How can we reliably predict ovarian reserve?
 Lamiya Mohiyiddeen, Tarek A. Gelbaya, and Luciano G. Nardo

Department of Reproductive Medicine, St Mary’s Hospital, CMFT University Hospitals, Manchester, United Kingdom

ABSTRACT

The search for the most representative markers of ovarian response can help in reducing the costs and potential side effects of excessive gonadotrophins administration. Such markers could help with individualized planning by determining the starting dose of gonadotrophins based on the estimated ovarian reserve. Woman’s chronological age is the most important prognostic factor for the likelihood of treatment’s success. However, the relationship between age and reproductive capacity is highly variable. A variety of endocrine, stimulatory and ultrasound tests have been suggested to improve prediction of oocytes yield and pregnancy outcome following in vitro fertilization (IVF). The markers of ovarian reserve have an important place in the initial approach to treatment of subfertile couples. The aim of this review is to evaluate the current evidence for the best available marker of ovarian reserve and ovarian response to gonadotrophins stimulation in women undergoing assisted conception. Of the currently available markers, anti-Müllerian hormone (AMH) and antral follicle count (AFC) have been proposed as being the most reliable predictors of ovarian reserve. As no study has succeeded in selecting a single marker of ovarian reserve of satisfactory sensitivity and specificity, the combination of markers has been proposed for a better estimate of functional gonadal capacity.

Key words: Age, AFC, AMH, FSH, IVF, ovarian reserve, ovarian performance.

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Beyond research ethics committees: acceptance by investigators and involvement of the community
 Heba Sh. Kassem, Faiza Rab, Alaa  Abouzeid, and Henry Silverman

Faculties of Medicine, Alexandria University and Cairo University, Egypt and University of Maryland School of Medicine, USA.

ABSTRACT

Although, there are generally accepted international research ethics guidelines, their application would differ between individual countries and communities due to cultural, religious, and social factors. With the current theme of globalization, and the exploding evolution in diagnostic and therapeutic research related to health issues, ethical issues have emerged and there is an urgent need for a parallel advancement of research ethics practice around the world. 

University officials need to support the concept of research ethics and impress upon their faculty the worthiness of these concepts in the conduct of research.  Additionally, policy makers need to enhance the concept of community involvement in research.  Examples of such activity would include the establishment of Community Advisory Boards that occurs in AIDS research in several African countries.

Conclusion: A robust system of research ethics requires 1) awareness campaigns in the Universities that promote discussions regarding ethics, especially among investigators and 2) public seminars and media exposure that can ensure transparency of the research enterprise, thus developing

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Immunohistochemical analysis of cyclo-oxygenase 2 (COX-2) and vascular endothelial growth factor (VEGF) cellular expression in ovarian endometrioma
 Samar M. ElSheikh, and Emad El Din Khalifa

Departments of Pathology and Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt

ABSTRACT

Objectives: To analyze immunohistochemical expression of Cyclo-oxygenase (COX-2) and Vascular Endothelial Growth Factor (VEGF) in ovarian endometriotic cysts and assess their association with microvessel count (MV) and angiogenesis.

Setting: Pathology and Obstetrics and Gynecology Departments, Faculty of Medicine, Alexandria University, Egypt.

Design: Retrospective study.

Materials and Methods: This study included 30 infertile cases with ovarian endometriotic cysts underlying laparoscopic excision. The streptavidin-biotin peroxidase complex method was used for immunohistochemistry (IHC). Semiquantitative analysis of COX-2 and VEGF immunostaining was carried out by light microscopy. Angiogenesis was evaluated by immunohistochemical staining of intralesional microvessels for Factor VIII.

Main Outcome Measures: Microvessel count and the expression of COX-2 and VEGF.

Results: COX-2 immunoreactivity was observed mainly in the glandular epithelial cells of all ovarian endometriotic cysts. VEGF was observed mainly in stroma cells and subepithelial macrophages in 93.3% of cases of ovarian endometriotic cysts. Both COX-2 and VEGF were highly correlated with each other (r=0.835, p=0.000). Microvessel count assessed by immunohistochemical planning of F VIII ranged from 13 to 91/0.74 mm2 with a mean ± S.D. 45.83 ± 4.36 (median, 48.00). There was a significant correlation between MV count and COX-2 (r=0.863, p=0.000) or VEGF (r=0.830, p=0.000). The diameter of endometriotic cyst was inversely correlated with COX-2 expression (r=-0.749, p=0.000), VEGF expression (r=-0.837, p=0.000) and MV count (r=-0.764, p=0.000).

