 |
The Official Journal of the Middle East Fertility Society Abstracts
of |
|
The Official Journal of the Middle East Fertility Society Abstracts
of |
Current perspectives of blastocyst stage
transfer
Cem L. Demirel, M.D.*, Safaa Al-Hasani, D.M.V.,
Ph.D.‡, Nikos Nikolettos, M.D.†
Department of Obstetrics and Gynecology, Medical University of Ankara, Ankara, Turkey, Democritus University of Thrace, Faculty of Medicine, Alexandroupolis, Greece, and Department of Obstetrics and Gynecology, Medical University of Lübeck, Lübeck, Germany.
ABSTRACT
With the current refinements in culturing conditions, blastocyst stage transfer has now been emerging as an acceptable strategy in current IVF practice. Extending the preimplantation culture period of the embryos to 5 or 6 days after insemination serves more as a selection process of the best competent and viable embryos for transfer than as a physiological synchronization with the endometrial secretory status. On the other hand, with new data on pronuclear polarity and cleavage symmetry, embryo vitality may be assessed effectively without extending the culture period. Blastocysts also provide the unique opportunity to sample multiple cells along with the trophectoderm cells for preimplantation genetic diagnosis. The improved implantation rates (between 21.4- 50 %) per blastocyst allow the transfer of only one or two embryos thereby reducing the risk of high order multiple pregnancies while not compromising a high pregnancy rate (between 29.4-52.5 %). Today with the use of sequential culture media designed to address the changing metabolic requirements of the developing embryo, acceptable rates of blastocyst development in vitro can be achieved (39-51 %). There seems to be a negative influence of male infertility on the rates of blastocyst formation. But whether the ICSI procedure itself is a causative factor or not is an unresolved debate. The morphological grade and the number of transferred blastocysts are the main factors influencing the clinical pregnancy rates. The best results are obtained with the transfer of fully expanded, a blastocele cavity and an inner cell mass bearing embryos. For the time being blastocyst culture should be reserved for patients with high oocyte and zygote yields.
Key words: Blastocyst, IVF, ICSI, embryo transfer, pregnancy
The presence of white blood cells in
semen
John Papadimas, M.D., Ph.D., Theodosia Zeginiadou,
Ph.D., Basil C. Tarlatzis, M.D., Ph.D., Serge Mantalenakis, M.D., Ph.D.
1st department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
ABSTRACT
The present article critically reviews the recent data in the literature concerning the methoof quantitation of round cells in semen and in particular of white blood cells. The most reliable methods for the differentiation of round cells in semen are the peroxidase cytochemistry with the use of benzidine or o-toluidine and immunocytochemistry with the use of antibodies. The effect of increased numbers of white blood cells in semen on parameters of semen analysis as well as most of the sperm function tests is not yet clear. The clinical significance of such a finding is discussed along with the influence that it will have on fertility and the outcome of in vitro fertilization.
Key words: Peroxidase cytochemistry, semen, white blood cells
A prospective randomized comparative cohort
study of either recombinant FSH (Puregon*) or urinary FSH (Metrodin*) in in
vitro fertilization treatment
Jarl A. Kahn, M.D.,
Ph.D.* Vidar von Düring, M.D.*, Arne Sunde, Ph.D.* Henk
J. Out, M.D.†
Department of Obstetrics and Gynecology, University of Trondheim, Trondheim Norway, and NV Organon, Oss, The Netherlands.
ABSTRACT
Objective: To determine the efficacy and efficiency of urine extracted (Metrodin) and recombinant (Puregon) produced Follicle stimulating hormone (FSH) for ovarian hyperstimulation in a cohort of women undergoing IVF treatment.
Design: Prospective randomized assessor-blind study.
Setting: Fertility unit, University hospital of Trondheim, Norway
Subjects: One hundred and fifty Norwegian women included in the study were offered a maximum of three IVF treatments. In total 262 treatment cycles, 147 treatments with Puregon and 115 with Metrodin
Results: The amount of Puregon used was lower than that of Metrodin in the first, second and in the total of the tree cycles. The number of oocytes and fertilized oocytes, were higher in the first cycle with Puregon. The mean delivery rate per cycle was similar (33.3 and 33.0%). With a mean of 1.8 cycles per women, 62.8% of the women gave birth in the Puregon group, and 66.7% in the Metrodin group.
Conclusion: The use of Metrodin and Puregon for ovarian hyperstimulation as part of IVF treatment seems to yield similar rate of deliveries, but women treated with Puregon seems to achieve this in less number of treatments with less amount of gonadotrophins.
