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Infertility and IVF center, "Geniki Kliniki", Thessaloniki, and Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.
ABSTRACT
Objective: The study was conducted to evaluate the results of tubal reconstructive surgery (microsurgical and laparoscopic) with various types of tubal infertility.
Design: Retrospective analysis.
Material and Methods: A total of 763 women were operated upon microsurgically or laparoscopically between January 1980 and December 1993, for infertility from various types of tubal diseases. All women were followed until July 1994.
Results: Microsurgical adhesiolysis was performed in 209 cases, achieving a 48% overall pregnancy rate, with 6% of them being ectopic. Laparoscopic adhesiolysis was applied in 73 cases obtaining 40% overall pregnancy, with 3.3% ectopic pregnancy rate. Microsurgical fimbrioplasty was performed in 97 cases resulting in 45% overall pregnancy rate, with 5% of them being ectopic. Laparoscopic fimbrioplasty was carried out in 60 cases, achieving 46% overall pregnancy rate, with 7.1% ectopic pregnancy rate. Microsurgical salpingostromy was applied in 219 patients, the overall pregnancy rate obtained was 27% with 10% of them being ectopic. Thirty-nine women were treated by laparoscopic salpingostomy, achieving a 17.9% overall conception rate with 2.6% ectopic pregnancies. Microsurgical tubal anastomosis was performed in 66 cases. Overall conception rate was 33.3%, whereas ectopic pregnancy rate was 1.2%.
Conclusion: Surgical (microsurgical or laparoscopic) management of tubal infertility was associated with satisfactory results. However, it seems that in vitro fertilization could be attempted after 12 months of failed conception. Patients with hydrosalpinx and disease stage III and IV should be managed from the beginning with in vitro fertilization and embryo transfer.
Keywords: Laparoscopic surgery, microsurgery, tubal infertility, adhesiolysis, fimbrioplasty, salpingostomy, anastomosis.
Autologous
granulosa cell co-culture as a simple method for in vitro fertilization.
Kamal A. Jaroudi, MD.**§ JA. Carver-Ward,
Msc.§§
** Reprint requests: King Faisal Specialist Hospital and Research Centre, PO Box 1314, Riyadh 11211, Saudi Arabia.
§ Department of Obstetrics and
Gynaecology, King Faisal Specialist Hospital and Research Centre.
§§ Department of Pathology and
Laboratory Medicine, King Faisal Specialist Hospital and Research Centre.
ABSTRACT
Objective: To investigate the effects of autologous co-culture of granulosa cells and pre-embryos on embryo quality, blastomere number, and clinical pregnancy rate.
Design and setting: Prospective clinical study, tertiary centre for infertility.
Patients: Patients undergoing IVF treatment were studied during a 2-month period. All patients achieving fertilization were allocated either to normal IVF culture techniques or to the co-culture scheme.
Intervention: 85 patients were allocated to the study; 46 to normal IVF and 39 to co-culture.
Main Outcome Measures: Embryo quality and number of blastomeres per embryo at 48 and 12 hours post-ovum aspiration. Clinical pregnancy rate for both groups.
Results: Embryo quality (48 and 72 hours) and blastomere number (48 and 72 hours) were not significantly different between both groups. Clinical pregnancy rates were significantly higher in the co-culture group (38.5%) than in the IVF group (19.6%): p<0.05.
Conclusions: Autologous co-culture of human pre-embryos significantly increases clinical pregnancy rates when compared to normal IVF culture conditions. No improvement of embryo quality or cleavage was noted.
Keywords: granulosa cells, co-culture, human embryos, in-vitro fertilization.
Effects of
human serum albumin sources on sperm wash and intrauterine insemination
results.
R. R. Yeomen, C. A. Huff, A. Helvacioglu,
S. Aksel and B. Rizk.
Division of reproductive Endocrinology, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, USA
ABSTRACT
Objective: To compare the effects of different human serum albumin preparations on sperm wash results and intrauterine insemination pregnancy rates.
Design: Prospective, split/paired sperm wash comparison. Retrospective intrauterine insemination comparison.
Setting: Tertiary care center reproductive endocrinology and infertility clinic.
Patients: Normospermic donors (n=8) for sperm was. Normospermic intrauterine insemination partners (n=29).
Intervention: Semen was washed with media containing 4% of human serum albumin for either a liquid or lyophilized preparation.
Main outcome measures: Sperm recovery and motility were evaluated in the split samples. Ultrasound confirmed pregnancy rates were compared in the intrauterine insemination patients.
Results: Post sperm wash parameters – recovery concentrations and motilities, were comparable between liquid human serum albumin and lyophilized human serum albumin sources (19±4.6 M/mL, 81.4±5.5% and 20.4±5.3 M/mL, 82.6±5.0%, respectively). Intrauterine insemination sperm preparations also were comparable and the pregnancy rates were 21.4% and 20.0% for liquid and lyophilized human serum albumin sperm pre, respectively.
Conclusion: At the high concentration of human serum albumin (4%) used in sperm washes to enhance capacitation, there were no detrimental effects noted of the stabilizing detergent additives in the aqueous preparation of sperm recovery, motility or pregnancy rates compared to the lyophilized preparation.