Conclusions: COX-2 and VEGF immunoreaction are highly correlated with each other and are closely associated with endometriotic angiogenesis. This opens the possibility of novel approahces to its medical treatment, particularly in the use of selective COX-2 inhibitors and antiangiogenic treatment.

Keywords: Immunohistochemical analysis, cyclo-oxygenase (COX-2), VEGF, ovarian endometrioma, microvessel count, angiogenesis.

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The prevalence of chlamydia trachomatis in patients attending an infertility clinic in the United Arab Emirates
 Adrian Eley, Mohammed El-Hag, Samar Abdul-Khalek, and Walid Sayed

Department of Medical Microbiology, United Arab Emirates University, Serology section, Clinical Support Services and Infertility Clinic, Tawam Hospital, Al Ain, United Arab Emirates.

ABSTRACT

Objective: To assess the prevalence of Chlamydia trachomatis in urine samples from patients attending an infertility clinic in the United Arab Emirates.

Materials and Methods: 239 randomly chosen males (n=160) and females (n=79) from infertile couples who attended an infertility clinic were tested for C. trachomatis using both Clearview and Nested Plasmid PCR.

Results: A total of three patients positive for C. trachomatis (3/232) gave an overall prevalence rate of 1.3%.

Conclusions: It would appear that the prevalence rate for C. trachomatis in patients attending an infertility clinic in the United Arab Emirates is generally on the low side.

Key words: Chlamydia trachomatis, infertility, prevalence

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Detection of human papillomavirus DNA in semen and testicular tissue: Does it play a role in the pathogenesis of male infertility?
 Samar M. ElSheikh, Tarek Hussein, Iman H. El-Morsi, and Nesrine F. Hanafi

Departments of Pathology1, Dermatology and Andrology2 and Medical Microbiology3, Faculty of Medicine, Alexandria University, Egypt.

ABSTRACT

Objectives: To determine the incidence of human papillomavirus (HPV) in semen of oligoasthenospermic cases and in testicular tissue of azoospermic patients.

Setting: Pathology, dermatology and andrology and medical microbiology departments, Faculty of Medicine, University of Alexandria.

Design: Prospective study.

Materials and Methods: This study included 20 semen samples of oligoasthenospermic patients, 20 cases of testicular tissue biopsies from patients with azoospermia and 20 control semen samples with normal sperm count and motility. Samples had undergone DNA extraction followed by amplification of DNA sequence using polymerase chain reaction (PCR) with labeled primers specific for HPV. Amplified products have then been identified using a hybridization process to a DNA microarray chips followed by staining using enzyme substrate reaction.

Main Outcome Measures: Detection of HPV DNA in semen samples and testicular tissue biopsies.

Results: Two of the semen samples tested in oligoasthenospermic patients were positive for HPV on PCR while none of the control group or testicular tissue biopsies from azoospermic males were positive for HPV. These account for only 3.3% positive results in all three groups. HPV type 59 was the only type giving positive results in the two positive cases.

Conclusions: HPV may have a possible role in the pathogenesis of idiopathic male infertility. Further researches in other communities with higher prevalence of HPV might be conclusive with this debate.

Keywords: Human papillomavirus DNA, semen, testicular tissue, male infertility.

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Hormonal changes associated with menstrual dysfunction in pulmonary tuberculosis
 Wafaa A. Hassan, Atef M. Darwish, and Emad Farah

Chest, Obstetric and Gynecology, Clinical Pathology departments, Assiut and Woman’s Health University Hospitals, Assuit, Egypt.

ABSTRACT

Objective: To investigate the role of leptin and female hormones particularly estradiol level in relation to weight loss and menstrual abnormalities in pulmonary tuberculosis (TB).

