Middle East Fertility Society Journal

Spermatogonial stem cells as a source for regenerative medicine

Liang Ning, Ellen Goossens, Mieke Geens, Dorien Van Saen, Herman Tournaye — 2012-03-01

Abstract: Several researchers have reported the derivation of multipotent cells from both mouse and human spermatogonial stem cells. These spermatogonia-derived stem cells show similarities with embryonic stem cells both for phenotype and functionality, indicating that these cells may be a promising alternative source for stem-cell based therapies in regenerative medicine.

Oocyte cryopreservation, will it be a real social choice and family solution?

Hossam Hassan Soliman, Amir Afshin Khaki, Tahani Al-Azawi, Safaa Al-Hasani — 2012-03-01

Abstract: Social changes, uprising ambitions and life demands have markedly affected the behavior and attitude of women toward the concept of composing a stable family and giving birth to children, that was clearly demarcated by the remarkably increased age of conception and child birth, postponement of such essential events could be followed later on by a sense of sorrow and regret. As such elderly ladies would sometimes find more difficulty in conceiving or in maintaining pregnancy till full term because of old age compared to the relatively younger women who might get better chances to get a healthy pregnancy, that could be attributed to the poorer quality of oocytes which progressively develops with the advancement of the maternal age. Oocyte cryopreservation at a younger age using vitrification has been proposed as a solution to maintain women’s fertility without the need for sperms; if done at a younger age where oocytes are still healthy and competent to yield a normal pregnancy, thus enabling women to delay conception.

OHSS-safe IVF practice: Dream or reality?

Essam al-Dein M.A. Khalifa — 2012-03-01

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening iatrogenic complication of ovarian stimulation. Severe forms complicate 1–3% of IVF cycles . It is characterized by a massive ovarian enlargement together with a fluid shift into extravascular compartments responsible for the development of ascites, sometimes pleural and/or pericardial effusion, hypovolemia, oliguria, and hydroelectrolytic disorders.

Routine office hysteroscopy prior to ICSI and its impact on assisted reproduction program outcome: A randomized controlled trial

Hossam Eldin Shawki, Mahmoud Elmorsy, Mostafa K. Eissa — 2012-03-01

Abstract: Objective: To assess the incidence of undiagnosed intrauterine pathology based on screening office hysteroscopy in women with normal hysterosalpingogram (HSG) and/or transvaginal ultrasonograghy (TVS), and their impact on the success rate of ICSI (intracytoplasmic sperm injection).Design: Randomized controlled trial.Setting: In El-Menya Infertility Research and Treatment Center (MIRTC), El-Menya, Egypt.Patient(s): Two hundred and forty consenting patients were eligible to participate in the study, who further randomized into two equal groups, 120 patients in group I (ICSI without office hysteroscopy), and 120 patients in group II (had ICSI after office hysteroscopy). Only 110 and 105 patients completed the study in group I and group II, respectively.Intervention(s): ICSI with or without office hysteroscopy.Main outcome measure(s): Undiagnosed uterine abnormalities, implantation and clinical pregnancy rates.Result(s): Unsuspected abnormal uterine findings were diagnosed in 35/105 (33.3%) patients with normal HSG and/or TVS among patients in group II by using office hysteroscopy. Implantation rate and clinical pregnancy rate were statistically significant between group I and group II, as clinical pregnancy rate between group I, group IIa (ICSI with normal office hysteroscopy) and group IIb (ICSI with abnormal office hysteroscopy) were 27.2%, 35.7%, 42.8%, respectively (P⩽0.05). Among group II 51 patients (48.5%) have repeated IVF or ICSI failure, 23 patients of them (45%) had abnormal hysteroscopy finding and 15 patients (65.2%) achieved pregnancy after correction of their uterine abnormalities. Hysteroscopy has high specificity (88%), high diagnostic accuracy (86.2%) but less sensitivity (80%) in predicting intrauterine abnormalities when compared to HSG and TVS (odd’s ratio 1.7, CI 1.33–2.44).Conclusion(s): The incidence of pathologic abnormalities based on hysteroscopic diagnosis was high especially with repeated IVF failure. Improvement in implantation and clinical pregnancy rates were observed after office hysteroscopy prior to ICS. So routine office hysteroscopy should be an essential step of the infertility workup before ART even in patients with normal HSG and /or TVS.

Transvaginal power Doppler sonography can discriminate between benign and malignant endometrial conditions in women with postmenopausal bleeding

