R.T. Mansour

Dummy embryo transfer: a technique that minimizes the problems of embryo transfer and improves the pregnancy rate in human in vitro fertilization

Three hundred thirty-five patients selected for in vitro fertilization (IVF) were randomly divided into two groups. Group A (n = 167) was subjected to dummy embryo transfer (ET) before the start of IVF treatment to choose the most suitable catheter for each patient. Group B (n = 168) started their IVF treatment without dummy ET. Embryo transfer technique was difficult in 50 cases (29.8%) in group B, whereas no difficulty was met in group A. Pregnancy rate and implantation rate (22.8%, 7.2%) in group A were significantly higher than in group B (13.1%, 4.3%). The lower pregnancy rate in group B is due to the very low pregnancy rate (4%) in difficult ET cases. Dummy ET is a simple procedure that determines the most suitable ET catheter for each patient and avoids unexpected difficult and failed ET.

Prospective controlled randomized study of in vitro fertilization versus intracytoplasmic sperm injection in the treatment of tubal factor infertility with normal semen parameters

OBJECTIVEnTo compare the results of IVF and intracytoplasmic sperm injection (ICSI) in tubal factor infertility with normal semen parameters.nnnDESIGNnA prospective randomized study.nnnSETTINGnThe Egyptian IVF-ET Center.nnnPARTICIPANTSnOne hundred sixteen patients infertile due to tubal factor were divided randomly into two groups. Group A(n = 58) was treated with IVF and group B(m = 58) was treated with ICSI.nnnINTERVENTIONnIn vitro fertilization and ICSI.nnnMAIN OUTCOME MEASUREnPregnancy rate.nnnRESULTSnIn group A, 736 oocytes were retrieved and normal (two pronuclear [2pN] fertilization occurred in 477 oocytes (64.8%). In group B, 748 oocytes were retrieved, 572 metaphase II oocytes were injected, and 2PN fertilization occurred in 400 oocytes (70% per injected oocyte and 53.5% per retrieved oocyte). Clinical pregnancy was diagnosed in 18 patients in group A (31%) and 19 patients in group B (32.8%). There was no significant difference in the pregnancy rate between the two groups. The fertilization rate per retrieved oocytes was significantly higher in group A.nnnCONCLUSIONSnIntracytoplasmic sperm injection does not offer a higher pregnancy rate as compared with IVF in the treatment of tubal factor infertility with normal semen.

Ultrasonically guided vaginal aspiration of ascites in the treatment of severe ovarian hyperstimulation syndrome

This study included 11 cases of severe OHSS that were treated by transvaginal aspiration of the ascitic fluid guided by ultrasound. Immediate improvement of the symptoms and general condition as well as a significantly shorter hospital stay was noticed when compared with the control group. It is a safe and simple procedure that does not require anesthesia.

Transvaginal ultrasonic needle guided aspiration of pelvic inflammatory cystic masses before ovulation induction for in vitro fertilization

Transvaginal aspiration of pelvic cystic inflammatory masses guided by a real time ultrasound vaginal transducer is described. The technique was successfully used in 32 patients to aspirate these masses before ovulation induction for in vitro fertilization (IVF). It is a safe and simple procedure that resulted in significantly higher ovarian response to stimulation for IVF, easier ultrasonic follow-up of the follicles, significant increase in the average number of oocytes per pick-up, and significant increase in the number of embryos per transfer when compared with the control group.

Ovarian superstimulation and intrauterine insemination for the treatment of unexplained infertility

OBJECTIVEnTo evaluate the efficacy of controlled ovarian hyperstimulation (COH) and IUI in the treatment of unexplained infertility.nnnDESIGNnThe pregnancy rate (PR) in patients with unexplained infertility treated by COH and IUI (group A) was compared with a no-treatment control (group B).nnnSETTINGnThe Egyptian IVF-ET Center.nnnPARTICIPANTSnFour hundred ninety-two patients with the diagnosis of unexplained infertility.nnnINTERVENTIONnControlled ovarian hyperstimulation and IUI.nnnMAIN OUTCOME MEASURESnCycle fecundity per treatment cycle and PR per patient.nnnRESULTSnIn group A cycle fecundity was 20.1% per treatment cycle, and the PR was 34.7% per patient. In group B the PR was 8.9% per patient. Pregnancy rate per patient was significantly higher in group A when compared with the spontaneous PR in group B.nnnCONCLUSIONnControlled ovarian hyperstimulation and IUI significantly increased the PR in patients with unexplained infertility when compared with a no-treatment control group.

Autotransfusion of the ascitic fluid in the treatment of severe ovarian hyperstimulation syndrome

Three cases of severe OHSS were treated by transvaginal aspiration of the ascitic fluid and autotransfusion of the aspirated fluid. Marked improvement of the symptoms, general condition, and urine output followed the aspiration shortly. No reactions were noticed during or after the autotransfusion. The blood parameters were corrected, and the general condition and urine output continued to improve. The procedure is simple, safe, and straightforward that showed a striking physiological success in correcting the maldistribution of fluid and proteins without the use of heterogeneous biological material.

Successful Treatment of Long-Term Unexplained Infertility with Gonadotropin-Releasing Hormone Agonist Analogue and Human Menopausal Gonadotropin

Thirty‐five couples with long‐term unexplained infertility were treated in 98 cycles by giving gonadotropin‐releasing hormone analogue, human minopausal gonadotropin and human chorionic gonadotropin for induction of superovulation. Pregnancy occurred in 24 cycles (24.5% per cycle and 68.6% per patient). All patients had been treated previously with clomiphene citrate and human menopausal gonadotropin in 110 cycles in conjunction with artificial insemination, but failed to achieve pregnancy. Pituitary suppression with gonadotropin‐releasing hormone analogue followed by ovarian stimulation with human menopausal gonadotropin may correct the subtle abnormalities at the hypothalamic hypophyseal level that could be present in cases of unexplained infertility and it should be tried first for these patients before resorting to in vitro fertilization or gamete intrafallopian transfer.