Key words: IVF, Rec-FSH, u-FSH
Total antioxidant status in infertile males
with leukocytospermia
Mohamed Nabil Momen, M.D.*, Taymour
Mostafa, M.D.*, Mohamed EL-Khodary, M.D.†, Hazem Abu Yossef, M.D.†
Andrology and STD and Chemical Pathology Departments, Faculty of Medicine, Cairo University, Cairo, Egypt
ABSTRACT
Objectives: To assess the possible significance of total antioxidant status in seminal plasma of infertile males with leukocytospermia.
Design: Prospective.
Materials and methods: 71 male patients were studied, divided into 6 groups according to semen analysis; fertile normospermia with leukocytospermia (n=10) and without (n=13), oligoasthenoteratospermia with leukocytospermia (n=10) and without (n=18), azoospermia with leukocytospermia (n=10) and without (n = 10). History taking and local genital examinations, complete semen analysis, peroxidase staining for semen and total antioxidant status activity in seminal plasma by ELISA method were done.
Results: Total antioxidant status activity was found in all studied cases of seminal plasma; mean 2.2, 1.62, 1.61, 1.55, 2.19 and 2.0 mmol/l respectively. Fertile cases without leukocytospermia showed significant difference compared to those with leukocytospermia (p< 0.05). There was significant difference also in all studied leukocytospermic cases compared to non-leukocytospermic one (mean 1.92 Vs 1.75 mmol/l, p<0.05). Positive correlation between total antioxidant status level in seminal plasma with sperm count, total sperm motility and negative correlation with pus cells and abnormal form percentage were ruled out.
Conclusion: Antioxidant scavenger system in semen has shown to be affected in leukocytospermic cases due to either decrease of antioxidant production or to exhausted reserves for neutralization and compensation of excess liberated reactive oxygen species (ROS).
Keywords: Male infertility, semen, ROS, antioxidants.
Accuracy and prognostic value of
computer-assisted (IVOS*) sperm morphology evaluations
Kevin Coetzee, M.Sc., Thinus F. Kruger M.D.
Reproductive Biology Unit, Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg Hospital, Tygerberg, South Africa.
ABSTRACT
Objective: We systematically investigated the critical aspects determining the performance and in vitro predictive value of the Hamilton Thorne Research semen analyzer (IVOS, dimension system).
Design: Repeat normal sperm morphology evaluations were performed. Semen samples to be used in our gamete intrafallopian tube transfer (GIFT) program were prospectively evaluated.
Setting: Reproductive Biology Unit.
Subjects: Liquefied semen samples from patients attending our Andrology and assisted reproduction laboratories.
Interventions: Liquified semen samples were washed
once and stained using Diff-Quik stain. The standard Tygerberg GIFT procedure
was followed with all supernumerary oocytes inseminated and cultures.
Outcome measures: Normal sperm morphology outcomes were produced using
the IVOS, according to the strict criteria. The repeat measures performed were,
cell-cell, intra-slide, inter-slide and inter-laboratory. Fertilization in vitro
and pregnancy outcomes were recorded.
Results: The predictive probabilities for an abnormal or a normal cell given two prior abnormal or two prior normal cell outcomes was 95% and 94% respectively. The average coefficients of variation obtained for the intra-slide trial was 9.73% and for the inter-slide trial it was 15.39%. The average inter-laboratory coefficients of variation obtained ranged between 16.3% and 23.1%. The logistic regression model showed that the normal sperm morphology outcomes recorded were significantly associated with fertilization in vitro and pregnancy. Analyzing the data across the 5% normal sperm morphology cut-point; fertilization rates of 39.4% (?5%) and 62.9% (>5%) and pregnancy rates of 15.2% (?5%) and 37.4% (>5%) were obtained.
Conclusion: The IVOS used produced a level of repeatability, precision and accuracy acceptable for routine application in assisted reproduction setting.
Key words: Hamilton Thorne Research, computer-assisted, human, sperm morphology
Multiple ejaculate collection via the use of a
semen collection device at intercourse versus masturbation
Panayota N. Zarmakoupis-Zavos, M.D.*†, Constantinos N. Zarmakoupis,
M.D.*, Juan R. Correa, Ph.D*‡, Panayiotis M. Zavos, Ed.S. Ph.D.*†
Andrology Institute of America and Kentucky Center for Reproductive Medicine, Lexington, Kentucky; and Centro de Fertilidad del Caribe, Rio Piedras, Puerto Rico
ABSTRACT
Objective: To assess the seminal characteristics of multiple ejaculates collected sequentially via masturbation or at intercourse using a semen collection device (Male Factor PakTM; MFPTM).
