Nermeen Abou-Salem

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome

To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).

A double-blind randomized controlled trial of vaginal misoprostol for cervical priming before outpatient hysteroscopy

OBJECTIVE To evaluate the efficacy and safety of vaginal misoprostol for cervical priming before diagnostic outpatient hysteroscopy (OH) without anesthesia. DESIGN Double-blind randomized controlled trial. SETTING University teaching hospital. PATIENT(S) One hundred fifty patients requiring diagnostic OH for investigation of infertility or abnormal uterine bleeding in the reproductive age. INTERVENTION(S) Patients were randomly allocated into two equal groups (n = 75). In group I, 200 μg misoprostol was inserted into the posterior vaginal fornix 3 hours before OH; in group II (control), vaginal examination was performed without misoprostol administration. A rigid 30° 4-mm hysteroscope was used in the vaginoscopic technique. MAIN OUTCOME MEASURE(S) Ease of cervical entry (Likert scale), procedural time, patient acceptability (Likert scale), and pain scoring (visual analog scale). RESULT(S) Vaginal misoprostol significantly facilitated the procedure; cervical entry was easier, procedural time was shorter, patient acceptability was higher, and pain scoring was lower in group I compared with group II. Side effects of misoprostol were infrequent, minor, and transient. No complications were reported. CONCLUSION(S) The regimen of 200 μg vaginal misoprostol administered 3 hours before diagnostic OH is a simple, effective, and safe method of cervical priming to facilitate the procedure without anesthesia.

Value of 3-Dimensional Sonohysterography for Detection of Intrauterine Lesions in Women with Abnormal Uterine Bleeding

STUDY OBJECTIVE To compare 2-dimensional (2D) sonohysterography (SHG) and 3D-SHG with saline solution infusion vs diagnostic hysteroscopy for investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding. DESIGN Comparative observational cross-sectional study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS Fifty perimenopausal and 20 postmenopausal women with abnormal intrauterine bleeding with clinically or ultrasonically suspected intrauterine lesions. INTERVENTIONS Conventional 2D- and 3D ultrasonography and 2D- and 3D-SHG with saline solution infusion followed by diagnostic hysteroscopy, and endometrial curettage or subsequent operative treatment (e.g., hysterectomy, myomectomy, or polypectomy). Ultrasonographic and hysteroscopic findings were compared with histopathologic findings. MEASUREMENTS AND MAIN RESULTS For 2D-SHG, sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio for a positive result, and likelihood ratio for a negative result were 79%, 72%, 89%, 54%, 76%, 2.82, and 0.29, respectively, and for 3D-SHG, were 92%, 89%, 96%, 80%, 91%, 8.36, and 0.09, respectively; and for diagnostic hysteroscopy, were 94%, 89%, 96%, 84%, 93%, 8.55, and 0.07, respectively. Thus, 3D-SHG was superior to 2D SHG (p = .02) and comparable to diagnostic hysteroscopy (p = .75) for diagnosis of intrauterine lesions. CONCLUSION 3D-SHG can be used in the initial investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding before resorting to invasive procedures such as diagnostic hysteroscopy. Further studies of computer-reconstructed 3D-SHG virtual hysteroscopy are recommended.

The Diagnostic Accuracy of Two- vs Three-Dimensional Sonohysterography for Evaluation of the Uterine Cavity in the Reproductive Age

STUDY OBJECTIVE To compare 2-dimensional sonohysterography (2D SHG) vs 3-dimensional sonohysterography (3D SHG) using saline solution infusion, with outpatient hysteroscopy as the gold standard, for evaluation of the uterine cavity in women of reproductive age. DESIGN Comparative observational cross-sectional study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred twenty women of reproductive age with abnormal uterine bleeding, infertility, or recurrent pregnancy loss and with clinically and/or ultrasongraphically suspected intrauterine lesions. INTERVENTIONS All patients underwent 2D SHG and 3D SHG using saline solution infusion followed by outpatient hysteroscopy. Sonographic findings were compared with hysteroscopic findings. MEASUREMENTS AND MAIN RESULTS For 2D SHG, sensitivity was 71.2%; specificity, 94.1%; positive predictive value, 90.2%; negative predictive value, 81.0%; and overall accuracy, 84.2%. For 3D SHG, sensitivity was 94.2%; specificity, 98.5%; positive predictive value, 98.0%; negative predictive value, 95.7%; and overall accuracy, 96.7%. Thus, 3D SHG was superior to 2D SHG (p = .02) and comparable with outpatient hysteroscopy (p = .12) for diagnosis of intrauterine lesions. CONCLUSION 3D SHG can be used in the initial evaluation of the uterine cavity in women of reproductive age, with accuracy comparable to that of hysteroscopy.

Three-dimensional power Doppler study of endometrial and subendometrial microvascularization in women with intrauterine device–induced menorrhagia

OBJECTIVE To evaluate endometrial and subendometrial microvascularization, using three-dimensional (3D) power Doppler ultrasound, in women with intrauterine device (IUD)-induced menorrhagia; and whether those potential findings could predict the risk of bleeding before IUD insertion. DESIGN Prospective clinical trial. SETTING University teaching hospital. PATIENT(S) One hundred twenty women, who requested the insertion of a copper IUD for contraception. INTERVENTION(S) Endometrial thickness and volume, uterine artery pulsatility index and resistance index, and endometrial and subendometrial 3D power Doppler vascularization index, flow index, and vascularization flow index were measured twice: immediately before and 3 months after IUD insertion. MAIN OUTCOME MEASURE(S) Doppler indices before and after IUD insertion. RESULT(S) Before IUD insertion, no significant difference was detected in the clinical characteristics, endometrial thickness and volume, and Doppler indices between women who had IUD-induced menorrhagia (n = 47) and those without menorrhagia (n = 73). However, after IUD insertion, there was a significant increase in the endometrial and subendometrial vascularization index, flow index, and vascularization flow index in women with menorrhagia, whereas other parameters remained not significantly different between the two groups. CONCLUSION(S) Endometrial and subendometrial microvascularization increases in women with IUD-induced menorrhagia; however, this finding has no predictive value before IUD insertion.

