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The Official Journal of the Middle East Fertility Society Abstracts
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The Official Journal of the Middle East Fertility Society Abstracts
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Fertility and reproduction in ancient
Egypt.
Eric Jauniaux , M.D., Ph.D
Academic Department of Obstetrics and Gynecology, University College London Hospital (UCLH), London, UK.
ABSTRACT
Egyptian Medicine became a science more than 4000 years ago. However, most historical reviews of medicine classically start with Greco-Roman medicine, which is widely accepted as the origin of clinical practice in Western Societies. The aim of this review is to highlight the knowledge of fertility and reproduction of Imhotep and his successors. As in any human society before and after the ancient Egyptians, the primary concern of a couple must have been its fertility. The survival of the society as a whole was highly dependent on the fertility of its people and also on the land that fed them. In ancient Egypt, religion and magic were, therefore, at the center of most fertility and regeneration rituals. However, observation studies and evidence-based medicine were current practice. For example the absence of an expected menstruation was already taken as a sign of conception. Furthermore, the ancient Egyptians had also developed a number of tests that could be performed to indicate if a woman was fertile or not, or pregnant or not. This review also demonstrates that at least 2000 years before the Greek and Roman civilizations emerged from obscurity, the Egyptians had already mastered some of the most important concepts in medical science. These concepts inspired the Greco-Roman invaders and many of them were rediscovered by the Europeans during the Renaissance.
Key Words: Fertility, reproduction, pregnancy, congenital abnormality, ancient Egypt.
Early human nutrition and chorionic villous
vascularization.
Babette A.M. Lisman, M.D.*, Niek Exalto,
M.D., Ph.D. †
Department of Obstetrics and Gynecology, Spaarne Ziekenhuis Haarlem and Division of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam
ABSTRACT
The yolk sac plays an active and important role in embryonic nutrition and organogenesis, and therefore can not be considered a vestigial organ. Since the last decade the functional significance of the placental circulation during the first trimester is discussed because of an absent maternal intervillous circulation during the first 12 weeks of pregnancy. The development of the embryo takes place in an oxygen poor environment and the yolk sac turned out to be important for the intercession of embryonic nutrition during the developmental period. Furthermore, the human yolk sac is the main source of numerous proteins and its biosynthetic activity plays an important role in haematopoiesis. Experiments on animals have demonstrated that the yolk sac can be damaged by various substances resulting in embryonic malformations. Ultrasonic studies examining the secondary yolk sac size do not appear to be a sensitive predictor of embryonic integrity and pregnancy outcome. Apart from implantation and organogenesis the development of the placenta tales place during the first 12 weeks of pregnancy but will not be functional until thereafter. The development of the chorionic villous vascular system in first trimester pregnancies is characterized by maturation of luminized vessels from primitive hemangioblastic cords and margination to a situation of peripherally located vessels. Normal chorionic villous vascularization is essential for the undisturbed development of pregnancy. Deficient vasculogenesis may play a role in pathological pregnancy. More clinical studies in this field should be performed to investigate chorionic villous vascularization in complicated pregnancy and its consequences.
Key words: Yolk sac, nutrition, embryology, CD34, chorionic villi, vascularization
The impact of cigarette
smoking on human reproduction: its effects on female and male
fecundity.
P. M. Zavos, Ed.S., Ph.D.*†‡, C. N.
Zarmakoupis, M.D.*, P. N. Zarmakoupis-Zavos, M.D.*†‡
Andrology Institute of America, Lexington, Kentucky, Greek-American Institute of Andrology, Athens, Greece, and Kentucky Center for Reproductive Medicine.
ABSTRACT
Cigarette smoking has become a serious health and social problem in society today and also presents a rather challenging dilemma for the physician or the health care provider. No doubt, the physician has a very difficult and yet very necessary and important role to play in convincing patients of the adverse health effects smoking has on the body's ability to properly function and reproduce. The smoking behavior can be defined only as physically self-destructive and anyone who smokes should be advised to stop. The data shown in this review depicts a great deal of epidemiological evidence that smoking adversely affects female and male fertility. It also shows the biological plausibility and mechanisms of action of cigarette smoke and its components on the various reproductive processes. The argument against smoking holds true for anyone wishing to reproduce, however, it is particularly imperative for individuals having difficulty in conceiving or experiencing infertility problems. Infertility, generally is defined as the inability of a couple to conceive after 12 months of trying to achieve pregnancy without the use of any means of contraception (unprotected sex). Data from 1982 reveal that infertility affects an estimated 2.4 million married couples in the U.S. and these figures continue to increase dramatically.