Design: Three ejaculates were collected by patients over a 3 day period (1 semen specimen/day) via masturbation or at intercourse by using the MFPTM. Semen specimens were assessed for volume (ml), sperm count (x106/mL), percentage and grade of motility, percentage of normal morphology and for the total functional sperm fraction (TFSF; x106).
Setting: Clinical and research environment.
Patient(s): Forty couples participating in an
intrauterine insemination (IUI) program.
Main Outcome
Measure(s): Differences in semen quantitative and qualitative characteristics of
ejaculates produced via masturbation or intercourse.
Result(s): The sperm count of the first ejaculate collected at intercourse or via masturbation yielded 170.0±19.0 and 150.0±21.0 x106 spermatozoa, respectively. The sperm count decreased by 53% and 32% on day 2 and 3 of semen collection via masturbation. The sperm count decreased by 71% and 49% on day 2 and 3 of semen collection via the use of the MFPTM at intercourse (P<0.05). The semen volume decreased by 45% and 50% after the third collection day in specimens collected at intercourse or via masturbation, respectively. Semen qualitative characteristics increased as a function of collection frequency, regardless of collection method. Those characteristics tended to be higher, but not significantly different (P>0.05), in specimens collected at intercourse.
Conclusion(s): Using the semen collection device, there was a tendency to have better quantitative and qualitative semen characteristics as well as the advantage that the method of collection will closely resemble the semen produced naturally when deposited in the vagina during intercourse and subsequent ejaculation.
Key words: semen, spermatozoa, masturbation, intercourse.
Conscious pain mapping of the appendix with
microlaparoscopy for the evaluation of women with chronic pelvic pain
Oscar D. Almeida, Jr., M.D. *†, John M. Val-Gallas, M.D.†
Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, and Providence Park OB-GYN, PC, Mobile, Alabama, USA
ABSTRACT
Objectives: To evaluate the efficacy of conscious pain mapping in the diagnosis of appendiceal pathology in women with chronic pelvic pain.
Design: Retrospective, non-selected cohort study.
Setting: Gynecology departments of a university-affiliated hospital and a private community hospital.
Patients: Twenty women with chronic pelvic pain
who underwent an appendectomy following conscious pain mapping were compared
with a cohort of patients who had an incidental appendectomy.
Interventions: Conscious pain mapping and appendectomy. Statistical
analysis was performed with the ?2 test.
Results: Fourteen (70%) of 20 women who underwent an appendectomy following evaluation of the appendix with conscious pain mapping had abnormal pathologic findings, compared to six (24%) of 25 patients who had an incidental appendectomy. The frequency of abnormal appendiceal pathology obtained using conscious pain mapping was statistically significant when compared with incidental appendectomy (p<0.002).
Conclusions: Conscious pain mapping of the appendix in women with chronic pelvic pain assists the clinician in identifying which patients should undergo an appendectomy compared to performing an incidental appendectomy on all patients with chronic pelvic pain.
Key words: Conscious pain mapping, microlaparoscopy, pelvic pain.
Intracytoplasmic sperm injection results with
percutaneously retrieved spermatozoa from the epididymis and testes
Pankaj Shrivastav, M.D., M.R.C.O.G.*, Prashant Nadkarni, M.R.C.O.G.,
Suresh Kattera, Ph.D., Ian Craft, FRCS, F.R.C.O.G., Meenakshi Bharath,
M.D.
Dubai Gynaecology & Fertility Centre, Department of Health and Medical Services, Dubai, U.A.E.
ABSTRACT
Objectives: The study was conducted to assess the suitability of a percutaneous method of retrieving spermatozoa from the epididymis (PESA) and testes (TESA) and comparing the ICSI results with these spermatozoa with those using ejaculated spermatozoa
Design and setting: Retrospective study at the Dubai Gynaecology & Fertility Centre, Dubai, U.A.E.
Subjects and intervention: Couples undergoing PESA-ICSI (54 cycles) and TESA-ICSI (29 cycles) were compared to 141 cycles of conventional ICSI conducted during the same period.
Main outcome measures: The success of retrieval of spermatozoa from the epididymis and testes and the fertilisation and pregnancy rates (positive serum ?hCG) following ICSI with these spermatozoa were analysed.
Results: Adequate numbers of spermatozoa could be retrieved by PESA and TESA for both, performing the ICSI procedure and for cryopreservation. The normal (2 PN) fertilisation rate with epididymal, testicular and ejaculated spermatozoa was 59.1%, 54.6% and 63.5% respectively. In most couples, embryos were generated and a failed fertilisation rate of 3.7%, 3.4% and 6.4% were observed with epididymal, testicular and ejaculated spermatozoa respectively (NS). While significantly more embryos were transferred in the women undergoing PESA-ICSI, the pregnancy rates (for women under the age of 40 years) of 34.7%, 30% and 29.8% using epididymal, testicular and ejaculated spermatozoa respectively, were not significantly different. Pregnancies have been obtained using cryopreserved epididymal spermatozoa and embryos generated using cryo-thawed testicular tissue.
