Waleed El-Khayat

Does a single endometrial biopsy regimen (S-EBR) improve ICSI outcome in patients with repeated implantation failure? A randomised controlled trial.

OBJECTIVE To evaluate the effect of a single endometrial biopsy regimen (S-EBR) in the cycle preceding the ICSI cycle in patients with repeated implantation failure. STUDY DESIGN This was a prospective randomized controlled trial which included two-hundred infertile women with a history of repeated implantation failure. The subjects were randomly divided into two groups. Group A subjects underwent hysteroscopy and endometrial scraping by Novak curette in the cycle preceding the ICSI cycle, while group B subjects underwent hysteroscopy without endometrial scraping. Implantation rate, clinical pregnancy rate, abortion rate and live birth rate were compared between both groups. RESULTS The number of retrieved oocytes in group A was 11.6 ± 3 and in group B was 11.6 ± 2.8 with no statistically significant difference (p=0.787). There were statistically significant differences regarding the implantation rate, the clinical pregnancy rate and live birth rate. The implantation rate in group A was 12% while in group B it was 7% (p=0.015), the clinical pregnancy rate was 32% in group A while it was only 18% in group B (p=0.034) and the live birth rate was 28% in group A while it was 14% in group B (p=0.024). CONCLUSIONS The single endometrial biopsy regimen (S-EBR) performed during hysteroscopy has statistically significant higher implantation rate, clinical pregnancy rate and live birth rate than hysteroscopy without endometrial scraping.

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.

Comparing the effect of office hysteroscopy with endometrial scratch versus office hysteroscopy on intrauterine insemination outcome: a randomized controlled trial §,§§

OBJECTIVE To evaluate the role of endometrial injury in the cycle preceding ovarian stimulation for intrauterine insemination (IUI) cycle on the clinical pregnancy rate. STUDY DESIGN This was a prospective randomized controlled trial which included three hundred and thirty two infertile women with an indication for IUI. The subjects were randomly divided into two groups. The intervention group (group A) (n=166) subjects underwent office hysteroscopy with endometrial injury using grasping forceps with teeth, while the control group (group B) (n=166) subjects underwent office hysteroscopy alone without endometrial injury. Primary outcome was clinical pregnancy rate. RESULTS There were no significant differences in baseline or clinical characteristics between the groups. There were no significant differences in clinical pregnancy rate [13.8% (23/166) versus 12% (20/166); RR 1.15 (95% CI 0.66-2.01), p=0.62]. The abortion rate [4.3% (1/23) versus 15% (3/20); RR 0.29 (95% CI 0.03-2.57), p=0.27], the multiple pregnancy rate [13% (3/23) versus 15% (3/20); RR 0.87 (95% CI 0.20-3.83), p=0.85] and the live birth rate [13.6% (22/166) versus 10.4% (17/166); RR 1.28 (95% CI 0.71-2.32), p=0.42]. CONCLUSION There is no evidence of significant difference on the clinical pregnancy rate when endometrial scratching during hysteroscopy is compared to only hysteroscopy in women undergoing IUI.

Calcium infusion for the prevention of ovarian hyperstimulation syndrome: a double-blind randomized controlled trial.

OBJECTIVE To evaluate the role of calcium infusion as a preventive strategy of ovarian hyperstimulation syndrome (OHSS) in women at high risk in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles. DESIGN Double-blinded randomized controlled trial. SETTING University hospital department of obstetrics and gynecology and private IVF center. PATIENT(S) Two hundred women at risk to develop OHSS undergoing IVF/ICSI treatment cycle. INTERVENTION(S) The intervention group (group 1; n = 100) received intravenous infusion of 10 mL 10% calcium gluconate in 100 mL 0.9% saline solution on the day of ovum pick-up (OPU) and days 1, 2, and 3 after, and the placebo group (group 2; n = 100) received 100 mL 0.9% saline solution on the day of OPU and days 1, 2, and 3 after. MAIN OUTCOME MEASURE(S) Incidence of OHSS. RESULT(S) OHSS incidence was significantly higher in the placebo group (group 2) than in the calcium infusion group (group 1): 23 (23%) vs. 7 (7%); moderate OHSS was significantly higher in group 2 than in group 1: 8 (8%) vs. 1 (1%); and severe OHSS was significantly higher in group 2 than in group 1: 4 (4%) vs. 0. CONCLUSION(S) Intravenous calcium infusion effectively reduced the incidence of OHSS development without reduction in the pregnancy rate. CLINICAL TRIAL REGISTRATION NUMBER NCT01427335.

Do Serum Angiopoietin-1, Angiopoietin-2, and Their Receptor Tie-2 and 4G/5G Variant of PAI-1 Gene Have a Role in the Pathogenesis of Preeclampsia?

