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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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Evidence-based medicine.
Salim Daya, M.B.
Departments of Obstetrics and Gynaecology and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
ABSTRACT
The ever-expanding volume of medical literature makes it more difficult to keep up with current clinical information. In addition, the physician’s knowledge of up-to-date care is inversely correlated with the amount of time since graduating from medical school. These facts, and the observation that traditional Continuing Medical Education programs are not successful in improving clinical performance, emphasize the need for physicians to acquire the skills necessary to appraise the literature critically so that the best quality evidence can be selected and applied to clinical care. Evidence-based medicine is becoming an increasingly important new paradigm because of its ability to assist clinicians in making decisions about clinical management. This approach has resulted in the traditional, opinion-based review article becoming less useful and is now being replaced by the more structured, systematic review which is a synthesis of information n a clinical area using scientific principles. The skills necessary for learning and practising evidence based medicine are not difficult to learn and should be acquired so that the concepts of good clinical practice and good clinical research can be integrated into an approach to clinical decision making that is effective and appropriate.
Key words: evidence-based medicine, EBM, clinical decision making, opinion-based medicine.
Dysthyroidism and gonadal function.
Ioannis Xenophontos Halikias, M.D., George Tolis, M.D.,
F.R.C.P.
Athens University, 2nd Department of Internal Medicine, Endocrinology Section, Athens, Greece
ABSTRACT
Dysthyroidism, i.e. hyperthyroidism and hypothyroidism, has been associated with various reproductive disorders. An outline of the current knowledge upon the effect of dysthyroidism on male and female gonadal function is reviewed herein.
Key Words: Dysthyroidism, hyperthyroidism, hypothyroidism, gonadal function, reproduction, infertility.
The value of oocyte and ovarian tissue banking
for cancer patients.
Osama H. Salha, M.R.C.O.G.,
M.R.C.P.*†, Vinay Sharma, M.R.C.O.G., Ph.D. *, Roger G. Gosden, D.Sc.,
Ph.D‡
Assisted Conception Unit, St., James’s University Hospital, and The Research School of Medicine, Centre for Reproduction, Growth and Development, University of Leeds, Leeds, UK.
ABSTRACT
Premature ovarian failure may occur in women with genetic diseases
(such as Turner’s syndrome), after chemotherapy or radiotherapy for malignant
disease, in severe or recurrent ovarian disease (such as cysts, benign tumors or
endometriomas), or after removal of the ovaries to treat endometriosis or
genital cancer. For women at risk of premature ovarian failure, there are now
three possibilities for preserving their fertility: cryopreservation of their
oocytes, embryos and most recently ovarian tissue.
Oocytes can
be collected when either mature or immature. Cryopreservation of mature oocytes,
although successful in the mouse has met with little success in most other
species, including human. All cryopreservation procedures; both slow and rapid
have led to impaired oocyte survival and reduced rates of fertilization and
embryo cleavage, with the result that fewer than 2% of oocytes are capable of
producing a term pregnancy.
The difficulties in cryopreserving
human oocytes are related to their large volume and variable membrane
permeability. This makes it difficult to achieve sufficient dehydration during
cooling to prevent ice formation, without disrupting other cytoplasmic and
nuclear components.
Spontaneous post-implantation embryo
resolution – a new concept in embryo loss.
R. H. Asch,
M.D. M.E. Vazquez, M.D., J.R. Verez, M.D. J.
Stern, M.D., B. Asch, M.D., E. Macedo, M.D., Gutuerrez Najar, M.D., R.
Montanari, M.D., M. Cantarelli, M.D., B. Valli, M.D., G.B. La Sala, M.D.
Group of Reproduction and Genetics AGN, Mexico, and Centro per la Diagnosi e la Terapia della Sterilita, Div. Ob-Gin. Reggio Emilia, Italy.
ABSTRACT
Objective: To determine and compare in an ART population the chances of complete abortion rate, and of spontaneous post-implantation embryo resolution (SPIER) (partial re-absorption of 1 or more gestational sacs) in clinical pregnancies according to the original number of gestational sacs observed.