Key words: Cigarette smoking, male fecundity, female fecundity.
Recombinant and urinary FSH preparations: a
comparative analysis of multifollicular development and IVF/ICSI outcome in
different categories of ovarian responders.
Sergio
Oehninger, M.D., Debi Jones, Gerardo Barroso, M.D., Suheil Muasher,
M.D.*
The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA*
ABSTRACT
Objectives: To compare recombinant and urinary FSH preparations in their capacity to induce ovarian multifollicular development and impact of IVF/ICSI outcome in different categories of ovarian responders.
Design: Retrospective, comparative analysis.
Setting: Academic fertility care institution.
Subjects: Seven hundred and seventy-nine patients
undergoing 835 consecutive treatment cycles.
Intervention:
Patients were stimulated with urinary FSH (uFSH), highly purified urinary FSH
(hpFSH) or recombinant FSH (rFSH) in combination with two different GnRH agonist
(GnRH-a) regimens (long and stop GnRH-a protocols).
Main outcome measures: Peak serum estradiol (E2) levels on day of hCG, number of gonadotropin ampoules administered, cancellation rate, number of mature oocytes recovered, fertilization and pregnancy rates.
Results: In intermediate and high responder patients (long GnRH-a protocol) the FSH preparations were equally effective in inducing multifollicular development. Importantly, rFSH resulted in significantly higher implantation and ongoing pregnancy rates than the urinary preparations. In low responders (stop GnRH-a protocol) the FSH preparations demonstrated similar effects in terms of ovarian response and pregnancy outcome. Separate analysis of IVF and ICSI patients revealed a similar positive impact of rFSH on implantation and pregnancy outcome in high and intermediate responders undergoing both treatments.
Conclusions: This study demonstrated that recombinant FSH appeared to be equally effective as urinary preparations in inducing multifollicular development. However, rFSH appeared to be superior in achieving an ongoing pregnancy in IVF and ICSI treatments in intermediate and high responders.
Key words: Recombinant FSH, urinary FSH, ovarian stimulation, pregnancy, IVF, ICSI
Impaired growth hormone secretion in
subfertile males with spermatogenic arrest.
Hosni A. Awad,
M.D.*, Asmaa A. El-Rewany, M.D. †, Ahmed M. Salem, M.D.*, Abdelazeez M.
Abdelazeez, M.sc.*
Faculty of Medicine, Cairo University, Cairo, Egypt.
ABSTRACT
Objective: To compare growth hormone secretion following stimulation among patients with spermatogenic arrest.
Design: Comparative prospective study.
Setting: Outpatient clinic of Andrology and the Department of Chemical Pathology, Kasr El-Aini Hospital, Cairo University, Cairo, Egypt.
Subjects: Thirty infertile males with complete
spermatogenic arrest, 30 infertile males with partial spermatogenic arrest, and
30 normozoospermic fertile males matched for age and body mass index.
Intervention: All subjects underwent oral clonidine growth hormone
stimulation test. Clonidine was given orally as a single dose (0.15
mg/m2).
Main outcome measures: Serum growth hormone levels before and after clonidine stimulation. Serum levels of FSH, LH, T, and PRL were also measured.
Results: Basal GH levels were similar in the three groups and serum GH increased in all subjects after clonidine stimulation. However, GH response to clonidine was significantly impaired in the two patient groups compared to the control group. Serum FSH level was significantly higher and serum T level was significantly lower in the two patient groups as compared to the control group. Serum LH and PRL were similar in all three groups.
Conclusion: The results demonstrate that infertile patients with spermatogenic arrest may suffer from relative growth hormone deficiency.
Key Words: Growth hormone, male infertility, spermatogenic arrest.
Estrogen receptor levels in
fibromyomata.
Penelope Anne Richards, Ph.D*, Peter David
Gordon Richards, M.Sc.*, Osama Shawki, M.D.†
Department of Anatomy, Faculty of Medicine, University of Pretoria, South Africa and Department of Gynecology, Cairo University, Egypt
ABSTRACT
Objective: To examine the estrogen receptor content of fibromyomata, in relation to the estrogen receptor content of their host myometria and normal myometria.