Materials and Methods: Sixty females with recently diagnosed pulmonary TB in child bearing period were included in this study. Study group included thirty patients with wasting and history of menstrual abnormalities after the onset of pulmonary TB (group A). They were compared to 30 age matched pulmonary tuberculosis women without loss of weight or menstrual dysfunction (group B). A third group included 30 healthy matched females attending family planning clinic of Woman's health University Center (group C). Serum leptin as well as estradiol, prolactin, LH and FSH were measured using ELISA and special kits in all cases. Follow up of the same measures after completion of anti-tuberculous treatment was done in groups A and B.

Results: Group A had significant low mean serum leptin (2.5±1.8, p, 0.01) and estradiol (21.0±11.1 pg/ml, p, 0.000) levels as compared to groups B and C. After successful anti-tuberculous treatment, 20 cases restored normal menstrual function, significant elevation of both serum leptin and estradiol levels as well as body mass index occurred in group A. Nevertheless, serum prolactin, LH and FSH were elevated in minority of cases as compared to other control groups and did not decrease after treatment.

Conclusions: Pulmonary TB-associated menstrual dysfunction and loss of weight could be related to low leptin and estradiol levels. TB associated wasting is correlated with low leptin levels. Low estradiol level is related to low serum leptin, low BMI and hence body fat which is an important source of estrogen. Larger sample sized studies are needed to confirm these findings in tuberculous patients as well as under weight females in general.

Key words: menstrual abnormalities, pulmonary TB, leptin, female hormones.

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The accuracy of clinical presentation in cases of adenomyosis
 Eman A. El Kattan, Khaled Abdel Malek and Hesham Al Inany

Department of Obstetrics and Gynecology department, Cairo University, Egypt

ABSTRACT

Objective: to investigate the prevalence of adenomyosis in histopathological examinations of patients who had undergone hysterectomy due to various indications and to detect the accuracy of the clinical presentation in diagnosing adenomyosis.

Study design: a prospective study.

Setting: Cairo University hospital

Materials and Methods: 352 women who were scheduled for hysterectomy for various indications underwent preoperative clinical evaluation. All the results were then correlated with histopathological results after hysterectomy.

Results: Adenomyosis was detected in 37/352 (10.5 %) patients at the histopathological examination .48 participants were ultrasonographically diagnosed as having adenomyosis from which 37 patients were histologically confirmed. Both groups were comparable in age, but adenomyosis tend to occur in multiparas. Adenomyosis was also significantly more associated with menometrorrhagia (p = 0.03), menorrhagia (p < 0.001), dysmenorrhea (p = 0.018) and tender pelvic examination (p= 0.004) but not with dyspareunia (p = 0.75) or postmenopausal bleeding (P=0.41).

Conclusion: adenomyosis tends to occur in multipara. Menometrorrhagia ,menorrhagia , dysmenorrhea and tender pelvic examination are clinically correlated with adenomyosis.

Keywords: clinical presentation, adenomyosis

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Role of antimullerian hormone (AMH) in women with previous poor response and normal FSH level
 Samir El-Halawaty, Ismail AboulFoutouh, Heba Al-Sawah, Yasser Shabaan and Eman El-Kattan

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

ABSTRACT

Objective: to evaluate the role of antimullerian hormone and serum estradiol in predicting the outcome of In vitro fertilization (IVF) in poor responders

Setting: Misr International IVF center

Materials and methods: eighty nine subfertile women with normal FSH and previous poor response were recruited. On cycle day 1, all women had ultrasound scan and Blood samples were withdrawn. Serum antimullerian hormone and estradiol were measured and the results were compared with the number of retrieved oocytes, number of transferred embryos, and pregnancy rate.

Results: There was significant correlation between AMH and number of retrieved oocytes, the number of embryos but not pregnancy rate. There was no significant correlation between AMH and multiple pregnancies. There was no significant correlation between serum estradiol at day1 with either number of retrieved oocytes, the number of embryos, pregnancy rate or multiple pregnancies.

Conclusion: In women with known previous poor response, AMH measurement does not have a role in predicting the outcome of IVF.

