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Department of Obstetrics and Gynecology, Naser Institute Hospital, Cairo, Egypt.
ABSTRACT
Objective: To assess the efficacy, safety and potential adverse effects of surgical treatment of polycystic ovary syndrome through conducting a systematic overview and analysis of the body of data in the literature.
Design: Relevant studies were identified through on-line searching of the National Library of Medicine’s MEDLINE data base, and manual scanning of relevant publications, review articles and abstracts of major scientific meetings.
Main Outcome Measures: Ovulation, pregnancy, and miscarriage rates, and post-operative adhesion formation rates.
Results: A total of 63 studies were analyzed. The bilateral ovarian wedge resection group included 23 studies, a total of 2050 patients, average ovulation rate 75%, average pregnancy rate 54%, and adhesion formation rate approached 100% in most studies, with an average rate of 78%. Forty reports on laparoscopic treatment of women with polycystic ovary syndrome included 1596 patients; average ovulation rate 80%, average pregnancy rate 54%, adhesion formation rate 32% and a miscarriage rate of 13%. There was no significant difference concerning ovulation, pregnancy, and miscarriage rates between different laparoscopic treatment modalities.
Conclusions: Surgical induction of ovulation may be of value in women with polycystic ovary syndrome resistant to clomiphene citrate for whom gonadotropin therapy is unsuccessful or unavailable. There is no role for bilateral ovarian wedge resection in the treatment of anovulatory women with polycystic ovary syndrome, as it is associated with low pregnancy rates due to an unacceptable incidence of peri-adnexal adhesion formation. Reported adhesion formation rates following laparoscopic ovarian drilling range between 0-100%. This wide variation in individual studies on laparoscopic ovarian drilling and the absence of a treatment-independent control group limit the conclusions that can be drawn from the published data. Wide utilization of laparoscopic ovarian drilling should be discouraged until prospective randomized trials establish the efficacy and long-term safety of these techniques compared to ovulation induction with gonadotropins.
Key Words: Polycystic ovary syndrome, ovulation induction, adhesions, laparoscopy, bilateral ovarian wedge resection, anovulation, laser, electrocautery, spontaneous miscarriage.
Estradiol-17B
potentiates ionophore mediated acrosome reaction as measured by flow cytometry.
Julie A. Carver-Ward, Ph.D. *†, J. M. G.
Hollanders, M.D. ‡, M. Einspenner, L.S.R.T. §
Laboratory, Department of Pathology and Laboratory Medicine, Department of Obstetrics and Gynecology, Department of Biological and Medical Research, King Faisal Specialist Hospital and Research Centre.
ABSTRACT
Objective: To investigate the effects of estradiol-17b on the spontaneous and ionophore-induced acrosome reaction of human spermatozoa.
Design: Flow cytometric analysis of the acrosome reaction after treatment with E for 1 hour and 24 hours. Concomitant analysis of effects upon sperm motility parameters and morphology.
Setting: Tertiary center for infertility.
Patients: 20 normal semen specimens from proven fertile patients.
Interventions: Motile
spermatozoa incubated for 1 hour with E (0.1, 1.0, 10 mg/ml) after 4 and
24 hours of capacitation, and for 24 hours with E (0.1, 1.0, 10 mg/ml).
Main Outcome Measures:
Effects of E on the SAR, IAR, sperm motility parameters and morphology.
Results: No effects of E on any sperm parameter
at any time course or dose. Capacitation for 24 hours prior to treatment
with E gave a significantly higher SAR than 4 hours capacitation (P>0.001).
For the IAR, all doses of E gave significantly higher results than the
controls, at all time courses (P>0.001). ARIC scores were significantly
increased after treatment with E (P=0.0022).
Conclusions: E does not, by itself, induce the acrosome reaction, or affect sperm motility parameters/morphology and vitality. Enhancement of the IAR would indicate that E could be a potentiator of the acrosome reaction in human spermatozoa.
Key Words: acrosome reaction, estradiol-17b, CD46 antibody, spermatozoa.
Effect of NorplantÒ
on the adrenal reserve capacity using a dynamic stress test.