Design: An observational cross-sectioned study.
Materials and Methods: Sections from large and small tumors (n=90) were stained immunocytochemically for estrogen receptors. Percentage positivity was calculated using 10 random fields per section and compared to previously counted normal and host myometrial sections.
Results: Tumor percentage positivity was significantly greater than normal midmyometrial (p<0.001) and subserosal regions (p<0.001) but only marginally higher than both the normal subendometrial region (p<0.05) and all regions of host myometria (p<0.05). Tumors from secretory phase uteri were significantly more positive than tumors from proliferative phase uteri (small tumors p<0.0037; large tumors p<0.027).
Conclusion: The increase in estrogen receptors in fibromyomata is expected given that the underlying host myometrium is abnormal. The phasic differences in receptor content may help explain the higher mitotic indices in tumors from secretory phase uteri. Furthermore the differential staining patterns of the nuclei may be related to differences in gene regulation as a result of the fibromyomata’s heightened sensitivity to estrogen. Finally further investigatory routes are suggested which could lead to novel treatment modalities for fibromyomata.
Keywords: Estrogen receptors, fibromyomata, myometrium.
Evaluation of different approaches for
prevention of intrauterine adhesions following hysteroscopic metroplasty for
septate uterus.
Osama A. Shawki, M.D., Alaa N. Ebrashi,
M.D., Hesham O. Kandeel, M.D., Ehab M. Soliman, M.D, Mohamed E. Saleet,
M.D.
Department of Obstetrics and Gynecology, Cairo university.
ABSTRACT
Objective: To evaluate the best method for the prevention of intrauterine adhesions (IUA) following metroplasty for a septate uterus.
Design: Prospective study.
Settings: Department of Obstetrics and Gynecology, Kaser El Aini Hospital, Cairo university.
Patients: Fifteen cases were enrolled in the study, all had recurrent first trimester pregnancy loss. Patient age ranged between 24 and 32 years.
Intervention: All patients were subjected to hysteroscopic removal of the septum during the follicular phase of the cycle without prior preparation for the endometrium. Postoperatively, the patients were managed as follows : five patients did not use any postoperative prophylaxis, five cases received conjugated estrogen and progestogen for three successive cycles, and five cases had an intrauterine contraceptive device (IUD) inserted immediately postoperatively for one cycle. Second lookhysteroscopy was performed after three cycles to assess the uterine cavity, the extent of adhesions and lysis of adhesions was carried out if required.
Results: Postoperative intrauterine adhesions (IUA) were found in 3 patients: one in the group allocated to use conjugated estrogen, second one was in the group with IUD being inserted postoperatively. The last patient was in the control group who was not allocated to use any postoperative treatment. The adhesions found in the three patients were filmy adhesions mainly at the fundus. A residual fundal notch, less than 1 cm, was found in 7 cases for which no treatment was required.
Conclusion: Insertion of IUD seems to be unnecessary for a favorable morphological outcome since IUA found in all cases were filmy fundal adhesions at the base of the treated area. Moreover, we found that the IUD insertion seemed to increase the likelihood of infection as well as uterine bleeding and abdominal cramps. The use of postoperative estrogen to reepithelize the freshly dissected surfaces may be harmless but seems to be optional and carries no additional benefits in prevention of IUA.
Key words: Uterine malformation, hysteroscopy, metroplasty, intrauterine adhesions, IUA.
Comparison of vaginal, rectal and oral
administration of lisuride hydrogen maleate in hyperprolactinemic
women.
Cem Ficicioglu, M.D., Ph.D., Zeynep Alpay, M.D.,
Murat Tasdemir, M.D., Serap Yalti, M.D., Seval Tasdemir, M.D.
Zeynep Kamil Maternity Hospital, Turkey.
ABSTRACT
Objectives: To compare the efficacy and adverse effects of vaginal, rectal and oral administration of lisuride hydrogen maleate.
Design: Prospective study.
Material and Methods: Thirty women with hyperprolactinemia were included in the study. The patients were randomly allocated into three groups for vaginal (0.2 mg/day), rectal (0.2 mg/day) and oral (0.4 mg/day) use. Serum prolactin levels were measured for four weeks: once before the treatment and three times at one-week intervals during the treatment.
Main outcome measures: Gastrointestinal adverse effects were observed and prolactin levels were detected during treatment in all groups.
