphism of glycogen synthetase may not appear to be higher in PCOS women compared to controls but this needs further verification by a larger study.

Keywords: PCOS, polymorphism, ß3-adrenergic receptor, glycogen synthetase           

(Back to index)

Angiopoietin-1 in polycystic ovary syndrome during in vitro fertilization cycles
 Hossam Fahem Abdel-Rahim

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

ABSTRACT

Objective: To evaluate levels of Angiopoietin-1 in serum and follicular fluid of PCOS patients during a controlled ovarian hyperstimulation in In Vitro Fertilization (IVF) cycles.

Study Design: Prospective case-control study.

Setting: IVF unit of a semi-private hospital in Cairo, Egypt.

Materials and Methods: In 60 patients undergoing in vitro fertilization treatments, 30 PCOS patients and 30 controls, serum Angiopoietin-1 levels were assessed before starting administration of follicle-stimulating hormone (FSH) (day 3), on the day of administration of human chorionic gonadotrophin (hCG) and on the day of oocyte retrieval. Follicular fluid levels of Angiopoietin-1 were also assessed on the day of oocyte retrieval.

Results: PCOS patients showed significantly higher serum levels of Angiopoietin-1 when compared to controls before starting administration of FSH (day 3), on the day of hCG administration and on the day of oocyte retrieval.

Similarly, in follicular fluid, significantly higher Angiopoietin-1 levels were found in PCOS patients than in controls.

Conclusion: The present study revealed elevated levels of Angiopoietin-1 in serum and follicular fluid in PCOS patients compared to controls. This might reinforce the hypothesis that there is a role for angiogenetic factors in this phenomenon.

Key words: Angiopoietin-1, PCOS, IVF

(Back to index)

Impact of lead exposure on pregnancy outcome
 Ismail Aboul Foutouh, Nashwa M. Samra and Ashraf A. Selim

Obstetrics and Gynecology Department , Cairo University, Pediatric Department, Fayoum University, National Egyptian Center for Toxicological and Environmental Research, Cairo University.

ABSTRACT

Objective: to study the effects of lead exposure on hematological parameters in maternal and neonatal umbilical cord blood.

Design: A cross-section study

Setting: El-Kasr-El Eini Hospital.

Materials and Methods: Fifty normal pregnant women were included and their newborns at the time of delivery. We exclude mothers with poor obstetric history, multiple gestation or had acute or chronic illness. 26 of them were from rural areas and 24 from urban areas. All neonates were full term, 27 of them were male.

Main outcome measures: Blood lead levels and complete blood counts were determined from the venous blood of all the mothers and from the umbilical cord of their neonates.

Results: The mean maternal blood lead level ±SD was 75.61 ± 27.03 microg/L and the mean neonatal umbilical cord blood lead level ± SD was 49.31 ± 17.53 microg/L. A strong positive correlation was found between maternal and cord blood lead (r=0.924, P< 0.001). No statistical significant differences were found in blood lead levels between mother-neonate pairs who are living in urban areas and those who are living in rural areas P> 0.05. No significant correlation was observed between maternal blood lead levels and maternal age. Insignificant statistical differences in cord blood lead levels were observed by fetal gender or child order. A highly statistical significant negative correlations were found between mother and neonate blood lead levels and neonatal birth weights (P<0.001). The assessment of neonatal well being after birth showed only one case with multiple congenital anomalies.

Conclusion: we need to strength our efforts towards prevention of lead exposure. Recognition and removal of environmental lead sources can prevent maternal and neonatal morbidity.

Keywords: Lead, neonatal morbidity, birth weight, umbilical cord blood.

(Back to index)

Evaluation of age, FSH, and ultrasound parameters as predictors of ovarian reserve and IVF outcome
 Mona Aboulghar, Hamdy Azab, Foad Abouhamila, Hatem Hetto and Amira Saeed

The Egyptian IVF-ET Center, Maadi, Cairo and Cairo university , Department of obstetrics and Gynecology, Cairo, Egypt

ABSTRACT

Objective: To evaluate the female age, FSH, and ultrasound parameters including the antral follicle count (AFC), ovarian volume, and Doppler indices in prediction of ovarian reserve and IVF outcome

Materials and Methods: 50 infertile patients with apparently normal ovarian reserve undergoing their 1st IVF trial were enrolled in the study. On day 2-5 of the cycle, they underwent ultrasound assessment of AFC, ovarian volume, and Doppler evaluation of ovarian stromal blood flow though measurement of RI, PI, PSV, and Vm. They also had serum FSH evaluation. Controlled ovarian stimulation was done according to a standard long GnRH agonist protocol. The 2 main outcomes were the occurrence of clinical pregnancy and the number of oocytes retrieved.