Design: A prospective, on going study in a University-based private practice and in a public hospital facility ART units.
Materials and Methods: We studied the outcome of 620 pregnancies originated from ART. There were 414 singletons (67%), 132 twins (21%), 48 triplets (8%), 19 quadruplets (3%) and 7 quintuplets (1%). At the first ultrasound observation of the clinical pregnancies (20-30 days post-conception) we detected 414 single gestational scans (44%), 264 double (28%), 144 triple (10%) 76 quadruple (8%) and 35 quintuple sacs (4%).
Results: A) complete pregnancy loss was observed in 22% of all pregnancies (n:160) with the following distribution: Singleton (29%), twin (10%), triplet (8%), quadruplet pregnancies (10%), and quintuplets (14%) respectively. The pregnancy loss decreased proportional to the magnitude of the multiple gestation, being statistically significantly higher in the group of patients with singletons (p<0.05). B) SPIER was found to be overall of 29% (n:293), with the following distribution; 29% in singletons, 25% in twins, 24% in triplets, 45% in quadruplet pregnancies, and 54% in quintuplets, respectively. The chance of losing a gestational sac does not differ between patients that originally had a singleton, twins or triplet pregnancies. However, it was statistically greater in those that began the gestation as a quadruplet. (p<0.005)
Conclusions: These results show that the frequency of complete pregnancy loss and the partial resolution of gestational sacs (SPIER) do not have a parallel correlation in singleton and multiple pregnancies (up to quadruplets). While the complete pregnancy wastage is increased in singleton vs. multiples, the SPIER is augmented only in high order multiple gestations. This information should be used for 1) counseling of patients about the prognosis and outcome of their pregnancies from ART once clinically confirmed, and 2) to assist in making decisions about the multifetal pregnancy reductions.
Key words: abortion rate, embryo resolution, SPIER.
In vitro evidence of better steroidogenesis by
granulosa cells from preovulatory follicles matured by GnRh-analogue induced LH
surge
D. A. G. Imoedemhe, F.R.C.O.G., E.L.A. Pacpaco,
B.Sc.
Human Reproductive Biology Unit, Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
ABSTRACT
Objective: To determine if follicular maturation by GnRH-analogue induced LH and FSH surge adversely affected intrinsic granulosa cells steroidogenesis in comparison to the conventional method of hCG.
Design: A Prospective study.
Setting: Human Reproductive Biology Unit, Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.
Materials and methods: Granulosa cells from 2 groups of 26 patients receiving either hCG or GnRH-analogue to induce LH and FSH flare up for preovulatory follicular maturation were cultured under similar conditions over a period of 10 days. The estradiol and progesterone titres were determined from culture medium obtained on Days 2, 4, 6, 8 and 10 of culture.
Results: A significantly better progesterone secretion by granulosa cells from those patients receiving GnRH-analogue in comparison to hCG with P values of 0.05 to 0.0005 irrespective of whether the culture medium had been supplemented with hCG or FSH during the first six days of culture. During the remaining period of culture P secretion remained higher in the GnRH-a group although the difference was not always significant. The E2 secretion by granulosa cells obtained from patients who received GnRH-a were generally higher than for those receiving hCG although these differenceswere not statistically significant.
Conclusion: The results indicate better granulosa cells luteinization when LH and FSH surges were induced by GnRH-analogue for follicular maturation in comparison to hCG. We believe that these in vitro culture observation indicate a better luteal phase when pre-ovulatory maturation of follicles is carried out by induction of gonadotrophin surge as in the natural cycle using this novel method in comparison to the present established method of hCG administration.
Key words: Follicular Maturation/GnRH-Analogue/hCG/Granulosa Cells
Y-linked microdeletion analysis by FISH and
sequence-tagged-sites Multiplex PCR of diverse spermatogenetic
defects.