Results: Gastrointestinal adverse effects were not observed during intravaginal and rectal lisuride hydrogen maleate administration. Whereas nausea, headache, dizziness, fatigue and sweating were seen in patients receiving oral lisuride. Although there was no significant difference among groups in the assessment of mean prolactin levels measured during the treatment, the efficacy of lisuride hydrogen maleate was significant in all treatment regimens (p<0.05).
Conclusion: This study is a clinical demonstration of the efficacy of intravaginal and rectal lisuride hydrogen maleate administrations, as well as the elimination of the adverse effects associated with the treatment. Rectal and intravaginal lisuride hydrogen maleate is an effective and safe alternative in the treatment of hyperprolactinemia. Therefore intravaginal and rectal lisuride hydrogen maleate administration can be recommended as safe and effective alternatives in hyperprolactinemic patients who cannot tolerate oral lisuride treatment, while the rectal administration can be the preferred route for virgin females.
Key words: Oral lisuride, intravaginal lisuride, rectal lisuride, hyperprolactinemia
Surgical induction of ovulation in polycystic
ovary syndrome using thermo aqua puncture (TAP).
Abdel-Maguid I. Ramzy, M.D.*, Nevine I. Ramzy, M.D. †
Department of Obstetrics & Gynecology and Department. of Pathology, Faculty of Medicine, Cairo University.
ABSTRACT
Objective: To study the effectiveness of conveying thermal energy into the stromal tissue of the ovary using warm saline (Thermo Aqua Puncture “TAP”) to surgically induce ovulation in cases of anovulatory infertility suffering from polycystic ovary syndrome (PCOS).
Design: A case series.
Materials and Methods: The study consisted of two experimental phases and a third clinical application trial. The first phase involved selective in vitro injection of 9 ovaries, shortly after surgical excision. The second phase included injection of 6 ovaries shortly before excision during laparotomy. The clinical phase included 18 primary infertility patients diagnosed on clinical, ultrasonographic and biochemical basis as having PCOS, and proved resistant to clomiphene citrate therapy. These patients were injected guided by laparoscopy. Twelve patients completed clinical follow-up for at least one year following TAP.
Results: Nine patients (75%) had an episode of bleeding a few days after the procedure. Seven patients (58.3%) had three spontaneous successive regular ovulatory cycles and five (41.6%) continued to do so for at least six cycles. Significant postoperative reduction in the mean basal LH levels and rise in the mean basal FSH level followed the procedure. No cases suggestive of ovarian atrophy were recorded. One patient (8.3%) became pregnant following two regular cycles. No pelvic adhesions were detected in two cases during second look laparoscopy.
Conclusion: TAP offers an effective method for surgical induction of ovulation in patients having PCOS resistant to medical induction of ovulation. Its safety and advantages may be concluded after its application on a larger series of patients. TAP has the potential of being applied guided by transvaginal ultrasonography.
Key Words: Surgical induction of ovulation, polycystic ovary syndrome, anovulation, amenorrhea oligohypomenorrhea, infertility, laparoscopy, adhesions, transvaginal ultrasonography
Intracytoplasmic sperm injection in men with
totally immotile ejaculated sperm.
Ahmed Kamal, M.D. *,
Ragaa T. Mansour, M.D. *, Catharine A. Rhodes, M.D. *, Mohamed A. Aboulghar,
M.D.*†, Ibrahim Fahmy, M.D. * †, Gamal I.Serour, M.D. * ‡
ABSTRACT
Objective: To present a case series of men with totally immotile ejaculated spermatozoa undergoing intracytoplasmic sperm injection (ICSI), and review the recent literature.
Design: Retrospective case series.
Setting: The Egyptian IVF-ET Center.
Subjects: Seventeen couples with totally immotile spermatozoa in the ejaculate.
Interventions: Intracytoplasmic sperm injection was performedin all cases using immotile ejaculated spermatozoa, testicular spermatozoa or spermatids.
Main outcome measures: Fertilization rates (FR) and pregnancy rates (PR).
Results: In the twelve cases of ICSI with testicular sperm extraction (TESE) the FR was 41.8% with a PR of 33.3%. In five couples, ICSI was performed using ejaculated spermatozoa, with a FR of 51.7% and a PR of 40%. The overall FR was 45.6%, with a PR of 35.3%.