Keywords: Human serum albumin, sperm, intrauterine insemination.
Ultrasonographic
endometrial pattern, and follicular size in luteal phase defect.
A. M. Aboul Ela.
Department of Obstetrics and Gynecology, Kasr El-Eini Hospital, Cairo University.
ABSTRACT
Objective: To study the value of pelvic ultrasonography as a non-invasive method for diagnosis of luteal phase defect.
Design: Prospective study to compare transvaginal ultrasonographic endometrial appearance and follicular size with other common clinical, hormonal, and histopathological tests used for diagnosis of luteal phase defect.
Setting: Department of obstetrics and gynecology, Kasr El-Aini Hospital.
Patients: 34 women evaluated for infertility.
Interventions: All subjects had the following tests performed in the same menstrual cycle; basal body temperature charts, maximum preovulatory follicular size, dated endometrial biopsies, and single serum mid luteal progesterone level.
Main outcome measures: All other tests were used in an attempt to predict which patient had out of phase endometrial biopsy.
Results: Unacceptably low sensitivity and/or specificity levels were found for the following tests: luteal phase length, preovulatory follicular diameter, and endometrial appearance. Midluteal single serum progesterone level was found to have marginally acceptable sensitivity and specificity levels for prediction of out of phase endometrial biopsy.
Conclusion: Endometrial ultrasonographic appearance and preovulatory follicular diameter had unacceptable low sensitivity and/or specificity levels for diagnosis of luteal phase defect.
Keywords: Luteal phase defects, diagnostic tests, follicular size, endometrium appearance.
Ovarian size
on the day of human chorionic gonadotropin as a measure to predict OHSS.
C. J. C. M.Hamilton, K. A. Jaroudi, U.
Sieck and W.N.P.Willemsen.
Infertility and IVF Unit, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Saudi Arabia and Radboud Ziekenhuis, University of Nijmegen, The Netherlands.
ABSTRACT
Objective: To weight the value of 17â-estradiol against a number of ultrasonographical parameters in predicting the midluteal ovarian size as a measure of ovarian hyperstimulation in cycles treated with human menopausal gonadotropin/human chorionic gonadotropin.
Design and setting: Prospective study, Tertairy care referral Hospital.
Patients: Consisted of 135 cycles of 135 infertility patients.
Intervention: A baseline
vaginal scan was made on cycle day 3 after which serial vaginal scans were
resumed on cycle day 8 until human chorionic gonadotropin was given. Blood
samples for . 17â-estradiol and luteinizing hormone levels were taken
the same days prior to the ultrasound scan.
Main outcome measures: The mid-luteal ovarian
size measured seven days after the human chorionic gonadotropin injection
served as criterion for the degree of ovarian hyperstimulation.
Results: Estradiol (R=0.76, p<0.0001) and the mean ovarian size on the day of human chorionic gonadotropin (R=0.72, p<0.001) showed the best correlation with the man midluteal ovarian size. Although the mean ovarian size on cycle day 3 (R=0.36, p<0.001), the total number of follicles above 10 mm (R=0.63, p<0.0001), the total number of mature follicles equal to or above 16 mm (R=0.19, p<0.05) and the size of the leading follicle on the day of human chorionic gonadotropin (R=0.33, p<0.0001) correlated also with the midluteal ovarian size, these parameters did not add significantly to the predictive power according to the multiple regression analysis. Ovarian hyperstimulation occurred more often in patients with polycystic ovarian disease (56.9%) than in patients with hypogonadotropin amenorrhea (17.8%) or patients with other forms of anovulation (17.6%) (P<0.025). The severe ovarian hyperstimulation syndrome did not occur in any of the 401 cycles monitored during the same period.
Conclusion: We conclude that a combination of 17â-estradiol level and the measurement of the ovarian size on the day of human chorionic gonadotropin holds the best predictive power for the midluteal ovarian size in patients treated with human menopausal gonadotropin / human chorionic gonadotropin, and should, therefore, be used in the prevention of severe ovarian hyperstimulation syndrome.
Keywords: Ovarian hyperstimulation, ovulation induction, ultrasound.
Intracytoplasmic
sperm injection in six hundred and fifty consecutive cycles: The Egyptian
IVF-ET Center experience.
R. T. Mansour, M. A. Aboulghar, G. I. Serour,
A. Kamal, N. A.Tawab and A.I. Ramzy.
The Egyptian IVF-ET Center, Madi, Cairo, Egypt.
ABSTRACT
Objective: To report the first 650 consecutive cycles of intracytoplasmic sperm injection.
Design: Retrospective study and analysis of results in correlation to different semen parameters and age of the female.
Setting: The Egyptian IVF-ET Center.
Intervention: Oocyte retrieval and intracytoplasmic sperm injection.
Main outcome measures: Fertilization and pregnancy rates.
