Yasser Ibrahim Orief

Factors affecting outcome after ICSI with spermatozoa retrieved from cryopreserved testicular tissue in non-obstructive azoospermia

There is a lack of data regarding variables affecting the treatment outcome for non-obstructive azoospermia when spermatozoa from cryopreserved testicular specimens are utilized for ICSI. The objective of the present retrospective analysis was to investigate the effect of various parameters on treatment outcome in such cases. One hundred and sixty-five couples with non-obstructive azoospermic males undergoing a total of 297 cycles were included. In all cases the testicular tissue retrieved by multiple open-biopsy testicular sperm extraction was stored in liquid nitrogen and, after thawing, only mature spermatozoa were used for ICSI. When no motile spermatozoa were recovered, immotile spermatozoa were used. In 159 cycles, motile spermatozoa were utilized for ICSI, while in 138 cycles immotile spermatozoa were utilized. Higher normal fertilization rate (60.4 +/- 3.1 versus 51.3 +/- 1.6%, P < 0.05), number of embryos transferred (2.8 +/- 0.06 versus 2.6 +/- 0.04, P < 0.05), modified cumulative embryo score (31.2 +/- 1.6 versus 23.9 +/- 0.8, P < 0.001), and proportion of motile spermatozoa injected (67.8 versus 49.8%, P < 0.05) were observed in cycles that resulted in clinical pregnancies. Binary logistic regression analysis showed that sperm motility (odds ratio 2.06, 95% CI 1.1-3.9, P < 0.05), but not womans age, number of treatment cycle, type of GnRH-analogue used for pituitary suppression, number of oocytes retrieved or number of embryos transferred was a significant determinant of the likelihood of clinical pregnancy. In conclusion, sperm motility after freeze/thawing of testicular tissue is the major determinant of the success of ICSI in non-obstructive azoospermia.

Should ICSI be used in non-male factor infertility?

There is general agreement that intracytoplasmic sperm injection (ICSI) should be used in male factor infertility cases, such as oligoasthenoteratozoospermia, presence of anti-sperm antibodies, or azoospermia, these cases being diagnosed through abnormal semen analysis. There are no randomized clinical trials comparing ICSI with IVF (or other interventions) where semen quality is so poor that IVF would not achieve fertilization. It is accepted that ICSI is the only treatment option in those circumstances. The role of ICSI where IVF can be expected to give a reasonable fertilization rate is the question that needs to be answered. The argument is whether or not ICSI should be used for all cases of infertility. This paper proposes and strongly supports the use of ICSI for all indications. Considerations of fertilization and embryo development, cost effectiveness and safety will be clearly discussed.

Cumulative pregnancy rate after ICSI with cryopreserved testicular tissue in non-obstructive azoospermia

The aim of the present study was to describe a simplified and inexpensive method of testicular tissue freezing, to assess the cumulative clinical pregnancy rate (CPR) by this technique, and to provide useful information for counselling couples with non-obstructive azoospermia. One hundred and sixty-five couples with non-obstructive azoospermic males pursuing assisted conception, from December 1995 to December 2002, were included. In all cases, the testicular tissue retrieved by open multiple-biopsy (both sides, by testicular sperm extraction) was frozen using a simple liquid nitrogen vapour freezing technique and was stored in liquid nitrogen thereafter. Only mature spermatozoa were used for intracytoplasmic sperm injection (ICSI) after thawing. Expected CPR were calculated using the Kaplan-Meier survival analysis. A total of 281 cycles were performed resulting in 53 clinical pregnancies. Crude and expected CPR (95% confidence intervals) after three cycles were 32.1 (25.7-40.1) and 55.7% (37.0-74.4) respectively. In conclusion, this simplified method for freezing testicular tissue resulted in a satisfactory outcome after ICSI in cases of non-obstructive azoospermia.

Embryo cryopreservation: is vitrification ready to replace slow freezing?

Cryopreservation of human gametes, embryos and blastocysts has become an integral part of assisted reproduction. This approach may have several advantages for infertile patients. It provides an opportunity to limit the numbers of embryos transferred while supernumerary embryos will be used in subsequent treatment cycles, thereby increasing the cumulative pregnancy rate. Furthermore, the potential risk of hyperstimulation syndrome can be reduced. In addition, storage of embryos from a cycle allows the patient to space the timing of sibling pregnancies and improve their potential of achieving a pregnancy at an advanced maternal age. Therefore, a reliable procedure for the cryopreservation of supernumerary embryos is needed. Since the early 1980s, two common techniques have been used in cryopreservation: the conventional slow cooling method and the more recent rapid procedure, known as vitrification. The latter needs a much higher concentration of cryoprotectants and faster cooling rates. Vitrification is qu...