Results: 22 (44%) women achieved clinical pregnancy. Only the age (29.4 ± 4.25 Vs 32.57 ± 5.01, p<0.05) and infertility duration (5.97 ± 4.2 Vs 9.62 ± 4.8, p<0.01) showed significant difference between pregnant and non pregnant women. Operator characteristic (ROC) curve was used to predict clinical pregnancy. Only the age (AUC=0.69, p<0.01), infertility duration (AUC=0.72, p<0.01) and the number of oocytes retrieved (AUC=0.66, p<0.05) were significant for predicting clinical pregnancy. A multiple regression analysis was used to predict the oocyte number, the AFC was the only significant predictor (p<0.01). Correlation between different variables was carried out. There was significant correlation between ovarian volume and AFC (r=0.56, p<0.01), ovarian volume and oocyte number (r=0.47, p<0.01), and ovarian volume and Vm (r=0.46, p<0.01). There was significant correlation between AFC and oocyte number (r=0.47, p<0.01) and AFC and Vm (r=0.51, p<0.01). There was also significant correlation between the oocyte number and Vm (r=0.31, p<0.05).

Conclusion: The variables which are strongly related to a successful IVF outcome include the age, infertility duration, oocyte number, and AFC. Doppler evaluation was not helpful in predicting clinical pregnancy or oocyte number.

Key words: age, FSH, AFC, ovarian volume, IVF outcome, ovarian stromal blood flow, color Doppler

(Back to index)

Free maternal plasma DNA as a predictive marker for preeclampsia
 Ahmed Rezk, Amr Hassan, Mohamed Saber, Amal Abou Al-Fadl, Mohamed Shemis and Nagla Fathy

Departments of Obstetrics and Gynecology, and Biochemistry, Benha University, Benha, Egypt

ABSTRACT

Objective: to test whether an abnormal increase in circulating free fetal DNA concentration in maternal plasma can be detected in preeclampsia before the onset of the clinical disease and so, whether it can be used as a predictor marker for preeclampsia.

Setting: Benha University

Design: prospective clinical trial

Materials and Methods: Blood samples were collected early in pregnancy from singleton pregnant women. Sixteen women subsequently developed preeclampsia as the only ante natal complication. Another 36 subjects of those who are carrying male fetuses, and have no antenatal complications were selected as positive controls. Samples from 9 pregnant women carrying female fetuses and have no antenatal complications were selected as the negative controls. DNA was extracted from the plasma and the amplified DNA was analyzed by electrophoresis.

Results: there was a statistically highly significant increase in the double stranded DNA concentrations in preeclamptic patients as compared to controls (p < 0.001), and this increase is significantly higher in early onset PE than late onset one. There was an increase in circulating free fetal DNA concentrations in PET patients prior to the onset of clinical disease than in those of positive controls with matched gestational ages.

Conclusions: free circulating total and fetal DNA in maternal plasma were increased in patients of PE before the onset of it's clinical symptoms and signs as compared to gestational matched control pregnancies.

Keywords: fetal DNA, maternal plasma, Pre-eclampsia, PCR

(Back to index)

Conservative management of cervical ectopic pregnancy following an ICSI cycle
 Mohamed Eid and Amany Tayae

Dr. S. Abbas IVF unit, Jeddah, KSA and Obs/Gyn department, Cairo University, Egypt

ABSTRACT

We report here a case of cervical ectopic pregnancy diagnosed very early by ultrasound at 6 weeks gestation following ICSI. The management plan started by IM methotrexate (MTX) and trans-vaginal misoprostol followed by ultrasound-guided aspiration of the gestational sac and curettage of the cervical canal under general anesthesia with Foley’s catheter left inside as a tamponade.

Key words: Cervical pregnancy, ICSI, methotrexate, misoprostol.

(Back to index)