Stem cells in Gynecology
 Eman M El Nashar and Mona A. Al Mushait

College of medicine, Departments of Anatomy and Obstetrics and Gynecology, King Khaled University, KSA

ABSTRACT

Stem cells are undifferentiated cells, under proper conditions they begin to develop into specialized tissues and organs and they are self-sustaining can replicate themselves for long periods of time. They can be obtained from embryos, amniotic fluid, Placental tissue, umbilical cord blood, fetal tissues and are also found in many adult tissues. Several gynecological conditions are associated with abnormal endometrial proliferation, and it is possible that putative endometrial stem/progenitor cells may play a role in the pathophysiology of diseases such as endometriosis, endometrial hyperplasia, endometrial cancer and adenomyosis. The presence of adult stem cells in the uterus could lead to women being able to use their own cells to repair pelvic floor prolapse. Further understanding of stem cell recruitment and differentiation will have clinical implications in Asherman’s syndrome. The ability to identify and characterize cervical stem cells is crucial for treating cervical cancer and human papilloma virus. The isolation of fetal mesenchymal stem cells from maternal blood has a role in non-invasive prenatal diagnosis.  Hematopoietic stem cells have been used to set up therapeutic strategies for the treatment of ovarian and breast cancer. The use of in utero Hematopoietic stem cell transplantation may be an alternative to the postnatal transplantation for treatment of many diseases.

Key words: Stem cells, definition, properties, differential potential, types and sources, endometrial, cervical, non-invasive prenatal diagnosis, gynecologic malignancies, gene therapy.

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Fertility-enhancing reconstructive endoscopic myomectomy in modern practice
 Atef M. M. Darwish

International Islamic Center for population Studies and Research, Al- Azhar University, Cairo, Egypt.

ABSTRACT

Objective: To evaluate the effect of consanguineous marriage on ICSI outcome among couples who are consanguineous first degree cousins compared to non consanguineous couples.

Setting: Al-Azhar Assisted Reproduction Unit, Cairo, Egypt.

Design: A retrospective study.

Materials and methods: During the period from 1/7/2005 to 31/12/2006, 566 couples were enrolled for ICSI procedure, 137 of them were consanguineous first cousins, while 429 were non consanguineous couples. The outcome after fertilization, embryo transfer, pregnancy test, early miscarriage, abortion, and delivery were analyzed using Chi square, Fischer exact and t tests.

Results: 20.45% (n= 27) from 132 first cousins couples achieved positive pregnancy test, while 21.51% (n=88) from 409 of non consanguineous group; showing no significant statistical difference. On follow up results of abortion, pregnancy and delivery were very close in both groups, while the difference in early miscarriage was higher and statistically significant in the non- consanguineous group.

Conclusion: First degree consanguineous cousins who underwent ICSI procedure had almost similar results compared to non consanguineous couples. Although consanguineous first cousins couples may have a longer time till achieving first pregnancy, consanguinity had no influence on ICSI results as a whole.

Key words: consanguineous first cousins, non consanguineous, ICSI.

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Effect of consanguinity on intracytoplasmic sperm injection (ICSI) outcome
 Aziza M. A. Mansour

International Islamic Center for population Studies and Research, Al- Azhar University, Cairo, Egypt.

ABSTRACT

Objective: To evaluate the effect of consanguineous marriage on ICSI outcome among couples who are consanguineous first degree cousins compared to non consanguineous couples.

Setting: Al-Azhar Assisted Reproduction Unit, Cairo, Egypt.

Design: A retrospective study.

Materials and methods: During the period from 1/7/2005 to 31/12/2006, 566 couples were enrolled for ICSI procedure, 137 of them were consanguineous first cousins, while 429 were non consanguineous couples. The outcome after fertilization, embryo transfer, pregnancy test, early miscarriage, abortion, and delivery were analyzed using Chi square, Fischer exact and t tests.

