Adel M. Nada

The effectiveness of clomiphene citrate in LH surge suppression in women undergoing IUI: a randomized controlled trial

OBJECTIVE To study the effectiveness of clomiphene citrate (CC) in preventing a premature LH surge during controlled ovarian stimulation in women undergoing assisted reproduction. DESIGN Prospective, randomized, controlled trial. SETTING University hospital. PATIENT(S) Two-hundred thirty couples with mild male factor, or unexplained infertility. INTERVENTION(S) Couples were randomized to receive human menopausal gonadotrophins (hMG) followed by CC or hMG alone until the day of hCG. MAIN OUTCOME MEASURE(S) The primary outcomes were the incidence of a clinical pregnancy and premature LH rise. Secondary outcomes were the E2 levels, number of mature follicles, and endometrial thickness as determined on the day of hCG. RESULT(S) The number of patients who had a premature LH surge was significantly lower in the hMG+CC group (5.45% vs. 15.89%). Additionally, the mean E2 levels (pg/mL) and the number of mature follicles were also significantly higher in the hMG+CC group (360.3±162.9 vs. 280±110.0 and 2.4±0.97 vs. 1.3±1.1, respectively), although there was no significant difference regarding number of canceled cycles, endometrial thickness, or clinical pregnancy rate. CONCLUSION(S) The addition of CC to hMG has been proven to be effective in reducing premature LH surges without compromising the pregnancy rate.

A simple and relatively painless technique for hysterosalpingography, using a thin catheter and closing the cervix with the vaginal speculum: a pilot study

Objective To evaluate the use of a thin catheter for hysterosalpingography (HSG) for reducing the pain experienced during the procedure. Methods Infertile women undergoing tubal patency tests were randomised into two groups. In the study group (n=66) a thin catheter originally designed for intrauterine insemination was used to inject the dye. Leakage of the dye was prevented using a vaginal speculum to press on the portiovaginalis of the cervix. The control group (n=23) underwent HSG using the standard metal cannula. Visual analogue scale (VAS) was used to evaluate the level of pain immediately after the procedure. The main outcome measures were the level of pain experienced by the patient during the procedure and the efficacy of the new technique. Results The mean (±SD) VAS was 11.2±3.1 in the study group and 54.7±10.1 in the metal cannula group (p<0.0001). During the dye injection, the VAS was 10.3±5.2 in the study group compared to 64.1±17.3 in the metal cannula group (p<0.0001). The new technique was successful in filling the uterine cavity with the dye and studying the fallopian tubes. Conclusions Using a thin catheter for HSG and pressing on the cervix with the vaginal speculum to prevent leakage of the dye is a successful method to study the uterine cavity and fallopian tubes, and it significantly reduces the pain as compared to a metal cannula.

Diagnostic accuracy of posterior cervical angle and cervical length in the prediction of successful induction of labor

To determine the accuracy of the posterior cervical angle (PCA) compared with the cervical length and the Bishop score in predicting the outcome of induction of labor (IOL).

Detection of Chlamydia Trachomatis in patients with unexplained infertility: A case control study

Our Objective: is to detect Chlamydia Trachomatis organism in cervical swabs obtained frompatients with unexplained infertility(UI) and to compare its incidence in infertile compared to fertile females in reproductive age. The study design was a case control observational study, done in Cairo University Hospitals. Methodology: One hundred females diagnosed as unexplained infertility and 100 normal fertile females were included in the study for detection of Chlamydia trachomatis by using polymerase chain reaction (PCR) of cervical swab samples. Results: Fifteen females were positive for Chlamydia trachomatis in infertile group while only 2were positive in healthy fertile group with p value of 0.002. Conclusion: The Incidence of Chlamydia trachomatis in cervical swabs was significantly higher in unexplained infertile females compared with the control group

Delayed Start Versus Conventional GnRH Antagonist Protocol in Poor Responders Pretreated With Estradiol in Luteal Phase A Randomized Controlled Trial