Ali Hellany*†, Veronique Bellec* , Yves Menezo*,
Jacque Rollet*, Mohamed Benahmed †, Moncef Benkhalifa*
Genetics & IVF. LMM, Merieux Foundation, and INSERM. U 407, Laboratoire de Biochimie, C.H.R.U. de Lyon, France.
ABSTRACT
Objective: To study the Y-chromosome profile by molecular cytogenetics and sequence-tagged-site (S-T-S) polymerase-chain reaction in patients with severe oligozoospermia and azoospermia.
Intervention: The genetic profile of Y chromosome (5 loci) was analysed in 20 infertile men (severe oligospermia or azoospermia, high FSH and normal LH ) before biopsy and intracytoplasmic sperm injection (ICSI) during a cycle of Assisted Reproductive Technology.
Results: The molecular cytogenetic and sequence-tagged-sites (S-T-S) multiplex PCR analysis showed 3 patients (15%) with a microdeletion in Yq11.23 and one patient (5%) with total Yq deletion and presenting iYp. Our results suggest that the deletion occurs during the father’s spermatogenetic process or the post-zygotic stage of embryonic development of the son. We also report a case in which 2 brothers show different deletions on the Y long arm while the father’s Y chromosome is normal. The possible existence of several genes implicated in spermatogenesis may explain the correlation between deletion size and the grade of spermatogenetic defect.
Conclusion: This study demonstrates the necessary role played by genetic analysis in the counselling of certain cases of infertility, especially before treating a patient for a cycle of intracytoplasmic sperm injection.
Key Words: Spermatogenetic defects, FISH, Multiplex PCR, Y chromosome microdeletion, ICSI
Comparative study between hysterosonography,
hysterography and hysteroscopy for evaluating the uterine cavity in recurrent
aborters.
Alaa. N. Ebrashi, M.D., Osama A. Shawki, M.D.,
Mohamed. Momtaz, M.D., Ehab M. Soliman, M.D., Hesham. Al-Inany M.Sc.
Department of obstetrics and gynecology, Cairo University
ABSTRACT
Objective: To evaluate and compare the diagnostic value of hysterosonography, and hysterography (HSG) using hysteroscopy as the gold standard, in evaluating uterine cavity abnormalities in recurrent aborters.
Design: Prospective study.
Setting: Department of Obstetrics and Gynecology Kaser El-Aini Hospital Cairo University.
Patients: 40 patients with a history of recurrent first trimester abortion (2 consecutive times).
Intervention: Hysterosonography, followed by hysterography and hysteroscopy were done for all cases.
Results: 19 out of 40 cases studied showed intracavitary lesions by both hysterosonography and hysterogrpahy, including 6 cases (15%) of septal defect,11 cases (27.5%)with uterine adhesions and 2 cases (15%) with submucous myoma. Two cases of mild intrauterine adhesions were overlooked by both hysterography and hysterosonography and diagnosed only by hysteroscopy. Using hysteroscopy as the gold standard both hysterosonography and hysterography have demonstrated 100% specificity and 90.5% and 95% sensitivity respectively.
Conclusion: Hysterosonography provides a sensitive and specific screening tool for evaluating the uterine cavity and it could be an accurate alternative to HSG in screening for uterine abnormalities.
Key words: Hysteroscopy, hysterosonography, hysterography, recurrent abortion, uterine cavity abnormalities.
Occurrence of osmotic shock in human
spermatozoa: its effects on the qualitative measurements of frozen-thawed
spermatozoa.
P. N. Zarmakoupis-Zavos, J. R. Correa, P.
Aslanis, S. Antypas and P. M. Zavos.
Andrology Institute of Lexington and Kentucky Center for Reproductive Medicine, Lexington, Kentucky; and Greek-American Andrology Institute of Athens and Children's Hospital "Ayia Sofia", Athens, Greece
ABSTRACT
Objective: Mammalian spermatozoa swell under hypotonic conditions. The exposure of spermatozoa to isotonic conditions after exposure to hypertonic conditions during cryopreservation results in the occurrence of osmotic shock, which is characterized by coiling of the distal end of the sperm tail. The objective of this study was to assess the effects of osmotic shock (% sperm coiling) on human cryopreserved spermatozoa following thawing and subsequent dilution in two different media.