2012-03-01

Abstract: Objective: To evaluate the role of transvaginal power Doppler sonography in differentiation between benign and malignant endometrial conditions in women with postmenopausal bleeding.Setting: OB/GYN Dept., Suzan Mubarak University Hospital and Radiology Dept., Minia University Hospital, Minia University, Minia, Egypt.Study design: Prospective observational study.Patients: Eighty patients with postmenopausal bleeding.Intervention(s): Grey scale transvaginal sonography, power Doppler study of the endometrium and endometrial-myometrial interface, and office hysteroscopy and the final diagnosis by histopathological examination of hysteroscopic guided biopsy.Results: Endometrial power Doppler signals were positive in 69 out of the eighty patients (86.25%): 8 cases showed multiple vessel pattern -A- (10%); 19 cases with single vessel pattern -B- (23.75%); 42 cases with scattered vessel pattern -C- (52.5%) while in the remaining 11 cases (13.75%), no power Doppler signals were detected. The hysteroscopic findings were endometrial polyp in 16 cases (20%), atrophic endometrium in 14 cases (17.5%), hyperplasic endometrium in 32 cases (40%), submucus fibroid in 6 cases (7.5%), cervical polyp in 3 cases (3.75%) and suspicious endometrium for malignancy in 8 cases (10%). Hysteroscopy was more accurate in cases with intra-cavitary masses (polyps and submucous fibroids) than power Doppler, but power Doppler had a more predictive value for malignant endometrium.Conclusion: Power Doppler blood flow mapping of the endometrium in women with postmenopausal bleeding is useful to discriminate carcinoma from other endometrial pathologies.

Pregnancy outcome after IUI for male and idiopathic infertility using a new simplified method for sperm preparation

Emad M. Siam — 2012-03-01

Abstract: Introduction: Intrauterine insemination (IUI) is a valid treatment for infertility with a cumulative pregnancy rate of 40–90% after 3–10 treatment cycles.Design: We prospectively studied the efficacy of a new simplified method for motile sperm preparation for IUI for both male causes of infertility, and for those diagnosed with idiopathic infertility.Methods: A prospective clinical trial was performed with 200 couples, with a 2–8years history of primary infertility. One hundred couples had been diagnosed as idiopathic, while another 100 couples with male factors of infertility. Motile sperm for IUI was prepared by: (A) the classic World Health Organization self-migration (swim-up) method which includes centrifugation, or (B) the proposed simplified swim-up procedure without centrifugation. Both anti-estrogens and HMG had been used for ovarian stimulation. Depending on the cause of infertility, patients were matched one-to-one at the time of IUI, so that when a total of 100 couples had been treated of both causes of infertility, 50/100 women received sperm prepared by method A and 50/100 by method B.Results: A statistically significant correlation was found between the percentage motile sperm of the original semen sample and the percentage of motile sperm recovered by method A (r=0.333, P<0.01) and B (r=0.400, P<0.01). A highly significant correlation (r=0.997, P<0.001) was found between the two methods. The pregnancy outcome after the proposed IUI procedure was not significantly different after the traditional swim-up sperm preparation.Conclusions: The simple proposed swim-up method was as effective as the classic swim-up method, regarding the sperm recovery and pregnancy outcome, but in an easier, and faster way.

Infecund evaluation of cycling female Sprague–Dawley rats: An aftermath treatment with Momordica charantia seed extract

Chyke Ifeanyi Amah, Oshiozokhai Eboetse Yama, Cressie Carmel Noronha — 2012-03-01

Abstract: Introduction: Bitter melon (Momordica charantia) grows in tropical areas including parts of the Amazon, Africa, Asia and the Caribbean. It has an array of biologically active plant chemicals including triterpenes, proteins and steroids.Aim: The aim is to evaluate the effect of methanolic seed extract of M. charantia (MC) on ova count, implantation and the fetus of Sprague–Dawley rats.Methodology: Thirty adult cyclic female Sprague–Dawley (S–D) rats divided into three groups (A, B and C) of 10 rats/group were used for the study. The female rats in Groups B and C were made pregnant by cohabiting with male S–D rats. In all the groups, MC extract was administered in the morning (9.00 a.m.) at a dose of 25mg/100g b.w./oral. In Group A, rats (in proestrous phase) were treated with a single dose and sacrificed the following day (estrous phase). Rats in Group B were fed once daily from day 1 to 10 of gestation and sacrificed on the 12th day. Rats in Group C were fed once daily from day 6 to 19 of gestation and sacrificed on the 20th day of gestation. The following were assessed: ova count, anti-implantation, early abortifacient properties and possible teratogenicity.Result: The extract completely suppressed the release of ova and exhibited highly significant anti-implantation activity. Significant (p<0.05) changes were seen in the mean body weight, mean crown rump length and mean tail length of the fetuses.Conclusion: In conclusion, MC (25mg/100g b.w.) exhibited anti-ovulatory and anti-implantation (early abortifacient) properties. These are certainly desirable anti-fertility actions. It also resulted in prenatal growth deficiencies.

Conversion of ICSI cycles to IUI in poor responders to controlled ovarian hyperstimulation