Conclusion: The results indicate that PESA and TESA which are minimally invasive, can be performed under local anaesthesia and cause no post operative discomfort. These techniques can be successfully used to retrieve adequate numbers of spermatozoa from the epididymis and testes which when used for ICSI gave satisfactory fertilisation and pregnancy rates.
Key words: Epididymal spermatozoa, intra cytoplasmic sperm injection, percutaneous, PESA, Testicular spermatozoa, TESA
Spontaneous fetal demise in twin pregnancy
following IVF-ET: the Kuwait experience
Egbase P., MRCOG
*†‡, Al Sharhan M., MD† , Grudzinskas J.G., MD*
Academic Department of Obstetrics & Gynaecology, St Bartholomew’s & The Royal London School of Medicine & Dentistry, Royal London Hospital, Whitechapel, London, and IVF Center, Maternity Hospital, Kuwait
ABSTRACT
Objective: To observe the rate of spontaneous fetal demise in twin pregnancy following IVF-ET.
Design: Observational, retrospective
Setting: Tertiary level, IVF Center.
Subjects: Seventy women with twin pregnancy at seven weeks’ gestation following in-vitro fertilization and embryo
Interventions: Transvaginal and transabdominal ultrasound at 9, 12, 16 and 20 weeks
Main outcome measure: To observe the occurrence of spontaneous fetal demise.
Results: The spontaneous fetal reduction of twins to singletons occurred in 11 of 66 women by nine weeks and 1 of 53 women by 12 weeks’ gestation. Spontaneous miscarriage was only observed in twin pregnancies in 4 of 70 women by nine weeks, 2 of 53 women by 12 weeks and 4 of 52 women between 21 and 24 weeks’ gestation.
Conclusion: Our study confirms that fetal loss is most likely to occur in the first trimester, the majority being before nine weeks’ gestation.
Keywords: fetal demise, twin pregnancy, IVF
Evidence based
gynecologic endoscopy: much more is needed!
Hesham G. Al-Inany
Department of Obstetrics & Gynecology, Cairo University, Egypt
ABSTRACT
In the last two decades, numerous endoscopic interventions have been promoted in the treatment of gynecological disorders all over the world. Unfortunately, these techniques have been introduced without strong scientific evidence of their effectiveness. The practice of gynecologic endoscopic surgery is largely based on evidence derived from uncontrolled case series studies and most of these trials are underpowered (much too small). Clinical medicine is currently in transition from experience-oriented practice to an evidence-based one which requires the best available evidence that answers our clinical questions. Randomised controlled trials (RCTs) are considered the “gold standard” for judging whether a new intervention does more good than harm. Increased cost and more efforts needed have been claimed as reasons for the limited use of RCTs in gynecologic endoscopy. The place and obstacles for evidence based gynecologic endoscopy will be discussed.
Key Words: Evidence based medicine, laparoscopy, hysteroscopy, randomized controlled trials.
Inappropriate timing of
human chorionic gonadotrophin administration: an avoidable cause of empty
follicle syndrome in in-vitro fertilization
Yacoub
Khalaf, M.D., M.R.C.O.G., Harriet Anderson, M.D., M.R.C.O.G., Yahia Amin,
M.D.
Guy’s and St.Thomas’ Assisted Conception Unit, London, United Kingdom and The Egyptian IVF Center, Cairo, Egypt
ABSTRACT
Objective: To describe two cases of empty follicle syndrome that were due to oocyte retrieval within 12 hours of hCG administration.
Design: Case report.
Setting: Assisted conception program in a tertiary care center.
Intervention: Transvaginal oocyte retrieval under ultrasound control 12 and 36 hours after administration of 10,000 units of hCG.
Results: No oocytes were found in the aspirate from mature pre-ovulatory follicles at 12 hours of hCG administration whereas both patients had successful retrieval of mature oocytes 24 hours later. In both patients, normal fertilisation, cleavage, implantation and clinical pregnancy were achieved.
Conclusion: Appropriate timing of hCG administration is crucial for successful retrieval of mature oocyte. It is important to ascertain that a period of 34-36 hours has elapsed before attempting oocyte retrieval.
Key words: Empty follicle syndrome, human chorionic gonadotrophins, oocyte retrieval