Design: Twenty ejaculates were collected, split and frozen in TEST-Yolk buffer (TYB) containing a final concentration of 8% or 12% glycerol (v/v). Specimens were thawed after a 10 day cryostorage period and diluted 1:1 (v/v) via a fast or slow dilution method (mode) using TYB or Ham’s F-10 media. Specimens were washed and assessed for qualitative characteristics and for the occurrence of osmotic shock.
Setting: Andrology Institute of Lexington, Inc., Lexington, Kentucky.
Patients: Twenty male subjects were instructed to produce a semen specimen each via the use of a semen collection device at intercourse.
Main Outcome Measure(s): Evaluation of osmotic shock occurrence as a function of glycerol level in the freezing media, dilution rate and media used for sperm washing procedures.
Result(s): The slow dilution method yielded improved qualitative characteristics than the fast dilution method, regardless of glycerol level or media used for sperm wash. The occurrence of osmotic shock was higher as the level of glycerol increased (from 8 to 12%) in specimens diluted at a fast mode and washed with Ham’s F-10.
Conclusion(s): It is believed that the observations made in this study are of great clinical significance to all involved with freezing and handling cryopreserved spermatozoa. Abrupt dilution of glycerol levels in cryopreserved sperm for IVF, or in vivo by the female reproductive tract fluids during artificial insemination (AI) could explain in part, the consistently lower fertility rates obtained when cryopreserved spermatozoa are used as compared to fresh ones.
Key Words: spermatozoa, freezing, glycerol, dilution, osmotic shock
Miscarriage rates with different ovulation
induction protocols in polycystic ovary syndrome patients.
Ali Rüstü Ergür, M.D., Yusuf Ziya Yergök, M.D., Professor Aktug
Ertekin, M.D., Ercüment Müngen, M.D., Associate Professor Levent Tütüncü,
M.D.
Gülhane Military Medical Academy, Department of Obstetrics and Gynecology, Istanbul, Turkey
ABSTRACT
Objective: To evaluate the incidence of miscarriage with the different ovulation induction protocols and the risk factors associated with the first trimester spontaneous miscarriage in polycystic ovary syndrome (PCOS) patients.
Design: A retrospective analysis of data.
Setting: Military Academic Center.
Patients: One hundred and eighty-three patients had induced cycles with different ovulation induction protocols up to a total of eight hundred and thirteen cycles.
Interventions: Induction protocols were classified as, clomiphene citrate, gonadotropin-releasing hormone analogue + human menopausal gonadotropin (GnRH-a+hMG), conventional dose hMG, low-dose hMG, conventional dose follicle-stimulating hormone (FSH), low-dose FSH and all of the patients were pursued for the first trimester spontaneous miscarriage.
Main outcome measures: First trimester spontaneous miscarriage rate.
Results: The miscarriage rates, in the above sequence, were 32.75 %, 28.57 %, 25 %, 20 %, 22.22 % and 26.66 %, respectively. There was no significant difference between these induction protocols according to the miscarriage rates (p ( 0.05). Luteinizing-hormone (LH) levels and body mass index (BMI) were significantly higher in the group with an abortion than the ones with healthy pregnancies (p ( 0.05).
Conclusions: As a result of the study, the variety of ovulation induction methods do not change the incidences of first trimester miscarriage in patients with polycystic ovary syndrome, but, specially high LH levels and obesity seem to have adverse effects on early pregnancies achieved by different ovulation induction methods.
Key Words: Miscarriage, ovulation induction, polycystic ovary syndrome.
Intracytoplasmic sperm injection followed by
tubal pronuclear stage embryo transfer in the treatment of severe male factor
infertility.