Keywords: AMH, serum estradiol, IVF outcome, ovarian reserve

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The role of the follicle stimulating hormone receptors genotype in the response to FSH in women undergoing controlled ovarian stimulation
 Yehia Waffa, Ahmed Roshdy, Essam El Gindy, Manal El hamshary, Khaled Kasim, and Hesham Al-Inany

Departments of Obstetrics and Gynecology, Al-Azhary, El-Menia, and Cairo Universities; ART unit, International Islamic Centre for Population Studies Research (IICPSR), Al-Azhar University; Molecular Biology department, Genetic Engineering and Biotechnology Institute, EL-Monofia University, and Department of Public Health and Community Medicine, Al-Azhar University, Cairo, Egypt.

ABSTRACT

Objective: to investigate the role of follicle stimulating hormone receptor (FSHR) genotype, in response to FSH in women undergoing controlled ovarian stimulation.

Design: prospective clinical trial

Setting: tertiary fertility care center

Materials and Methods: The frequency distributions of FSHR allelic variants were 20 patients (37%) for the allelic variant (aa), 20 patients (37%) for allelic variant (ss) and 14 patients (26%) for the allelic variant (as) patients.

Results: The mean number of HMG ampoules given to the studied patients was 24.6 ± 5.1 in allelic (aa) patients , 41.3 ± 4.8 in allelic (ss) patients, and 37.5 ± 6.3 in allelic (as) patients and showed statistically significant difference (p <.0001). In patients belonging to allelic variant (aa), the larger the HMG dose, the less the oocytes number will the patient develop, the more the E2HCG will the patient produce and the more the MII oocytes that will develop. In patients belonging to allelic variant (ss), the larger the dose of HMG, the more the oocytes number will the patient develop, the more the E2HCG will the patient produce and the more the MII oocytes that will develop. In patients belonging to allelic variant (as), the results are roughly similar to that observed in allelic (aa) group.

Conclusion: it seems that a different ovarian response to FSH stimulation do occur, depending on the FSHR genotype.

Key words: IVF, FSH, FSHR genotypes, controlled ovarian stimulation, prospective study.

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Accuracy of 3D-ultrasound plus color Doppler for the evaluation of acquired intrauterine lesions compared to diagnostic hysteroscopy
Mohamed Eid, Amany Tayae, and Ahmed Hesham Said

Dr. Samir Abbas Medical Center, IVF unit and Ultrasound unit, Jeddah, KSA; Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt; and Department of Radiology, Cairo University, Egypt.

ABSTRACT

Objective: To evaluate the diagnostic accuracy of 3D-ultrasond (US) and color Doppler for detection of acquired intra-uterine lesions in comparison with the results of hysteroscopy (the gold standard test).

Design: Prospective-descriptive study and test of diagnostic accuracy.

Setting: Private IVF center.

Materials and Methods: 70 women, 22-37 years old were included in the study. Patients were undergoing investigation for infertility or recurrent abortions with noticeable intra-uterine pathology diagnosed on 2D-US or with history of uterine abnormalities. 3D-US and color Doppler ± index compared with hysteroscopy.

Main outcome measures: Sensitivity and specificity of 3 diagnosed lesions by 3D-US (endometrial polyp, submucous myoma and intrauterine adhesion), were calculated and compared to those of hysteroscopy aiming to state the degree of accuracy. 

Results: 40 (57%) women were diagnosed having intra-uterine lesions, 7 (10%) with congenital anomalies were excluded and 33 (47%) with acquired intra-uterine lesions (20% polyp, 16% submucous myoma, 8% adhesion & 3% combined) were included for assessment. The diagnostic accuracy of 3D-US & hysteroscopy for endometrial polyp & submucous myoma, were identical as the sensitivity and specificity for both interventions were 100%. Color Doppler & duplex Doppler (resistance index = RI) of polypoid lesions (polyp & myoma), facilitated the differential diagnosis between both the subtypes; polyp, RI (0.52-0.56) & myoma, RI (0.63-0.68). 3D-US for intrauterine adhesions had a limited accuracy, as the sensitivity and specificity was 63% and 85%, respectively; on the other hand the sensitivity and specificity of hysteroscopy were 100%.

Conclusions: The accuracy of 3D-US in identifying polypoid lesions is confirmed. However, 3D-US had a limited accuracy for the evaluation of intrauterine adhesion. More prospective studies are needed to confirm these results.

Key word: Hysteroscopy / 3D-US / Uterine cavity abnormalities.

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