Group B streptococcal carriage, antimicrobial susceptibility, and virulence related genes among pregnant women in Alexandria, Egypt

Abstract Background and aim Group B Streptococcus (GBS) has emerged as a leading cause of illness and death among neonates. The study was conducted to estimate the prevalence of recto-vaginal carriage of GBS among pregnant women at 35–37 weeks, gestation, to describe GBS antimicrobial susceptibility profile and to investigate selected virulence genes by PCR. Subjects and methods Two-hundred pregnant women at 35–37 weeks of gestation attending antenatal clinic at Al-Shatby University Hospital were enrolled in the study. Both vaginal and rectal swabs were collected from each subject. Swabs were inoculated onto CHROMagar™ StrepB and sheep blood agar plates. All GBS isolates were subjected to antimicrobial susceptibility testing using disc diffusion. Disc approximation test was performed to detect erythromycin resistance phenotype (MLSB). GBS virulence genes scpB, bac, bca, and rib were identified by PCR. Results Among the 200 pregnant women, 53 (26.5%) were identified as GBS carriers. All carriers had vaginal colonization (100%), four (7.5%) had combined recto-vaginal colonization. None of the carriers had rectal colonization alone. All isolates (100%) were susceptible to penicillin, ampicillin, ceftriaxone, cefotaxime, cefepime, vancomycin, and linezolid. On the other hand, 43.4%, 28.3%, 22.6%, and 15% of isolates were resistant to levofloxacin, azithromycin, erythromycin, and clindamycin respectively. Out of 12 erythromycin resistant isolates, six isolates had constitutive while two had inducible MLSB resistance. scpB was identified in 100%, rib in 79.2%, and bac in 35.8% of GBS isolates. None of the isolates possessed the bca gene. Conclusion Introduction of GBS screening in Egyptian pregnant women is recommended. Penicillin or ampicillin is still the antibiotic of choice for intrapartum prophylaxis.

Endometrial preparation for cryoembryo transfer: effect of gonadotrophin-releasing hormone agonist coupled with estrogen and progesterone on hormonal profile and pregnancy rate

Objective The aim of the study was to compare artificial endometrial preparation using estrogen and progesterone with pretreatment with gonadotrophin-releasing hormone agonist along with estrogen or progesterone for cryoembryo transfer on the basis of clinical pregnancy rate. Design This was a randomized controlled trial. Setting The study was conducted at the Dar Al Khosouba Center. Sample A total of 140 couples underwent cryoembryo transfer as treatment for infertility between November 2013 and October 2014. Patients and methods Artificial endometrial preparation was performed for cryoembryo transfer. The main outcome measure was the clinical pregnancy rate. Results The couples were randomly subdivided equally into two groups: group A and group B. Group A underwent endometrial preparation with estrogen and progesterone, whereas group B underwent endometrial preparation by pretreatment with gonadotrophin-releasing hormone agonist along with estrogen or progesterone. The clinical pregnancy rate in group A was 50% and that in group B was 58.6%. There was no statistically significant difference in the clinical pregnancy rates between groups A and B. Conclusion Endometrial preparation for frozen–thawed embryo transfer based exclusively on steroid administration appears to be as effective as the protocol involving preliminary desensitization with a GnRha.

Day-3 versus day-5 embryo transfer in intracytoplasmic sperm injection

Introduction In vitro fertilization (IVF) is fast becoming the gold standard for the treatment of infertility, with nearly a million IVF babies being born. The time of embryo transfer still rises a big question and is still a field of great debate as to whether the embryo should be transferred early at day 3 or one should wait until day 5 to give a good chance for embryo selection. This question has led us to design this prospective randomized clinical trial study aimed to determine whether embryo transfer on day 3 versus day 5 shows a significant difference in implantation, clinical pregnancy, live birth, miscarriage, and multiple pregnancy rates among women undergoing intracytoplasmic sperm injection. Patients and methods We included 240 infertile women retrieved from Alexandria University Hospital, who were randomly divided into two groups at the day of ovum pick up. Group I underwent day-3 embryo transfer, whereas group II underwent day-5 embryo transfer. Inclusion criteria were as follows: age less than 35 years, mild male factor, and normal uterine cavity. Women with endometriosis were excluded from the study. Results In the day-3 embryo transfer group 65 patients conceived, whereas in the day-5 embryo transfer group 66 patients conceived, which showed no significant difference between the two groups. There were 16 patients with multiple pregnancy in the day-3 embryo transfer group compared with 12 patients in the day-5 transfer group, which showed no significant difference between the two groups. There was only slight difference in live birth between the two groups; in the day-3 embryo transfer group there were 43 single live birth, whereas in the day-5 embryo transfer group there were 36 live births. Pearson’s &khgr;2 test revealed no significant difference between the two groups as regards live birth (&khgr;2=1.385, P=0.500). Conclusion There was no significant difference in the success rates and outcome of embryo transfer between the two groups.