Cryopreservation of the occasionally improved semen samples for intrauterine insemination : a new approach in the treatment of idiopathic male infertility

Objective To assess the value of treating idiopathic male infertility by intrauterine insemination (IUI) of the occasionally improved cryopreserved semen. Design Two groups of idiopathic oligospermic patients were chosen at random and treated by IUI using processed fresh semen in group A and the best available cryopreserved semen samples pooled with fresh samples in group B. Setting Egyptian IVF-ET Centre, Maadi, Cairo, Egypt. Patients, Participants One hundred fifty infertile couples because of idiopathic oligoasthenospermia. Intervention Intrauterine insemination. Main Outcome Measure The pregnancy rate was evaluated after an average of three treatment cycles. Results The pregnancy rate (PR) was significantly higher in group B when compared with group A. The improvement in the PR was highly significant in the subgroup of patients for whom reasonable semen samples could be collected and cryopreserved. Conclusions Our study indicates that IUI with fresh semen pooled with cryopreserved occasionally improved semen samples for the treatment of oligoasthenospermia results in an improved PR.

Choosing an infertility center in the United States of America: An internet based approach

The Internet is becoming increasingly important as a way for patients to acquire medical information, as a means for patient-physician communication and most importantly access to medical treatment and therapies. Questions about appropriate use of this new technology have been brought to the fore by the many patients using the Internet to seek medications to treat erectile dysfunction. Objective: To present a description of a Discuss for the treatment of erectile dysfunction together with data covering more than 25,000 patient encounters. Design: Retrospective analysis of a large case series, with informal comparison to patients seen in a conventional office based practice setting. Setting: A medical practice that prescribes sildenafil and vardenafil based on medical and sexual information obtained through a physician designed and directed Internet site. For comparison, we utilized patients from clinics at a Midwestern inner city medical center, patient comments about their office based care and survey information form questionnaires. Patients: All 26,650 Internet patients seeking vardenafil and/or sildenafil prescriptions between June 14, 1998, and September 10, 2003. Main Outcome Measures: Completeness of medical record; patient safety as noted by the follow up responses of all patients requesting refills, any comments received by the Internet site , satisfaction as noted by the follow up responses of all patients requesting refills, any comments received by the Internet site survey data collected during the summer of 2003. Results: Seventy-six percent of Internet requests came from United States, and 24% from other countries. Most request reviewed by the physicians were granted. All patients requesting medication refills: reported erections sufficient for intercourse and 69% said their satisfaction exceeded all expectations; none were totally dissatisfied with either the service or medication. Side effect rates were comparable to those in the literature. Comparison of the medical history obtained from Internet patients with that recorded in clinic patients charts revealed that the former was far more complete as were the instructions given to each patient. The dissatisfaction rate of sildenafil seems higher than previously suspected. There were no reported deaths or serious complications. Conclusions: Internet-based vardenafil and sildenafil prescribing provides the physician with a complete and very detailed medical and sexual history for 100% of patients without denying any information routinely obtained in a direct patient contact setting. Internet-based practice, which may be expected to require far fewer healthcare resources than traditional settings, rates very high in patient satisfaction. Overall, these data support the safety, convenience, cost and clinical effectiveness of Internet prescribing 330 Scientific Papers of selected medications. Internet prescribing appears to offer greater and faster patient access and superior patient confidentiality than does traditional office practice. More intensive study of this new style of practice is warranted. [38] Low cost telemedicine using cable TV Network & TV Set Mohamed Junaid a, Ravi Chandran b, A. Natarajana, G. Ravindranc, S. Maheswaran a and Nithya Priyac aKongu Engineering College, India bVelalar College Of Engineering & Technology, India cAnnamalai University, Erode, India Nowadays, the need for specific health support at home is very much required for the benefit of patients and also for the doctors to to follow up after treatment for their patients. There are number of web based communication systems are developed for this application. The access and understanding of web service is very difficult for the society,particularly in rural regions. These systems also ensure high investment cost, technical skills and computers in both ends. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. TV and cable TV networks are the mass media, which attract and understand by each and everybody in the society. The proposed method uses an innovative telehomecare technique which runs by using multimedia platform over integrated services consisting of a set top box,and a standard TV set with remote control for patient interaction. Since our government has planned to implement Conditional access TV (CATV) system throughout the country using set top box, this method ensures an innovative,low cost and modern health care system which will be attracted and utilised by the entire society. This platform allows on-line ECG, BLOOD PRESSURE, TEMPERATURE and HEART SOUND monitoring. Even an expert opinion and interaction between the doctors and exchange of medical images from various speciality hospitals can also be achieved. Usability, and affordability were considered as the important factors in the design and development of its hardware and software components. The home station [HS] or 1st station is composed of two detachable units: the video conference data processing unit and vital signs recording module [VSRM]. The first module is a PC based set top box. The medical center set up is composed of a call center,the patient record database management and peripherals such as printer and scanner. The solution to the better health care delivery to the rural society can be achieved by the above method by installing this scheme in the rural hospitals. [39] eHealth Market Players

Intracytoplasmic Sperm Injection in Difficult Cases: The Egyptian Experience

The first successful pregnancies after intracytoplasmic sperm injection (ICSI) in human were reported by Palermo et al. (1). Since then, major developments occurred in this field and ICSI became a standard treatment for male factor infertility irrespective of the severity of the condition. The scope of ICSI widened to include a broad range of indications.