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Division of Reproductive Endo-crinology and Infertility, Department
of Obstetrics and Gynecology, McGill University, Montreal, Quebec,
Canada.
ABSTRACT
Objectives: To review some of the recent advances in gynecologic laparoscopic surgery. Current reports on the use of laparoscopy for hysterectomy, myomectomy and endometriosis are summarized and the role of laparoscopy in urogynecol-ogy, reproductive surgery and gynecologic oncology is examined.
Design: Pertinent studies were identified through computer Medline search.
Conclusions: In most cases, laparoscopic hysterectomy can replace its laparotomy counterpart. It is associated with shorter hospital stay and shorter recovery time, but the operating time is longer than that of vaginal or abdominal hysterectomy. Laparoscopic myomectomy is an alternative approach in selected cases. Surgical treatment of endometriosis is best done by laparoscopy and excision of the lesions leads to a more complete removal than vaporiza-tion or coagulation. Long term results of laparoscopic uterine nerve ablation is discouraging and long term results of laparoscopic urethropexy remain unknown. Laparoscopic ovarian drilling is an alternative treatment for clomiphene resistant anovulatory women with polycystic ovarian syndrome. The role of laparoscopy in the management of gynecologic malignancy remains to be de- fined.
Keywords: Laparoscopy, hysterectomy, myomectomy, polycystic ovaries, urethro-pexy, ovarian cancer.
Gamete intrafallopian
transfer: a critical analysis of published data and speculation on future
trends.
Mohamed Aboulghar, M.D.*
The Egyptian IVF-ET Center, Maadi, Cairo, Egypt
ABSTRACT
Objective: To review and critically analyze the published data on gamete intrafallopian transfer.
Study Design: To analyze published reports on gamete intrafallopian transfer in national registries and other published papers dealing with the comparison between gamete intrafallopian transfer and in vitro fertilization or gamete intrafallopian transfer and controlled ovarian hyperstimulation and intrauterine insemination.
Results: The data available in the national registries showed that the pregnancy rate for gamete intrafallopian transfer was higher than that reported in in-vitro fertilization. However, in prospective studies the results of gamete intrafallopian transfer in general were not superior to in vitro fertilization. There is a controversy concerning the results of gamete intrafallopian transfer as compared to controlled ovarian hyperstimulation and intrauterine insemination. Many reports showed a higher pregnancy rate with gamete intrafallopian transfer, however some reports claim no difference in the pregnancy rates between the two procedures.
Conclusion: The discrepancy in the results of gamete intrafallopian transfer as compared to in vitro fertilization could be explained by the wide range of heterogeneous groups of patients treated by gamete intrafallopian transfer and in vitro fertilization and the higher number of gametes transferred in gamete intrafallopian transfer. The superior results of gamete intrafallopian transfer as compared to intrauterine insemination in some reports is partially due to the difference in the stimulation protocols between the two groups.
Key words: GIFT, COH, IUI, IVF, unexplained infertility.
Diagnostic
criteria for polycystic ovarian disease: a prospective study.
Magdy El-Sheikh, M.R.C.O.G., F.R.C.S. (Glasgow)*†, Hussein El-Orabi,
M.D.‡
Al-Salama Hospital, Jeddah, Saudi Arabia
ABSTRACT
Objective: To evaluate different criteria involved in the diagnosis of polycystic ovarian disease.
Design: Prospective study.
Patients: Sixty females referred to the infertility unit with the diagnosis of polycystic ovaries and 27 females referred to the unit for conditions other than PCOD as a control group.
Setting: A private tertiary referral unit for infertility treatment.
Materials and Methods: All patients had full history analysis, clinical examination, pituitary hormones, androgen profile, fasting insulin level measurements and ultrasound calculation of ovarian volume, after exclusion of ovarian tumors or cysts more than 1.2 cm. Wilcoxon and Rank correlation tests were used in the absence of normal distribution otherwise (t) test was used, Regression correlation analysis was used to evaluate relationship between variables. Receiver Operating Characteristic curve was used to evaluate sensitivity and specificity of tests.
Results: Menstrual cycle disturbances, Increased body mass index, Large ovarian volume and increased fasting insulin level were better diagnostic criteria for the polycystic ovarian disease than the traditionally used pituitary and androgen hormone tests.