Objective To evaluate whether serum angiogenesis markers such as angiopoietins (Ang-1, Ang-2) and their receptor (Tie-2) are altered in women with preeclampsia. We also performed genotyping to determine if the 4G/5G genotypes of −675 PAI-1 gene may play a role in the pathogenesis of preeclampsia. Materials and Methods Sixty-eight pregnant women with preeclampsia were compared to 35 normotensive pregnant women and 24 normotensive nonpregnant women in a cross-sectional study. Using enzyme-linked immunosorbent assay, levels of serum Ang-1 and Ang-2, and Tie-2 were measured. A single base pair insertion/deletion 4G/5G polymorphism of the PAI-1 gene was determined by polymerase chain reaction. Results Serum levels of Ang-1 and Tie-2 were significantly different among the study groups (P = 0.001 and P = 0.025, respectively) being lower in the preeclamptic group. Positive significant correlation was found between Ang-2 and Tie-2, (r = 0.26, P = 0.024). The frequency of the genotypes (4G/5G, 4G/4G, and 5G/5G) differed among the groups (P = 0.001). Also, the mean of systolic and diastolic blood pressures differed significantly according to the PAI-1 genotype being higher in those bearing the 4G allele; P = 0.04 and P = 0.023, respectively. Conclusion Sera Ang-1 and Ang-2, and Tie-2 as well as variants of 4G/5G of PAI-1 polymorphism have positive implications in the pathogenesis of preeclampsia.

Relationship of the Protein Z Intron F G79A and IL6 C634G Gene Polymorphisms With the Risk of Recurrent Pregnancy Loss in Egyptian Women

Purpose To investigate the relationship between recurrent pregnancy loss and single nucleotide polymorphisms in the protein Z (PZ) intron F G79A and the promoter region of the IL6 C634G genes in Egyptian women. Procedures Single nucleotide polymorphisms in the PZ intron F G79A gene and the promoter region of the IL6 C634G gene were studied in 70 Egyptian women; 40 patients and 30 healthy and parous volunteers using the polymerase chain reaction-restriction fragment length polymorphism technique. Results Regarding the PZ intron F G79A polymorphism; a higher prevalence of the A allele in the controls (53.3%) compared with the cases (22.5%) was found, and the difference proved to be statistically significant (P = 0.008). As for the IL6 C634G polymorphism, the frequency of the G allele was higher in the controls (100%) than in the cases (95%), but the difference did not prove to be statistically significant (P = 0.503). A statistically significant difference between the prevalence of the IL6 C634G (95%) and the PZ intron F G79A (22.5%) was detected (P ≤ 0.001). Conclusion A statistically significant difference of the frequency of the A allele of the PZ intron F G79A polymorphism was found with a higher prevalence of the A allele among the controls compared with the patients, suggesting a lower risk of recurrent pregnancy loss among the studied patients, but the IL6 C634G polymorphism did not prove to have an equivalent effect.

Intralipid supplementation in women with recurrent spontaneous abortion and elevated levels of natural killer cells

To investigate the efficacy of intralipid supplementation in women with recurrent spontaneous abortion (RSA) and elevated natural killer cell activity undergoing in vitro fertilization/intracytoplasmic sperm injection.

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.

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.

Association between preterm labor and genitourinary tract infections caused by Trichomonas vaginalis, Mycoplasma hominis, Gram-negative bacilli, and coryneforms

Background Preterm labor (PTL) is responsible for most cases of neonatal death. In most of these cases, the causes of PTL have not been established although several risk factors have been described. Therefore, the aim of this study was to investigate risk factors for PTL before 37 gestational weeks among Egyptian women. Methods In this case‐control study, 117 pregnant women without risk factors for PTL were chosen. The control group (n = 45) had term labor (gestational weeks ≥ 37 weeks), and the case group (n = 72) had PTL (gestational weeks < 37 weeks). The two groups were screened for urinary and vaginal infections. The role of different demographic characteristics, patient history, and clinical signs were also investigated. Results Several risk factors were identified in this study, including age < 20 years, nulliparity, previous abortion and previous preterm birth, menses vaginal bleeding, a vaginal pH > 5, a positive whiff test, Trichomonas vaginalis infection, Mycoplasma hominis infection, coryneforms heavy vaginal growth, and any vaginal growth of Gram‐negative bacilli. Urinary tract infection with any colony count was not associated with PTL. Conclusion Our study demonstrated that the main risk factors for PTL were vaginal infection with T. vaginalis, M. hominis, coryneforms, and Gram‐negative bacilli, and their determinants (vaginal pH > 5, positive whiff test, heavy vaginal bleeding). Both young age (< 20 years) and poor obstetric history were also the risk factors. Therefore, screening for genitourinary tract infections is strongly recommended to be included in prenatal care.