Ahmed Y. Shahin

Reproductive organ transplantation: advances and controversies

OBJECTIVE To review the advances and controversies in the field of reproductive organ transplantation. RESULT(S) Although many cancer treatments can damage female reproductive organs, leading to temporary or permanent infertility, recent advances in cancer management have translated into improved patient survival, making preservation of reproductive function a more important priority than ever before. Reproductive organ transplantation represents a new potential treatment for patients facing infertility as a result of cancer treatment. Pregnancies have now been reported from several centers after transplanting fresh and frozen ovarian tissue pieces. The longevity of the graft and its potential long-term complications are unknown. However, it seems clear that the ovarian tissue graft has a shortened life span. Allogeneic reproductive organ transplants are under investigation. Patients must take immunosuppressive medications following heterologus transplantation, and these medications can cause adverse side effects. The effects on the fetus are largely unknown. CONCLUSION(S) Despite the recent biologic and clinical advances, reproductive organ transplantation remains experimental and controversial.

Differential expression of follicular fluid cytokines: relationship to subsequent pregnancy in IVF cycles.

The objective of this study was to investigate the role of cytokines in the peri-ovulatory follicular fluid (FF) during IVF cycles. FF from 112 women was obtained during oocyte retrieval for IVF. The concentrations of five cytokines [interleukin (IL)- 1beta, IL-6, IL-12, IL-13, and tumour necrosis factor alpha (TNFalpha )] were measured in FF and their concentrations compared among women who became pregnant and those who did not. Thirty-one endometriosis patients, 15 idiopathic infertility, 21 tubal factor infertility, 15 ovarian factor infertility, and 30 patients with male factor infertility were included. Interleukin-13 and TNFalpha were absent in the peri-ovulatory FF of all patients. Fifty-two patients achieved pregnancy, whereas 60 did not. Both pregnant and non-pregnant groups were comparable for age, parity, ovarian stimulation parameters, fertilization rates, and embryo freezing rates. Concentrations of FF IL-1beta were not significantly different between pregnant and non-pregnant cycles. Concentrations of FF IL-6 were significantly higher in pregnant compared with non-pregnant cycles (P = 0.0005). Concentrations of FF IL-12 were significantly lower in pregnant compared with non-pregnant cycles (P = 0.0002). Higher concentrations of IL-12 and lower concentrations of IL-6 in the peri-ovulatory FF are associated with a negative outcome in IVF treatment. Interleukins-12 and IL-6 are biological markers that appear to affect IVF outcome.

Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt.

To study the prevalence and associated risk factors for female sexual dysfunction (FSD) in Upper Egypt.

Parietal peritoneal closure and persistent postcesarean pain

To assess the incidence of persistent pain after cesarean delivery.

Effect of oral N‐acetyl cysteine on recurrent preterm labor following treatment for bacterial vaginosis

To evaluate the effect of N‐acetyl cysteine (NAC) on gestational age at delivery in women with previous preterm labor and bacterial vaginosis.

Hysterosalpingo-contrast sonography versus radiographic hysterosalpingography in the evaluation of tubal patency

To compare the efficacy of hysterosalpingo‐contrast sonography (HyCoSy) using a saline solution with that of radiographic hysterosalpingography (HSG) in the assessment of tubal patency.

Rectal misoprostol versus intravenous oxytocin for prevention of postpartum hemorrhage

To assess the effectiveness of 800 μg of rectal misoprostol compared with an intravenous infusion of 5 IU of oxytocin as prophylaxis against postpartum hemorrhage (PPH).

Adding phytoestrogens to clomiphene induction in unexplained infertility patients – a randomized trial

This study investigated the role of oral phytoestrogens in improving pregnancy rate and cycle outcomes with clomiphene citrate. Patients with unexplained infertility and recurrent clomiphene citrate induction failure, were randomly divided into two groups: group I (n = 60) and group II (n = 59). Both groups received clomiphene citrate 150 mg per day (days 3 to 7). Group I received additional oral phytoestrogen (Cimicifuga racemosa) 120 mg/day from days 1 to 12. Human chorionic gonadotrophin (HCG) injection (10,000 IU i.m.) was given and timed intercourse was recommended when a leading follicle reached >17 mm and serum oestradiol exceeded 200 (pg/ml). There was a non-significant shortening of induction cycles in group I. Oestradiol and LH concentrations were higher in group I compared with group II. Endometrial thickness, serum progesterone and clinical pregnancy rate were significantly higher in group I (8.9 +/- 1.4 mm versus 7.5 +/- 1.3 mm, P < 0.001; 13.3 +/- 3.1 ng/ml versus 9.3 +/- 2.0 ng/ml, P < 0.01; 36.7% versus 13.6%, P < 0.01, respectively). It is concluded that adding C. racemosa rhizome dry extract to clomiphene citrate induction can improve the pregnancy rate and cycle outcomes in these couples.

The problem of IVF cost in developing countries: has natural cycle IVF a place?

Infertility represents a national health problem in some African countries. Limited financial health resources in developing countries are a major obstacle facing infertility management. IVF is the definitive line of treatment for many couples. Stimulation cycles are associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. This study evaluates the client acceptability of stimulated versus natural cycle IVF among couples attending one infertility clinic, with respect to cost and pregnancy outcome. Of the patients who were indicated for IVF, 15% (16/107) cancelled, due mostly (12/16, 75%) to financial reasons. The majority of patients who completed their IVF treatment (82/91, 90.1%) felt the price of the medical service offered was high, and 68.1% (62/91) accepted the idea of having cheaper drugs with fewer side effects but with possibly lower chances of pregnancy. Natural cycle IVF has emerged as a potential option that might be suitable for patients worldwide, especially in developing countries.

Sublingual versus vaginal misoprostol for induction of labor at term: A randomized prospective placebo-controlled study

Aims:  To assess the effectiveness and safety of sublingual misoprostol (50 µg), compared with the same dose administered vaginally every 6 h for cervical ripening and labor induction in women with a viable fetus in the third trimester of pregnancy.