Conclusion: Ultrasound measurement of ovarian volume is a reliable diagnostic test for PCOD. Those patients with ovaries of 6.2 mL or more are likely to have high body mass index, raised fasting serum insulin level with menstrual disturbances. On the contrary traditional tests for pituitary hormones and androgens are not reliable diagnostic tests for PCOD.
Keywords: Polycystic Ovarian Disease (PCOD),Polycystic Ovarian Syndrome
Adhesion formation
after laparoscopic surgery.
Mohamad Roushdy, M.D.*†, Omar Farag, M.D.*, Gaafar Kinawy, M.D.*
The Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University.
ABSTRACT
Objectives: The study was conducted to evaluate the rate of adhesion formation and reformation after different laparoscopic procedures.
Design: Prospective study.
Material and method: Forty-seven patients underwent laparoscopic surgery for ovarian cystectomy, ovarian drilling, salpingostomy for ectopic pregnancy, endometriosis, myomectomy, and adhesiolysis.
Setting: Kasr El Aini University Hospital and authors private practice.
Results: Eighteen patients had no initial adhesions and at second-look laparoscopy had adhesion score 1.6 ± 2.2. The other 29 patients had an initial score 13.2 ± 0.7. The higher the initial adhesion score at the primary procedure, the more likely is the adhesion recurrence. Twenty-six out of 29 patients who underwent adhesiolysis either improved or became totally free.
Conclusion: Laparoscopic surgery is a recommended choice for surgery and is a much preferred method to prevent adhesion formation. Thick and extensive adhesions are less likely to give a favorable result after adhesiolysis.
Key Words: Adhesion formation, gynecological surgery, laparoscopic surgery.
Female chronological
age determines the implantation rate after intracytoplasmic sperm
injection.
Imam El-Danasouri, D.V.M., Ph.D.*, Eda
Chung, B.S.M.T. *, Ekkehard Kemmann, M.D. *, Botros Rizk, M.D., F.R.C.S.(c),
M.R.C.O.G. †‡
Divisions of Reproductive Endocrinology and Fertility, Departments of Obstetrics and Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, New Brunswick and University of South Alabama, Mobile, Alabama, USA
ABSTRACT
Objective: To assess male and female factors which contribute to the success of ICSI treatment.
Design: Retrospective study.
Setting: University-based reproductive endocrinology clinic.
Interventions: Analysis of 120 ICSI cycles to determine the correlation between fertilization, cleavage, pregnancy and implantation rates in relation to sperm parameters, as well as the female partner’s age.
Main Outcome Measures: Fertilization, cleavage, pregnancy and implantation rates.
Results: The rates of fertilization, cleavage, and ongoing pregnancy per embryo transfer were 61.2%, 94.9% and 42.2% respectively. Pregnancy rate per ICSI cycle was significantly higher in patients £ 37 years old compared to > 37 years old patients (44.2 vs. 9.9%, respectively) (p<0.05). Embryos originated from the younger group had a significantly higher implantation rate than those from the older age group (26.7% vs. 11.7%) (p= 0.01). The male partner’s sperm parameters had no effect on the outcome of the treatment.
Conclusions: This stsuggests that female age is a crucial factor determining the pregnancy and implantation rates after ICSI performed for severe male factor patients.
Key Words: assisted fertilization, Intracytoplasmic sperm injection, male infertility/ micromanipulation
Pregnancy and
delivery after intracytoplasmic injection of spermatids into human oocytes.
Ragaa T. Mansour, M.D. *†, Nevine A.Tawab B.Sc.†, Mohamed A.
Aboulghar, M.D.†‡, Ibrahim Fahmy, M.D.‡,
Gamal I. Serour, M.D.†, Yehia M. Amin, M.D.†, Ahmed Kamal, M.D.†
The Egyptian IVF-ET Center, Maadi, Cairo, Egypt
ABSTRACT
Objective: To investigate the potentials of spermatids in achieving fertilization and pregnancy.
Design: Prospective study
Setting: The Egyptian IVF-ET Center
Participants: Fifteen infertile males with non-obstructive azoospermia due to deficient spermatogenesis.
Intervention: Intracytoplasmic injection of spermatids obtained from testicular biopsies
Main Outcome Measure: Fertilization and pregnancy
Results: One hundred and five metaphase II oocytes were injected using round and elongated spermatids and normal fertilization was observed in 40 oocytes (38%). Embryo transfer was done for twelve patients achieving one pregnancy that resulted in the delivery of a healthy boy with normal karyotyping.