M. Magdy EL-Sheikh, M.R.C.O.G., F.R.C.S.*,
Sally Fouad, M.B.B.Ch., M. Sc.*, Hassan Youssef, L.R.C.P., M.R.C.S.,
M.R.C.O.G.†, Mohamed Ibrahim, M. Med. Sc.†, Safaa Al - Hasani, Ph.D.‡, Wael
Ahmed, M. Med. Sc.†, Moustafa Hussein, M.B.B.Ch., D.G.O.*, Mohamed Abo Zaid, M.
D.*, Abd Al-Samad M. Sheikh, B.S.M.T., M.Sc. Bio. Sc.*
Al Salama Hospital IVF Unit, Dr. Erfan and Bagedo Hospital IVF Unit, Jeddah. Saudi Arabia and Assisted reproduction unit, Lubeck University, Lubeck, Germany.
ABSTRACT
Objective: To evaluate the results of ICSI- PROST in the treatment of severe forms of male infertility.
Design: A prospective clinical study involving two independent IVF Units, during the period from July 1st to November 30th, 1996.
Settings: IVF units of Al Salama Hospital (Unit I) and Dr. Erfan and Bagedo Hospital (Unit II).
Patients: Sixty two consecutive couples treated for severe male infertility in the presence of healthy fallopian tubes.
Intervention: Ovulation induction, ICSI-PROST.
Outcome Measure: Pregnancy rate, Implantation rate, Multiple pregnancies and miscarriage rate.
Results: Sixty two treatment cycles of ICSI-PROST resulted in twenty six pregnancies (42% pregnancy rate), Implantation rate was 15%, with 7 multiple pregnancies (27%), and 7 miscarriages (27%). One pregnancy resulted from a frozen testicular tissue sample.
Conclusion: ICSI-PROST is a successful option, the procedure involves a shorter incubation time for embryos, and could be used under particular circumstances. The high implantation rate observed necessitates the implementation of restrictions on the number of embryos transferred to reduce the incidence of multiple pregnancies.
Key Words: ICSI, PROST, ZIFT, TET, male infertility
Laparoscopically assisted vaginal
hysterectomy: A gimmick or an advance?
Diaa El-Mowafi,
M.D., Chitranjan Lall, M.D., F.R.C.S., F.A.C.O.G.
Hutzel Hospital, Detroit Medical Center, Wayne State University,Detroit MI, USA.
ABSTRACT
Objective: To evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size that can be operated upon, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures, postoperative period and complications, and average total cost.
Design and setting: Retrospective study.
Subjects and Interventions: A total of 136 patients underwent LAVH between October 1996 and October 1997 at Hutzel Hospital, Detroit Medical Center, Wayne State University, Michigan, USA.
Results: The mean age of our patients was 45.8±0.7 years (range, 30-59). Thirty-one patients (22.8%) had previous abdomino-pelvic surgery. The most common indication for LAVH and postoperative pathological finding were myoma(s). The mean length of the removed uteri was 11.8±0.4 cm (range, 5.6-14). Their mean weight was 235±8 gm (range, 59-560). The bipolar cautery was used in 96 cases (71%), Endo GIA alone in 4 cases (3%), and both in 36 cases (26%). There was no significant difference between these three modalities in terms of operative time, estimated blood loss, intraoperative and postoperative complications. The mean estimated blood loss was 149±7 ml (range, 75-750). The mean operative time was 150±4 min (range, 60-215). Interaoperative complications included one case of bladder injury due to thick adhesions, two cases of inferior epigastric vessels injuries that were easily repaired. Two cases had to be switched from laparoscopic to laparotomy procedure due to bleeding from the uterine artery in one case and from the infundibulopelvic ligament in the other. No blood transfusion was indicated in any of our patients. Postoperative complications included two cases of cystitis, four cases of ileus, one case of pelvic infection, and one case of pelvic abscess. All our patients had a hospital stay of 1-2 days. The estimated average total cost of LAVH was $ 7,500.
Conclusion: LAVH is a true advance in gynecological surgery enables the surgeon to convert most of the abdominal hysterectomies into vaginal ones and hence decreases morbidity, postoperative pain and complications.
Key words: LAVH, laparoscopic hysterectomy