Mohamed Ramadan, M.D.*, Mohamed T.R. Mehanna,
M.D.*, Mokhtar K. Toppozada, M.D.*†, Youssri Khamis, M.D*, Momtaz El-Sawi,
M.D.*, Salah Marzouk, M.D.‡
Department of Obstetrics and Gynecology and Department of Clinical Pathology, The University of Alexandria, Alexandria, Egypt.
ABSTRACT
Objective: To evaluate the response of the adrenals to the effect of stress among NorplantÒ users.
Design and setting: A comparative study between NorplantÒ users and matched controls.
Patients: Fifteen NorplantÒ users for at least 6 months and fifteen non-Norplant users matched for age and body mass index as controls.
Interventions: Each woman was subjected to the dynamic stress test of insulin hypoglycemia. Serum glucose and cortisol were measured before and 30, 45, 60 and 90 minutes after intravenous injection of crystalline aqueous insulin (0.15 U/Kg).
Results: Cortisol measurements were significantly lower among NorplantÒ users than controls at all times (before, and 30, 45, 60 and 90 minutes after intravenous insulin injection), with a trend towards a delayed response to reach a peak. In spite of the trend for a delayed response among NorplantÒ users, no significant differences were found in the time intervals needed for cortisol to rise by 275 nmol/ L or to reach a peak.
Conclusions: The adrenal response to stress induced by insulin hypoglycemia was significantly reduced at all times during the test among NorplantÒ users compared to controls. The number of women studied was rather small and future evaluation of a larger number of cases would confirm the present data. However, all cases were able to achieve the cortisol levels accepted as the lower limits of a normal response. A careful assessment of adrenal function may be required in NorplantÒ users in situations of acute or prolonged stress as surgical interventions.
Keywords: NorplantÒ , adrenal reserve, hypoglycemia, stress.
Andrology Institute of Lexington, University of Kentucky and Kentucky
Center for Reproductive Medicine,
Lexington, Kentucky, USA; and Tottori University School
of Medicine, Yonago, Japan.
ABSTRACT
Objective: To evaluate the effects of pentoxifylline (PF) on sperm motility and yield of low quality spermatozoa recovered via various sperm preparation techniques.
Design: Human spermatozoa were treated with Ham’s F-10 medium containing 0 or 1.0 mg/mL PF and processed via a variety of sperm preparation techniques, followed by quantitative and qualitative assessment of the recovered spermatozoa. Semen specimens were prepared via sperm wash, swim-up, Percoll density gradient centrifugation and Sephadex (SpermPrep™) filtration.
Setting: Andrology Institute of Lexington, Lexington, Kentucky.
Patients: Patients (N=25) referred for male infertility workup, whose ejaculates exhibited various spermatogenic deficiencies, were selected for this study.
Main Outcome Measures: Improvements in the sperm number and quality of sfollowing semen processing via various methods used in assisted reproductive technology.
Results: Spermatozoa separated via a variety of sperm preparation methods were qualitatively superior to either fresh or washed specimens. Additional improvements were noted when spermatozoa were processed with media containing 1.0 mg/mL PF.
Conclusions: The use of pentoxifylline, as applied in this study, enhanced the recovery of spermatozoa with improved qualitative characteristics. The sperm quantitative and qualitative improvements were more noticeable in sperm preparation techniques that required sperm progressive motility as the mode of separation for these spermatozoa.
Key Words: Spermatozoa, sperm preparation, sperm selection, pentoxifylline, motility.
Intracytoplasmic
injection of surgically retrieved sperm and spermatids in obstructive and
non-obstructive azoospermia: a comparative study.
Ibrahim Fahmy, M.D. * † ‡, Ahmed Kamal.
M.D. *, Ragaa Mansour, M.D. *, Nevine A. Tawab, B.Sc. *, Mohamed Aboulghar,
M.D. *, Abdel Maguid Ramzy, M.D. *, Gamal Serour, F.R.C.O.G., F.R.C.S.
*, Yahia Amin, M.D. *
The Egyptian IVF-ET Center and the department of Andrology, Cairo University, Cairo, Egypt,
ABSTRACT
Objectives: To compare the results of intracytoplasmic injection using surgically retrieved sperm and spermatids in obstructive and non-obstructive azoospermia.
Design: Retrospective study.
Setting: The Egyptian IVF-ET center.
Patients: Ninety eight
patients with obstructive azoospermia and 56 patients with non-obstructive
azoospermia.