Conclusion: Intracytoplasmic sperm injection using immotile testicular or ejaculated sperm is a reasonable treatment option in cases of totally immotile ejaculated spermatozoa.
Key words: totally immotile sperm / intracytoplasmic sperm injection / testicular sperm extraction.
A randomized prospective comparison between
intrauterine insemination and two methods of fallopian tube sperm
perfusion.
Ehab M. Soliman, M.D, Mohamed E. Salit M.D.,
Alaa N. Ebrashy M.D, Mamdouh A. Sheiba, M.D, Abdelhamid M. Attia, M.D.
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University.
ABSTRACT
Objective: This study was done to compare fecundity rates in patients undergoing classical intrauterine insemination (IUI) versus fallopian tube sperm perfusion (FSP) using two different techniques.
Design: Prospective randomized clinical trial from May 1996 till August 1998.
Setting: Cairo University teaching hospital and private practice.
Patients: Thirty-eight patients with unexplained infertility, with a total of 118 treatment cycles, were included in this study. Their age ranged from 22-37 years (mean= 30.1 ± 4.1 years) and the duration of infertility ranged from 2-13 years (mean= 4.2 ± 5.8 years). Twenty-nine had primary infertility and 9 had secondary infertility.
Interventions: Controlled ovarian hyperstimulation was done with CC and hMG. Thirty-four hours after hCG administration, patients were randomly allocated to one of three groups for insemination; Group I: standard IUI where I ml sperm suspension was injected using the Makler® catheter, group II: FSP using the same Makler® catheter where additional media was used to dilute the sperm suspension to 4 ml, and group III: FSP using the FAST® System especially adapted to ensure good cervical sealing.
Results: Of the 118 cycles observed in this study we obtained a total of 36 conceptions (30.5% per cycle). Nine pregnancies occurred in group I (18% per cycle), 14 in group II (38.9% per cycle) and 13 in group III (40.6% per cycle). There was a significant difference in PR between group I and each of groups II and III (P < 0.05). The difference in PR between groups II and III was not statistically significant. There was no significant difference in the incidence of miscarriage, multiple pregnancy and OHSS between the three groups.
Conclusions: The results of this prospective randomized trial indicate a significant improvement of PR with fallopian tube sperm perfusion (FSP) compared with standard IUI in patients with unexplained infertility. The type of catheter does not seem to affect the PR in cases of fallopian sperm perfusion, preferably a simple and cheap one.
Key words: infertility, intrauterine insemination, fallopian tube, sperm perfusion.
Frequency of infertility
and induction of ovulation in Iranian ovarian cancer patients: a preliminary
report.
Mahnaz Ashrafi, Reza
Alaghebandan and Shahram Tavajjohi
Department of Obstetrics and gynecology, Iran University of Medical Sciences, Tehran, Iran
ABSTRACT
Objective: To determine the frequency of infertility and induction of ovulation and their relationship with types of ovarian cancers in Iranian ovarian cancer patients.
Design: Retrospective.
Setting: Four gynecologic oncology centers in Tehran.
Patients: Two hundred and seventy eight women with diagnosis of ovarian cancer.
Intervention(s): Analysis of data from patients records.
Results: Frequency of infertility and nulliparity among our ovarian cancer patients were 5% (95% CI, 2,8%-8.3%) and 18.3% (95% CI, 14%-23.4%), respectively. Frequency of infertility among epithelial ovarian cancer patients was 4.6% (95% CI, 2%-8.9%), while in non-epithelial ovarian cancer was 5.7% (95% CI, 2.1%-12%). Frequency of induction of ovulation in our patients was 4.3% (95% CI, 2.3%-7.4%). Frequency of induction of ovulation in epithelial and non-epithelial ovarian cancer patients were 4.05% (95% CI, 1.64%-8.16%) and 4.76% (95% CI, 1.56%-10.76%), respectively. There was no significant statistical difference between infertility in epithelial and non-epithelial ovarian cancer patients (P=0.7). No significant difference, however, was seen between induction of ovulation in epithelial and non-epithelial ovarian cancer patients (P=0.86).
Conclusion(s): Our data do not support the incessant ovulation as a main etio-pathologic factor in the development of epithelial ovarian cancer. However, further investigation is required to resolve the question of the possible association between infertility and fertility drugs with ovarian cancer through large epidemiological studies.
Keywords: Ovarian cancer, infertility, induction of ovulation.