Results: 20.45% (n= 27) from 132 first cousins couples achieved positive pregnancy test, while 21.51% (n=88) from 409 of non consanguineous group; showing no significant statistical difference. On follow up results of abortion, pregnancy and delivery were very close in both groups, while the difference in early miscarriage was higher and statistically significant in the non- consanguineous group.

Conclusion: First degree consanguineous cousins who underwent ICSI procedure had almost similar results compared to non consanguineous couples. Although consanguineous first cousins couples may have a longer time till achieving first pregnancy, consanguinity had no influence on ICSI results as a whole.

Key words: consanguineous first cousins, non consanguineous, ICSI.

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Ovulation induction with rosiglitazone/clomiphene citrate versus metformin /clomiphene citrate in women with clomiphene citrate-resistant polycystic ovary syndrome
 Mahmoud R. Fayed, and Thanaa Hamed

Department of Obstetrics and Gynecology and Biochemistry, Faculty of Medicine, Benha University, Egypt

ABSTRACT

Objectives: To compare the effect of rosiglitazone plus clomiphene citrate versus metformin plus clomiphene citrate on ovulation induction, hormonal and biochemical changes clomiphene citrate resistant polycystic ovary syndrome women.

Setting: King Khalid Military City Hospital (KKMCH), Hafr El Batin, KSA.

Design: A prospective randomized comparative study. Randomization was done by means of sequentially numbered opaque, sealed envelopes. The envelopes were assigned to either group with the use of random number table.

Materials and Methods: Thirty infertile women with clomiphene citrate resistant polycystic ovary syndrome were divided into two groups: ROSI group: (n=15) given rosiglitazone plus clomiphene citrate and MET group: (n=15) given metformin plus clomiphene citrate for three treatment cycles. The first cycle started on the first day of menstruation with rosiglitazone 4mg twice daily (ROSI group) and metformin 850mg twice daily (MET group), that continued for three cycles. Clomiphene citrate 100mg was added to each cycle in both groups from the third day for 5 days. Body mass index, serum fasting glucose, fasting insulin, luteinizing hormone, follicle-stimulating hormone, total testosterone, free testosterone and dehydroepiandrosterone sulfate were estimated before starting the treatment and at the end of the study period. Outcomes were defined as number of mature follicles, endometrial thickness, ovulation rate, pregnancy rate, body mass index changes, hormonal and biochemical changes.

 Results: After 3-months treatment, there was significant improvement (P<0.05) in ovulation rate in ROSI group (67.56%) compared to MET group (40.47%). Moreover, statistically significant differences (P<0.05) were reported in the number of follicles ≥18 mm in ROSI group (2.2±1) compared with MET group (1.1±0.9). The pregnancy rate was also significantly higher (P<0.05) in ROSI group (46.67%) compared to MET group (20%). Both groups showed decrease in fasting insulin, total testosterone, free testosterone, dehydroepiandrosterone sulfate but the decrease was significant in ROSI group(P<0.05). On the contrary, both groups showed significant (P<0.05) decrease in luteinizing hormone levels compared to the pretreatment levels. Both groups showed no changes in the body mass index, follicle-stimulating hormone or fasting glucose concentration.

Conclusion: Rosiglitazone appears to be a well tolerated and more effective adjunct treatment to clomiphene citrate than metformin in ovulation induction with decreasing androgen levels and improving the ovulation and conception in infertile women with clomiphene resistant Polycystic Ovary Syndrome.

Keywords: Polycystic Ovary Syndrome, metformin, rosiglitazone, clomiphene resistance.

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Nitric oxide donors in intracytoplasmic sperm injection (ICSI) poor responders
 Seham El-Berry, Ahmed Yousef, and Mohamed Abdel Razik

Department of Obstetrics and Gynecology, Benha Faculty of Medicine, Benha, Egypt

ABSTRACT

Objectives: To evaluate the effects of the nitric oxide (NO) donor isosorbid mononitrate (ISMN) 20 mg tablets applied vaginally as an adjuvant therapy with the long down-regulation stimulation protocol in poor responder patients undergoing ICSI.