Doppler study of uterine hemodynamics in women with unexplained infertility

OBJECTIVE To evaluate uterine artery blood flow using pulsed Doppler, and endometrial and subendometrial microvascularization using three-dimensional (3D) power Doppler, in women with unexplained infertility. STUDY DESIGN In a prospective clinical trial at a university teaching hospital, 40 women with unexplained infertility were compared to 40 fertile parous controls. In the mid-luteal (peri-implantation) phase, the endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were measured in both groups. RESULTS The uterine artery PI (P = 0.003) and RI (P = 0.007) were significantly increased and the endometrial VI (P = 0.029), FI (P = 0.031), and VFI (P = 0.001) and subendometrial VI (P = 0.032), FI (P = 0.040), and VFI (P = 0.005) were significantly decreased in the unexplained infertility group. The endometrial thickness and volume and serum estradiol and progesterone levels, however, were not significantly different between the two groups. CONCLUSION Peri-implantation endometrial perfusion is impaired in women with unexplained infertility: Doppler study of uterine hemodynamics should therefore be considered in infertility work-up.

The value of fallopian tube sperm perfusion in the management of mild–moderate male factor infertility

To investigate whether fallopian tube sperm perfusion (FSP) would improve pregnancy rates compared with standard intrauterine insemination (IUI) in cases of male factor infertility.

Anti-Müllerian hormone and antral follicle count for prediction of ovarian stimulation response in polycystic ovary syndrome

Abstract Objective: To evaluate the ability of a combination of multiple ovarian reserve markers to predict ovarian stimulation response in polycystic ovary syndrome (PCOS). Methods: On cycle Day 3 of 75 infertile patients with PCOS, serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) were measured, and antral follicle count (AFC) and ovarian volume (OV) were evaluated by transvaginal sonography (TVS). All patients underwent the same mild ovarian stimulation protocol using clomiphene citrate and highly purified FSH. Ovulation was monitored by TVS and confirmed by midluteal serum progesterone level. Results: AMH, AFC, and “ovulation index” [OI, serum AMH (ng/ml) × bilateral AFC] were significantly lower in the ovulatory group (n = 57, 76%) compared with the anovulatory group, whereas LH, FSH, LH/FSH ratio, and OV were not significantly different. Using receiver-operating characteristic curve analysis, the OI at a cutoff value of “85” had a sensitivity of 73.7% and a specificity of 72.2% in the prediction of ovulation, with an area under the curve of 0.733. Patients with OI < 85 had significantly higher ovulation rate (p < 0.001). Conclusion: The OI, combining both AMH and AFC, is a potentially useful predictor of the outcome of ovarian stimulation in PCOS.

Hysteroscopic tubal electrocoagulation versus laparoscopic tubal ligation for patients with hydrosalpinges undergoing in vitro fertilization.

To investigate the use and success rate of hysteroscopic tubal electrocoagulation for the treatment of hydrosalpinx‐related infertility among patients undergoing in vitro fertilization (IVF) who have laparoscopic contraindications.

The value of middle cerebral artery and umbilical artery Doppler indices in assessment of fetal well-being and prediction of neonatal outcome in IUGR and preeclampsia

Objective The purpose of this study was to assess the accuracy of the middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices in predicting fetal outcome in pregnancies complicated by preeclampsia and/or intrauterine growth retardation (IUGR). Study design It was a prospective study. Patients and methods One hundred and twenty-one pregnant women were categorized into four groups: group A, preeclampsia without IUGR group (38 cases); group B, IUGR without preeclampsia group (24 cases); group C, preeclampsia complicated with IUGR group (19 cases); and group D, the control group (40 cases). The perinatal outcomes correlated to the results of UA and MCA Doppler indices and cerebroplacental ratio (CPR). The accuracy of UA and MCA Doppler indices and CPR in the prediction of adverse outcome was calculated. Results Adverse neonatal outcome in group A was significantly correlated to UA-resistance index (RI) and UA-pulsatility index (PI) (r=0.537, P<0.001; r=0.405, P=0.0116, respectively). However, it showed no significant correlation with other parameter of Doppler indices and CPR. In group B, it was significantly correlated to all Doppler parameters indices and CPR. UA-RI and CPR were stronger parameters, to predict adverse neonatal outcome, than other parameters, with r-value of 0.869 and 0.803, respectively. In group C, it was significantly correlated to UA-RI and UA-PI, MCA-RI, and CPR. However, it showed no significant correlation with MCA-peak systolic velocity. CPR and UA-RI were stronger parameters, to predict adverse neonatal outcome, than other parameters, with r-value of 0.677 and 0.631, respectively. In group D, it was significantly correlated to UA-RI, UA-PI, and CPR. However, it showed no significant correlation with other parameters of Doppler indices. UA-RI and UA-PI were stronger parameters, to predict adverse neonatal outcome, than CPR, with r-value of 0.789 and 0.787, respectively. Conclusion The primary aim of antepartum surveillance is timely recognition of fetal compromise to enable appropriate intervention and to prevent further serious complications. MCA and UA Doppler indices are good utilities for the assessment of fetal well-being and prediction of neonatal outcome in pregnant women with IUGR and/or preeclampsia. CPR and MCA-peak systolic velocity are strong parameters to predict the adverse neonatal outcome in pregnant women with IUGR.