T.A. Farghaly

Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta

To assess the effectiveness of bilateral uterine artery ligation followed by B‐Lynch compression suturing in women with atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta.

The effect of follicullar fluid pesticides and polychlorinated biphenyls concentrations on intracytoplasmic sperm injection (ICSI) embryological and clinical outcome

OBJECTIVES The present study evaluated the correlation between the concentrations of polychlorinated biphenyls (PCBs) and pesticides in the follicular fluid (FF) obtained during intracytoplasmic sperm injection (ICSI) with the ovarian response, endometrial thickness, and embryological and clinical outcomes. DESIGN Cross-sectional observational study. MATERIALS AND METHODS Women aged 20 to 38 years (300 infertile couples) presenting to a university-affiliated fertility center were approached to participate in the study. Only 150 couples that underwent ICSI for male factor infertility agreed to participate, and 94 of them had retrieved enough FF samples suitable for laboratory testing. The FF sample was obtained, centrifuged, and stored in liquid nitrogen. Two organochlorine pesticides (OCPs), Lindane and DDT;three organophosphates (OPs);chlorpyrifos;Diazinon; malathion; one Chloroacetanilide (Pretilachlor);two pyrethroids(Bioallethrin and β-cyfluthrin); and the concentrations of four PCBs, 28, 52, 138, 180, were estimated in the obtained FF samples by using gas chromatography/mass spectrometry. SPSS statistical analysis program (version 17) was used for analysis. Multiple regression analysis was used to correlate the PCBs and pesticides with ICSI outcomes. RESULTS There were significant negative correlations between FF concentrations of the eight examined pesticides and the four PCBs on the endometrial thickness. However, Pretilachlor, chlorpyrifos, β-cyfluthrin, and Diazinon were the only toxic agents that negatively correlated with the number of the oocytes retrieved. Fertilization and early embryo cleavage rates were negatively correlated with Pretilachlor and β-cyfluthrin. Moreover, high concentrations of Lindane,DDT, Diazinon,and chlorpyrifos were significantly associated lower implantation rate. PCB 28 and 180 concentration in the FF was associated with a lower number of retrieved oocytes and fertilization rate, respectively. The number of implanted embryos was negatively correlated with PCB 52 FF concentration. However, the clinical pregnancy rate did not reach the level of significance. CONCLUSION Higher concentrations of any studied PCBs and pesticides are associated with thinner endometrial thickness. The higher the level of Pretilachlor, β-cyfluthrin, PCB 28 and 180, the lower the retrieval, fertilization, and embryo cleavage rates. High PCB and pesticide concentrations in the FF adversely affected embryological ICSI outcomes. However, more data are needed to evaluate their effect on the clinical outcome.

Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Controlled Trial:

Objectives: To evaluate the impact of metformin on in vitro fertilization (IVF) outcomes in overweight and obese women with polycystic ovary syndrome (PCOS). Methods: This was a randomized double-blind placebo-controlled study (ClinicalTrials.gov: NCT 02910817) carried out in a University IVF Center. The study included 102 overweight and obese women (body mass index [BMI] >24 kg/m2) with PCOS who underwent their first fresh autologous IVF-embryo transfer cycle and agreed to participate in the study. The study participants were randomized into 2 groups: metformin group received metformin (1000 mg per day) at the start of controlled ovarian stimulation (COH) until the day of the pregnancy check, and placebo group received placebo tablets in the same duration. The primary outcome measure was the total number of retrieved oocytes. Results: Both groups were homogenous in baseline demographic characteristics. Metformin group versus the placebo group demonstrated decrease in the mean number of the retrieved oocytes (9.06 ± 4.23 vs 16.86 ± 8.3, P < .01) and similar live birth rate (LBR; 25.5% vs 17.6%, P = .34). The number of fertilized oocytes was lower in the metformin group (5.65 ± 2.66 vs 9 ± 4.55, P < .01). However, the fertilization rate was similar in both groups (62.3% vs 53.4%, P = .10). There was no difference in the implantation rate (15.7% vs 11.8%, P = .32), multiple pregnancy rate (13.4% vs 3.9%, P = .08), or miscarriage rate (23.5% vs 35.7%, P = .46). No cases of ovarian hyperstimulation syndrome (OHSS) were observed in both groups. Conclusion: Short-term administration of metformin to overweight or obese women with PCOS undergoing IVF decreased number of the retrieved oocytes but did not improve the LBR. Synopsis Metformin use could decrease the number of retrieved oocytes in overweight and obese women with polycystic ovary syndrome undergoing IVF.