Study design: Prospective, non-randomized clinical trial.

Setting: Benha university hospital, January 2008-January 2009.

Materials and Methods: The study included twenty infertile poor responder women having their first ICSI treatment failed and undergoing a second attempt within 6 months. Patients received besides the long down-regulation stimulation protocol a daily 20 mg ISMN tablets applied vaginally till pregnancy was confirmed.

Primary outcome measures: Number of live births with the long down-regulation stimulation protocol plus ISMN compared to the long down-regulation stimulation protocol alone used in the failed ICSI.

Secondary outcome measures: Number of FSH ampoules, number of poor responders and cancelled cycles, number of mature follicles, retrieved oocytes and transferred embryos in both protocols.

Results: In the long down-regulation stimulation protocol plus ISMN the live birth rate was significantly higher. The number of FSH ampoules, poor responders and cancelled cycles were significantly lower. The number of mature follicles, retrieved oocytes and transferred embryos were significantly higher.

Conclusions: The novel addition of ISMN tablets applied vaginally- as a source of NO - to the long down-regulation stimulation protocol increases the live births rate in poor responder patients.

Key words: nitric oxide donors, ICSI, poor responders,

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Pregnancy outcome after metformin co-treatment in ovulation induction
 Mohamed A Bedaiwy, Edward Ryan, Omar Shaaban, E.A. Claessens, Ahmed Nasr, Samith Sandadi, Sonia Blanco Mejia, and Robert F.Casper

Toronto Centre For Advanced Reproductive Technologies (TCART), and Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt and Toronto West Fertility Center Etobicoke, Ontario Canada

ABSTRACT

Objective: To evaluate the outcome of pregnancies achieved after metformin co-treatment for ovulation induction in polycystic ovary syndrome (PCOS) patients as well as its continued use in the first trimester.

Design: A prospective controlled clinical trial comparing the outcome of pregnancies achieved with or without the use of metformin in PCOS patients undergoing ovulation induction.

Materials and methods: Two hundred and fifty two pregnant women treated for infertility secondary to PCOS were followed-up in two tertiary referral centers. Of the 252 pregnancies achieved, 131 were the result of ovulation induction protocols including metformin and in the remaining 121 metformin was not used. Both groups were compared regarding their pregnancy outcome.

Results: Pregnancies achieved after metformin co-treatment were associated with the same rates of miscarriage or ectopic pregnancy, compared to non-metformin users (21.2% vs. 13% and 1.8% vs. 0.9 %; respectively, p=0.24). Metformin treatment during the first trimester did not significantly affect the incidence of developing gestational diabetes (7.6%), preeclampsia (6.1%) or preterm labor (17.5%). Birth weights were comparable in both groups. There were only two minor congenital anomalies reported in the non-metformin group.

Conclusions: Periconceptional exposure to metformin in the first trimester of pregnancy in PCOS patients does not affect the overall pregnancy outcome.

Keywords: PCOS; Metformin; Ovulation induction; Pregnancy outcome

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Enhanced vaginal acidity produces structural cervical maturation in the non-pregnant rabbit
 Abbas A.S. Ghazy, Karim H.I. Abd-El-Maeboud, Salwa M. Abdel-Tawab, Suzi H. Ibrahim, and Ghada F. Mohamed

Departments of Obstetrics  and Gynecology, and Histology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

ABSTRACT

Objective: To investigate if enhancement of vaginal acidity would produce cervical histological changes that might be relevant to the process of cervical priming.

Design: Prospective randomized controlled study.

Setting: Faculty of Medicine, Ain Shams University

Materials and Methods: Twenty-four non-pregnant sexually mature white New Zealand female rabbits were allocated at random to three groups and treated with 3.5% (w/v) lactic acid lotion (group I), 5% (w/v) acetic acid lotion (group II) or distilled water (group III, controls). The lotions were applied into the vagina twelve hourly for three days. The animals were then sacrificed and longitudinal sections of the cervices were prepared, stained with hematoxylin and eosin stain and Mallory’s Triple stain. The main outcome measures were relative collagen concentration using an image analyzer and structural histological changes.