Objective: To compare the new delayed start protocol against the conventional gonadotropin (Gn)-releasing hormone antagonist protocol in poor responders (PORs). Study Design: A total of 160 women with poor response to previous in vitro fertilization (IVF) cycle were randomized either to start Gn then Cetrotide 0.25 subcutaneously (sc) added when leading follicle (DF) reach >12 mm or Cetrotide 0.25 mg sc started first from day 2 to day 8 then Gn therapy was added and Cetrotide restarted when DF reach >12 mm. Results: There was a statistically significant difference between conventional and delayed start protocols regarding the needed dose of Gn for stimulation (4368 ± 643 and 3798 ± 515), level of estradiol (E2; 778 ± 371 and 1076 ± 453), and endometrial thickness at human chorionic gonadotropin triggering (8.6 ± 1.8 and 9.8 ± 1.9), the number of DF (3.4 ± 1.5 and 4.9 ± 2.1), the number of retrieved follicles (2.4 ± 2.1 and 4.3 ± 2.5), and successful embryo transfer (13 vs 16), respectively (P < .05). There was a highly statistically significant difference between the 2 study groups regarding the number of oocytes fertilized (1.2 ± 2.0 vs 3.3 ± 1.4), metaphase II oocytes (0.9 ± 1.0 vs 2.7 + 1.6), and grade I embryos (0.7 ± 0.9 vs 2.1 + 1.1; P < .001). The chemical pregnancy, clinical pregnancy, and abortion rate showed a statistically significant difference between the 2 study groups (P value .003 and .006, respectively). Conclusion: Delayed start protocol significantly improved clinical pregnancy rate and IVF cycle parameters in PORs.

Morula transfer as alternative to blastocyst transfer or day 3 transfer: is there a role?

Objective The aim of this study was to evaluate the clinical outcomes of day 4 embryo transfers (ETs) and compare the efficacy of day 4 ET with day 5 and day 3. Study design All women undergoing ICSI-ET with grade I embryos only were included and divided into: group A with 1224 patients (ET day 3); group B with 159 patients (ET day 4); and group C with 84 patients (ET day 5). Luteal phase support was given to all patients by administering 800 mg cyclogest intravaginally per day for 14 days, starting from Ovum pick up day, and then quantitative &bgr;-human chorionic gonadotropin was measured in serum. Pregnant patients were closely followed up till 12 weeks postmenstrual. Results There was no significant difference between ET day 3 and ET day 4 regarding age, duration of infertility, and oocytes retrieved. Clinical pregnancy rate in group A was 37% and in group B 31.4% (P=0.17) compared with group C (ET day 5) where clinical pregnancy rate was 26.2% (P=0.39). Conclusion ET at the morula stage does not affect pregnancy outcome in in-vitro fertilization/ICSI cycles.

Suburethral sling: a new technique for treatment of female genuine urinary stress incontinence

Objective The aim of the study was to produce and evaluate a new technique using a small-fashioned prolene tape to treat female genuine stress incontinence. Patients and methods A total of 120 (n=120) female patients with genuine stress urinary incontinence were subjected to history taking, physical examination, and other investigations and were then operated upon at El-Galaa Teaching Hospital and Cairo University Hospital using a small-fashioned prolene tape of 5×1 cm applied below the midurethra and sutured to the tissues just over the inferior pubic rami on either sides of the urethra. The patients were followed up every month for 1 year for complications, complaints, cure, and satisfaction. Results All patients showed marked improvement during the follow-up period for up to 12 months postoperatively. There were no intraoperative or postoperative complications. The operative time was about 15 min, the duration of hospital stay was about 6 h, and the cost involved was very low. Conclusion Suburethral sling is a simple and easy technique that can be easily learned and applied.

Is there an association between Helicobacter pylori infection and hyperemesis gravidarum among Egyptian women

Objectives To detect the association between Helicobacter pylori infection and hyperemesis gravidarum among Egyptian women. Participants and methods Thirty pregnant women with hyperemesis gravidarum were recruited from the Cairo University outpatient clinics and 30 healthy pregnant volunteers with no vomiting were selected as controls. The age range in both the groups were between 18 and 39 years and the gestational age ranged from 5 to 12 weeks. All participants were subjected to full history taking, clinical examination, and ultrasound to exclude obstetric causes of hyperemesis gravidarum. Routine and special laboratory investigations were performed to test the serum for H. pylori seropositivity IgG using an enzyme-linked immunosorbent assay. Results There was a highly significant difference in the H. pylori IgG antibody titer between the cases (18.1–100 U/ml) and the controls (0.9–62.7 U/ml) (P<0.01). The number of cases found to be seropositive to H. pylori IgG (100%) was higher than the number of the control individuals (86.67%), but the difference between both the groups was not statistically significant (P=0.37). Conclusion Our results showed that there might be an association between H. pylori infection and hyperemesis gravidarum. We recommend that further studies be carried out to confirm this finding with a larger number of participants and for a longer duration of time.