Insulin sensitizing agent improves clinical pregnancy rate and insulin resistant parameters in polycystic ovarian syndrome patients with acanthosis nigricans: a randomized controlled study

Objective: To investigate the effect of adding metformin to clomiphene citrate (CC) in polycystic ovarian syndrome (PCOS) patients with acanthosis nigricans (AN) who were previously not responding to CC. Material and Methods: A double blinded randomized controlled trial (NCT02562664) included 66 PCOS women with acanthosis nigricans who were CC resistant (at least 3 months). Day 3 follicle stimulating hormone (FSH) level, fasting insulin, fasting glucose and homeostatic model assessment were used to quantify insulin resistance. Participants were randomly assigned to either group I (CC with placebo tablets) or group II (CC with metformin) for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi- square and Fischer exact tests. Results: The demographic data was comparable in both groups, however; there was higher cumulative pregnancy rate after three cycles of stimulation in group II (18/33) (54.5%) in comparison with group I (7/33) (21.1%) (P=0.03). There was a significant improvement in the insulin resistance parameters after three months of combining clomiphene citrate with metformin as compared with CC alone. Conclusion: Adding metformin to CC in clomiphene citrate resistant PCOS patients who have acanthosis nigricans improves the pregnancy rate and insulin resistant parameters. 1

Prevalence of prior reproductive surgery among women scheduled for IVF

OBJECTIVE: Optimization of the function and anatomy of reproductive organs either by medications or surgery is the main target of many clinicians prior to IVF in order to get favorable cycle outcomes. Our objective was to evaluate the prevalence of reproductive surgery in women scheduled for IVF, and to correlate the baseline characteristics of these women to the probability of undergoing a reproductive surgery. DESIGN: Prospective cross-sectional cohort. MATERIALS AND METHODS: Through one-year cross sectional survey, infertile women scheduled for IVF were categorized into 3 groups based on their history of prior reproductive surgery. Group 1 comprised women who did not undergo any reproductive surgery before; group 2 included women with history of one reproductive surgery; while group 3 included subjects with history of 2 or more surgeries. The 3 groups were compared as regards their baseline demographic and clinical characteristics. Statistical methods used for comparisons included t-test, Chi-square test, Wilcoxon rank sum test and logistic regression. RESULTS: 244 women accepted to participate in the study; 76% of them (n1⁄4185) reported prior reproductive surgery.Women in group 3 (n1⁄459) were more likely to have a longer duration of infertility (Mean SD; 5.8 3 vs. 5.2 3.2 vs. 4.5 3; p1⁄40.009), and comprised more women with endometriosis (50.8% vs. 21.45% vs. 1%; p1⁄40.000) and tubal block (22% vs. 11.1% vs. 3.4%; p1⁄40.000), when compared to groups 2 and 1 respectively. The total number of surgical procedures in the whole cohort was 238 surgical procedures. Out of them; 29.4%, 18.9%, and 16.4% were procedures for endometriosis, uterine procedures, and diagnostic laparoscopies, respectively. In stepwise multivariate regression analysis, after adjustment of other variables; longer duration of infertility (aOR 1⁄4 1.2, 95% CI1⁄41.04-1.3, P1⁄40.007), having moderate endometriosis (aOR1⁄4 12.1, 95% CI1⁄45.6-26.4, P1⁄40.000), and having tubal disease (aOR 1⁄4 6.7, 95% CI1⁄42.7-16.6, P1⁄40.000) were significantly associated with likelihood of an IVF woman to have 2 surgical reproductive procedures through her infertility treatment. CONCLUSIONS: Reproductive surgeries are common among IVF women presenting a sort of financial burden. Women with endometriosis have substantial probability of undergoing a high order reproductive surgery.