Results: Compared to controls, the relative collagen concentration was significantly reduced, being 52.8% and 51.1% in groups I and II; respectively. In both groups, histological examination revealed changes akin to those of cervical ripening with no evidence of any cytopathic effect.

Conclusion: Enhancement of vaginal acidity with organic acid preparations appears to be safe and effective in producing cervical histological changes relevant to cervical priming in non-pregnant animal model. The impact of these findings in inducing or enhancing cervical ripening deserves further evaluation in human studies.

Key words: acidity; cervical ripening; cervical structure; collagen; rabbit; vaginal acidity

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The hormonal activity of the postmenopausal ovary
 Dina Gamal Eldeen Elkholi, Lamiaa Mohamed Elahwal, and Halah Mohamed Nagy

Department of Obstetrics and Gynecology, and Department of Clinical Pathology ,Tanta University, Egypt

ABSTRACT

Objective: To study the relation between the hormonal activity of the postmenopausal ovary (PMO), and the androgen-secreting cells in  its histological structure.

Design: a cross-sectional study.

Mean outcome measure: average serum levels of androgens before and after oophorectomy in postmenopausal women (PMW) and the presence or absence of androgen secreting cells in the histological structure of the PMO.

Material and methods: Thirty-four PMW were submitted to total hysterectomy and bilateral salpingoophorectomy (abdominally and vaginally) for different indications. Serum levels of testosterone (T), androstenedione (A), dihydroepiandrosterone (DHEA), estrone (E1) and estradiol (E2) were estimated by RIA before and six weeks after oophorectomy. PMOs were submitted to histological study to search for androgen-secreting cells.

Results: When androgen-secreting cells were present in PMOs: average serum levels of androgens and estrogens before oophorectomy were T: 2.6± 0.3 ng/ml, A: 0.6±0.2 ng/ml, DHEA: 2.2±0.4 ng/ml, E1: 46.0±15 pg/ml and E2: 15.9±3 pg/ml. After oophorectomy average serum hormonal levels were T: 1.5±0.6/ml, A: 0.5±0.2ng/ml DHEA: 1.8±0.5 ng/ml, E1: 33.9±8 pg/ml and E2: 14.7±4 pg/ml. The difference between preoperative and postoperative average serum levels was significant (P<0.005) only with T and E1. The differences between the preoperative and postoperative average serum levels of all the mentioned hormones were not statistically significant when no androgen – secreting cells were present in PMOs. The preoperative average serum levels of T and E1 when the androgen-secreting cells were not detected in PMOs were 1.8±0.2 ng/ml and 34.6±8 pg/ml respectively and the postoperative levels were 1.6±0.1ng/ml and 0.61±0.4 pg/ml respectively. The differences between the preoperative average serum levels of T and E1 levels when androgen-secreting tissues were present and when not present in PMOs were statistically significant (P<0.05 and P<0.01 respectively). Androgen-secreting cells were demonstrated  in 21 PMOs (61.76%) and were not detected in 13 PMOs (38.23%). Stromal hyperplasia and luteinization were detected in 7 cases (33.33%), secondary interstitial (theca interna) cells in 13 cases (57.14%) and hyperplasia of hilar-Leydig cells in 2 cases (9.05%). The highest preoperative average serum levels of T and E1 were encountered with hilar-Leydig cells hyperplasia: 3.3±0.6 ng/ml and 52.6±13 pg/ml respectively. The difference between them and the average serum levels with other androgen-secreting cells were statistically (P<0.05) significant. The average serum levels of all hormones after oophorectomy were similar in all groups.

Conclusion: PMO may be hormonally active, secreting T and E1 when  androgen – secreting cells are present in its histological structure.

Keywords: Postmenopause, androgen-secreting cells, DHEA, testosterone, androstenadione, estradiol.

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