Amal Shohieb, Mona Mostafa, Waleed El-Khayat — 2012-03-01

Abstract: Aim: Comparison between the results of the oocyte retrieval technique and the conversion to the intra-uterine insemination (IUI) technique in cases with poor ovarian response to the controlled ovarian hyperstimulation (COH) procedure.Patients and methods: It is a retrospective observational study in women with poor ovarian response to COH which is defined as estradiol (E2) peak level <1000pg/mL or with ⩽4 follicles which are ⩾14mm in diameter. Four hundred and sixteen cases were reported as poor responders in 2 IVF centers since December 2007 to July 2010. One hundred and fifty two cases of them proceeded to the oocyte retrieval procedure. These cases were assigned as group (A). Sixty eight cases converted to IUI and were assigned as group (B). One hundred and ninety six cases canceled their cycles. These cases were not included in the current study. Our data were collected from the databases of two In Vitro Fertilization (IVF) centers and analyzed retrospectively to compare the results of the different applied techniques in the studied groups. The main measured outcome parameters were the clinical pregnancy rate and the live birth rate.Results: The group of cases proceeded to the oocyte retrieval procedure had a higher basal Follicle Stimulating Hormone (FSH) level, needed a longer duration of stimulation with higher Human Menopausal Gonadotropin (HMG) doses and had higher E2 peak levels. The clinical pregnancy rates and the live birth rates were higher in the group proceeded to the oocyte retrieval than the group converted to IUI but the difference was not statistically significant.Conclusion: As the pregnancy rates difference between both groups was not statistically significant the conversion to IUI could be considered a useful substitute to the oocyte retrieval procedure in the poor responder cases. However, to adopt this conclusion, further confirmation in other prospective studies with larger sample size is a must.

Effect of L-carnitine and meloxicam treatment on testicular leydig cell numbers of varicocelized rats

Fouad K. Al-Rubiey — 2012-03-01

Abstract: Objective: Varicocele is a pathobiological condition associated with abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord; it is one of the leading causes of male infertility. Although several studies have considered the relationship between varicocele and semen L-carnitine concentrations, no study on the effects of L-carnitine on testicular number of Leydig cells which are important in fertility of the individual has been reported.Design: Prospective study.Setting: Institute of the Embryo Research and Infertility Treatment, College of Medicine, AL-Nahrain University.Materials and methods: Thirty male albino Wister rats divided into three groups, 10 animals each. The groups A and B underwent a left experimental varicocele induction. Group C was not operated on and served as control. Animals in group A (Treatment group) were treated with L-carnitine twice daily and meloxicam once every four days. Group B (Placebo group) and C (Control group) received placebo and distilled water, respectively; using the same treatment program of group A. Treatment in all cases was given orally by oral cavage, and continued daily for 12weeks. At the end of treatment rats were sacrificed. Serial histological sections were then prepared and examined microscopically for number of testicular leydig cells.Main outcome measure: The number of Leydig cells was used to evaluate testicular changes:Results: Histological examination shows new findings of significant improvement of decrease in the number of leydig cells (P<0.05) in treatment groups as compared to placebo.Conclusion: It is concluded that L-carnitine plus meloxicam treatment appears to have a beneficial effect in decreasing, restoring and maintaining the number of testicular leydig cells in experimental varicocelized rats close to that control of non-varicocelized rats.

Amnion graft as a possible source of stem cells for endometrial regeneration after lysis of severe intrauterine adhesions

Mohamed I. Amer, Karim Abd-El-Maeboud, Amal Alloub — 2012-03-01

Abstract: Background: The current traditional management of severe intrauterine adhesions (IUAs) is hysteroscopic adhesiolysis with application of either an intrauterine contraceptive device or a Foley catheter balloon with reported recurrence in up to 50% of cases. Recently, significant improvement with the use of amnion graft following hysteroscopic lysis of severe IUA was reported.Case: In the present case, endometrial stromal cells (ESCs) were found within and on the surface of amniotic membrane two months after its grafting intrauterine which was confirmed with CD10 immunohistochemistry.Conclusion: Amniotic membrane graft after hysteroscopic lysis of severe IUA, might act as a source of stem cells for endometrial regeneration; a role that will be of great value especially in severe IUAs. Further studies to confirm this finding are warranted.

Evidence based surgical management of endometriosis

Mohamed A. Bedaiwy, Nichole M. Barker — 2012-03-01

Abstract: The management approach to patients with pelvic endometriosis is multidimensional. One must consider several factors such as patient’s age, parity, extent of the disease, and menopausal status when planning treatment strategies. The main goals of therapy are targeted at symptom control and achieving fertility in women who so desire. Medical and/or surgical therapies can be considered in these patients. Individualized patient care is essential for the success of treatment. In this review, we focus our discussion on surgical approach strategies and the management of endometriosis with an emphasis on pain and fertility outcomes.

Mohamed Aboulghar — 2012-03-01

This book covers medical microbiology from the point of view of experts in reproduction and is specifically targeted for scientists and clinicians working in assisted reproduction. The authors describe the purpose of the book as to select areas and topics in microbiology that are specifically relevant to assisted reproductive technology (ART) in order to provide a very basic background of facts and fundamental principles. This background can help to prevent contamination and transmission of disease in ART and limit the opportunities for microbial survival in embryo culture and cryopreservation systems. Thus, the book fills the gap which existed in the literature between microbiology and ART.

OHSS-free IVF practice: Dream or reality

Tarek K. Al-Hussaini — 2012-03-01

Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life-threatening complication of controlled ovarian stimulation (COS). OHSS is an iatrogenic complication of ovulation induction, which may cause serious impact on patient’s health. OHSS is the most feared complication of IVF-related ovarian stimulation, which in its severe form leads to hospitalization and in the worst case scenario fatal complications .