Conclusion: Injection of spermatids inside the ooplasm has clearly demonstrated the potential of these cells to achieve fertilization and pregnancy.
Key Words: Spermatid injection, ICSI, non-obstructive azoospermia, testicular biopsy.
Oocyte release
in luteinized unruptured follicles with a second dose of human chorionic
gonadotrophin.
Hany Lashen, M.R.C.O.G*, William Ledger, M.A., D Phil. M.R.C.O.G.
†, William A.R. Davies, F.R.C.S., F.R.C.O.G.‡, Ros Smith‡
Assisted Conception Unit, Birmingham University, Birmingham Women’s Hospital, Birmingham, UK
ABSTRACT
Objectives: To study the effect of a booster dose of hCG on the luteinized unruptured follicles.
Design: Prospective observational cohort study.
Patients: 112 patients who underwent 186 cycles of controlled ovarian stimulation and intrauterine insemination.
Settings: Private Assisted Conception Unit.
Interventions: Administration of a 5000 IU of hCG as a booster dose in the patients who developed LUF.
Main outcome measure: Incidence of ovulation and pregnancy in LUF patients.
Results: In 18 out of 186 cycles the patients failed to ovulate in response to the routine dose of 10,000 IU hCG. A booster dose of 5000 IU hCG effected ovulation in 8 patients (44%). Only one patient in the LUF group conceived.
Conclusion: Ovulation could be induced in LUF cycles with a hCG booster dose. However the chances of pregnancy in these cases are low.
Key words: Luteinized unruptured follicle, LUF, hCG booster dose.
Adam International Clinic, Cairo, Egypt.
ABSTRACT
Objectives: To perform electroejaculation combined with intrauterine insemination for the wives of anejaculatory patients with spinal cord injury.
Design: Ten male patients with spinal cord injuries were submitted to electrostimulation and insemination of their wives by the antegrade or retrograde ejaculate or both after processing.
Setting: Adam International Clinic, Cairo, Egypt.
Results: Three patients were azoospermic and two patients had a poor quality semen in antegrade and retrograde ejaculation. Five patients had an antegrade and/or retrograde ejaculation of sufficient quality, and intrauterine insemination was performed. Twin pregnancy confirmed by ultrasonography was reported in two patients.
Conclusion: Electroejaculation combined with intrauterine insemination gives a reasonable fertility potential for patients with spinal cord injuries.
Key words: Electroejaculation, intrauterine insemination, anejaculation.
Early ovarian
endometrioid carcinoma: an accidental finding in an infertile patient.
Raafat M. Reyad, M.D.*
Department of Obstetrics and Gynecology, Cairo University
ABSTRACT
Objective: To present a case of ovarian endometrioid carcinoma in an infertile patient.
Design: A case report.
Setting: Private hospital.
Intervention: Total abdominal hysterectomy and bilateral salpingo-oophorectomy.
Results: The pathology report showed the presence of endometriotic adenocarcinoma with acanthotic changes grade II in the right and left ovaries, the uterus and tubes were normal.
Conclusion: Solid adnexal masses should be thoroughly investigated irrespective of patient’s age and complaint. Conventional ultrasonography can not rule out malignant change in an ovarian swelling.
Keywords: Infertility, Ovarian endometrioid carcinoma.
Botros Rizk, M.D., M.R.C.O.G., F.R.C.S.c.*, Susan L. Baker, M.D., Lynn J. Groome, Ph.D. M.D.
Department of Obstetrics and Gynecology, University of South Alabama, Mobile Alabama
ABSTRACT
Objective: To present the first case in the world literature of Diamond Blackfan anemia following in vitro fertilization.
Design: A case report.
Setting: Tertiary Care Center, Reproductive Endocrinology and infertility Clinic.
Intervention: In vitro fertilization and embryo transfer.
Results: A case of infertility due to tubal factor was treated by IVF and gave birth to a female infant with Diamond blackfan anemia.
Conclusion: Diamond Blackfan anemia, which is an extremely rare disease was diagnosed in a baby born after IVF-ET treatment.
Keywords: IVF, Diamond Blackfan anemia.