Results: A total of 7495 oocytes were retrieved and 5145 (70%) metaphase II oocytes were injected. A total of 5004 (96%) of the injected oocytes were intact after the injection and when examined the next morning. Two pronuclei were observed in 3123 oocytes (61%). Embryo transfer was done in 634 cycles (97.5%) and a total of 2441 embryos were transferred with an average of 3.8 embryo/patient. A total of 193 clinical pregnancies were established (30.5%). Cryopreservation was done for 785 two pronuclei oocytes in 116 cycles. The pregnancy rates were correlated to different semen parameters and age of the female.
Conclusion: Intracytoplasmic sperm injection is a highly successful treatment for male factor infertility. The results were not correlated to different semen parameters. The female age had a significant impact on the outcome.
Keywords: Intracytoplasmic sperm injection, male factor.
Gamete intrafallopian
transfer in conjunction with intracervical insemination and embryo cryopreservation
program in treating unexplained infertility.
H. Youssef, M. M. Aggag, H. A. Hashim,
M. Henman.
Jeddah-Sydney IVF Center, Dr. Erfan & Bagedo Hospital, Jeddah, Saudi Arabia
ABSTRACT
Objective: To report on the results of treating long standing (more than three years) unexplained primary infertility with gamete intrafallopian transfer in connection with intracervical insemination and embryo cryopreservation.
Design: Patients were treated by gamete intrafallopian transfer and intrauterine insemination, extra eggs were fertilized in vitro and cryopreserved. Later, embryos were transferred in patients who did not conceive from gamete intrafallopian transfer.
Patients: Fourty five
consecutive patients diagnosed as long standing unexplained infertility.
Results: In 45 patients, 19 clinical pregnancies
(42.2%), and additional 4 pregnancies resulted from embryo transfer of
thawed embryos.
Conclusion: Gamete intrafallopian transfer in conjunction with intracervical insemination and cryopreservation of extra oocytes for transfer in future cycles produced a high pregnancy rate in long standing unexplained infertility.
Keywords: Gamete intrafallopian transfer, intracervical insemination, unexplained infertility, embryo cryopreservation, embryo thawing.
Return of fertility
after Norplant removal.
E. O. Hassan, A. Kashmiry, N. El Nahal.
Egyptian Fertility Care Society, Cairo, Egypt.
ABSTRACT
Objective: To study the return of fertility after removal of Norplant.
Design: Retrospective study.
Setting: Conducted by the Egyptian Fertility Care Society in 5 universityhospitals.
Patients: One hundred and fifty seven cases were enrolled in this study who requested removal of Norplant before 5 years of use, for personal reasons.
Main outcome measures:
Pregnancy rate, and return of regular menstruation after removal of Norplant.
Interventions: A pretested questionnaire
was prepared and interview with the patients at their home by social workers.
Results: One year after Norplant removal return of regular menses occurred in almost all cases (98.9) and pregnancy occurred in 64.4% of women.
Conclusion: The return of normal menstruation was very prompt after removal of the capsule and about 2/3 of cases who did not use a contraceptive method get pregnant within one year after Norplant removal.
Keywords: Norplant, return of fertility.
Body weight
and outcome of in vitro fertilization.
A. I. Ramzy, R. T. Mansour, G. I. Serour,
Inas El Attar, Y. Amin and M. A. Aboulghar.
The Egyptian IVF-ET Center, Madi, Cairo, Egypt.
ABSTRACT
Objective: Obesity changes the endocrine environment within the body. Some authors suggested that obesity may play a notorious role on ovarian function and fertility. Our study aims at studying the effect of excessive body weight on pregnancy rate in in-vitro fertilization cycles.
Design: A retrospective study was done on 118 patients undergoing in vitro fertilization cycles randomly selected within the age group 25-35 years. Cases with male infertility, irregular menstrual cycles, clinical or ultrasonographic picture suggestive of polycystic ovary syndrome were excluded from this study. Cases not achieving sufficient response (> 4 follicles) during the course of the stimulated cycle were excluded as well. We divided our patients according to their body weight into 3 groups: accepted, overweight and obese. We compared the duration and dose of human menopausal gonadotrophin, the peak serum estradiol, the number of oocytes retrieved, those fertilized and the pregnancy rate among the study groups.
Setting: The study took place at The Egyptian IVF-ET Center, Maadi.
Intervention: Ovulation was induced and follicles were aspirated.
Results: Analyzing our data considering the three body weight strata, we found that there was no statistically significant difference in the pregnancy rates. However, there was a trend that heavier women generally needed larger number of ampoules of human menopausal gonadotrophin to achieve sufficient response. This was specially true among obese women who needed significantly larger doses of human menopausal gonadotrophin (mean of 48.8 ampoules/cycle) as compared to leaner women (36.6 ampoules). There was no significant difference observed in the peak serum estradiol (E2) level, the number of oocytes retrieved nor the fertilisation rate among the three groups.
Conclusion: Obesity has no deleterious effect on pregnancy rate among responders to ovarian stimulation using Gonadotrophin releasing Hormone agonist analogue and human menopausal gonadotrophin in in-vitro fertilization cycles. However, we found that these women needed larger doses of gonadotrophin to achieve ovulation. This is true, in our study, in obese women not suffering from polycystic ovary syndrome or irregular cycles.
Keywords: Body weight, ovarian stimulation, ovarian response, polycystic ovary, pregnancy rate.