Intervention: Twenty microsurgical epididymal
sperm aspiration, 12 percutaneous epididymal sperm aspiration,and 72 testicular
sperm extraction procedures were done for obstructive cases. Fifty six
testicular biopsy procedures were done for non-obstructive cases. Retrieved
spermatozoa or spermatids were used for 165 intracytoplasmic sperm injection
cycles.
Main Outcome Measures: Fertilization rate per injected metaphase-II oocyte and the clinical pregnancy rate per intracytoplasmic sperm injection cycle.
Results: The overall fertilization and pregnancy rates were 49.8% and 26.0% respectively. In patients with obstructive azoospermia, when epididymal spermatozoa were used, the fertilization rate and the pregnancy rate were 57.8% and 30.6%. When testicular spermatozoa were used, the fertilization rate and the pregnancy rate were 53.2% and 33.3%. In non-obstructive cases the overall fertilization rate and pregnancy rate were 38.9% and 14%. When spermatozoa were used for injection, the fertilization rate and the pregnancy rate were 40.4% and 20.6% and when only spermatids were injected they were 35.4% and 6.3%. Both were significantly lower than fertilization and pregnancy rates in obstructive cases (P < 0.05).
Conclusions: Intracytoplasmic sperm injection using surgically retrieved sperm offers a valuable therapeutic option in obstructive azoospermia. The results of intracytoplasmic sperm injection in cases with severe spermatogenic impairment were less than that in cases of obstructive azoospermia especially if spermatids were used for injection.
Keywords: Epididymal sperm, testicular sperm, intracytoplasmic sperm injection, azoospermia, testis biopsy, spermatids.
The relation
between uterine volume and the success of endometrial resection in menorrhagia.
M. Roushdy, O. Farag, M. Momtaz, and M.
Zayed.
The Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University.
ABSTRACT
Objectives: The study was conducted to determine the factors deciding the success of endometrial resection in menorrhagia patients.
Design: Prospective analysis.
Material and Methods:
This study included 124 patients 35-47 years old, complaining of functional
menorrhagia. Endometrial resection using diathermy resectoscope was
done to all patients. The success of endometrial ablation treatment
was evaluated as a response after 18-36 months follow up, by either amenorrhea
or improvement of menorrhagia. Failure of treatment was recorded
when the menorrhagia persisted at the six months’ evaluation.
Results: The three
response groups did not significantly differ regarding age, parity, operation
time or glycine volume. Patients in the group of persistent menorrhagia
or recurrence had uteri of significantly larger volume when compared to
the group that responded by amenorrhea. None of the patients with
uteri with volume <110 mL had recurrence or persistence of the menorrhagia.
Conclusion: Menorrhagia
patients with a uterine volume <110 mL are candidates for successful
endometrial resection.
Key words: Endometrial resection, menorrhagia, uterine volume, success rate.
A microscopic
approach of sperm preparation for intracytoplasmic sperm injection.
Amjad Hossain Ph.D.* †, Botros Rizk
M.D. *, Sailen Barik Ph.D. ‡, Ian H. Thorneycroft*
Department of Obstetrics and Gynecology, Department of Biochemistry, University of South Alabama Mobile, AL, USA.
ABSTRACT
Objective: To develop a microscopic sperm preparation technique that is specially suited for ICSI.
Design: Microscopic sperm separation column is designed to be constructed on a 60 mm petri dish that is usually used in ICSI so an ideal number of capacitated and hyperactivated sperm are available at the time of ICSI procedure.
Materials and Methods: A 15 uL volume microgradient column was constructed in the shape of a square with an open corner on a petri dish. One open end of the square contained semen, while the three arms contained 3 variable concentrations of albumin used to maintain the gradient. The microgradient column, covered with mineral oil, was observed under an inverted microscope. When sufficient number of sperm reached the harvest zone (column-end), it was disconnected from the rest of the column by mild scratching at the specific location with the pipet tip. Twelve semen samples with different male factor etiologies were processed with the column and the quality of the sperm yield was evaluated.
Results: Sperm preparation was successful from 12/12 (100%) semen samples. The motility of the prepared sperm in all samples were 100±0% with grade "a" quality (WHO criteria). 96±6% sperm in the yield exhibited hypo-osmotic swelling. The percentage of spermatozoa with normal morphology (Kruger's strict criteria) was 53±7%. The number of sperm reaching the harvest zone correlated with the time in all samples. However, one hour incubation was found sufficient to harvest more sperm than the number of sperm required to perform ICSI.
Conclusion: Microscopic sperm preparation does not induce any gross and ultrastructural physical damage to the sperm since the procedure does not require any pretreatment such as centrifugation of the semen. Furthermore, since the technique is based on self migration of motile sperm in horizontal column, it always yields morphologically superior sperm with 100% motility from semen irrespective of its male factor quality. Quality sperm obtained in microscopic sperm preparation technique thus might enhance ICSI fertilization rate and embryo quality.
Key Words: Microscopic approach, sperm preparation, ICSI.
Perinatal outcome
after in vitro fertilization and spontaneous pregnancy: a comparative study.
Salah Nassar, M.D.* †, Jaennette Boutros, M.D.*, Hanna
Aboulghar, M.Sc.*, Ragaa Mansour, M.D. §, Mahmoud Hussein, M.D. ‡,
Mohamed Aboulghar, M.D. † ‡.
Department of Pediatrics and Department of Obstetrics and Gynecology,
Faculty of Medicine, Cairo University,
and the Egyptian IVF-ET Center, Cairo, Egypt
ABSTRACT
Objective: To compare the outcome of babies born after in vitro fertilization with a control group of babies born after spontaneous pregnancies.
Design: Retrospective study.
Setting: Department of pediatrics, Cairo University, The Egyptian IVF-ET Center, and Department of Obstetrics and gynecology, Cairo University.
Intervention: In vitro fertilization.
Main outcome measures: Multiple pregnancy, Prematurity, congenital malformations, perinatal mortality and Cesarean Section rates.
Results: The perinatal outcome in 100 in
vitrfertilization deliveries (group A) was compared to the fetal outcome
in 200 non in vitro fertilization deliveries (group B). In group A the
multiple pregnancy rate was 23%, prematurity 37%, perinatal mortality 133
per 1000 births, low birth weight 37.5% and cesarean section rate was 82%
as compared to 1.5%, 8%, 19.7 per 1000, 8.8% and 18% in group B respectively.
The difference was statistically significant in all parameters. Singleton
babies of in vitro fertilization pregnancies, babies had a significantly
lower birth weight and higher small-for-dates and prematurity rates when
compared to singleton spontaneous pregnancies. A total of 3 (2.3%) major
malformations were observed in group A.
Conclusions: Babies born after in vitro fertilization have a
high perinatal mortality rate mainly due to multiple pregnancy and prematurity.
Singleton in vitro fertilization pregnancy also has an increased risk to
the baby. Major malformations are within the range of registers of malformation
in the general population.
Key words: IVF, fetal outcome, multiple pregnancy, prematurity, low birth weight, perinatal morbidity, congenital anomalies.
Effects of
day 9 administration of human chorionic gonadotropin: a possible monthly
injectable contraceptive.
Hassan N. Sallam, M.D., F.R.C.O.G., Ph.D.(London)*†,
Ahmed N. Sallam, M.Ch., M.D.*
Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Alexandria, Alexandria, Egypt
ABSTRACT
Objectives: To study the effects of day 9 administration of human chorionic gonadotropin on follicular development, endometrial thickness, day 12 plasma oestradiol concentration, the cervical mucus score and day 21 plasma progesterone concentration.
Design: Prospective study.
Patients: Seventeen patients studied for 2 successive menstrual cycles.
Intervention: Human chorionic gonadotropin administered on day 9 of the second cycle with the first cycle used as a control cycle.
Main outcome measures: Follicular diameter, endometrial thickness, plasma oestradiol and the cervical mucus score on day 12 of the cycle, plasma progesterone and endometrial thickness on day 21 of the cycle.
Results: All studied parameters were significantly lower after day 9 administration of human chorionic gonadotropin as compared to the control cycle.
Conclusion: Day 9 administration of human chorionic gonadotropin disturbs follicular development, endometrial thickness, plasma oestradiol and progesterone concentrations as well as the cervical mucus score and may be explored as a monthly injectable contraceptive.
Key words: hCG, injectable contraceptives, contraception.