Yehia Amin

Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials

OBJECTIVE To investigate the optimum number of cycles of controlled ovarian hyperstimulation and intrauterine insemination in the treatment of unexplained infertility. DESIGN Observational prospective study. SETTING In vitro fertilization embryo transfer center. PATIENT(S) Five hundred ninety-four couples with unexplained infertility. INTERVENTION(S) Controlled ovarian hyperstimulation (COH), intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S) Cycle fecundity. RESULT(S) One to 3 cycles of COH/IUI were performed in 594 patients (group A) undergoing 1,112 cycles (mean, 1.9 cycles/patient). Up to 3 further trials (cycles 4-6) of COH/IUI were then performed in 91 of these women (group B), a total of 161 cycles (mean, 1.8 cycles/patient). A historical comparison group C consisted of 131 patients with 3 failed cycles of COH/IUI who underwent 1 cycle of IVF and ICSI at our center. In group A, 182 pregnancies occurred, with a cycle fecundity of 16.4% and a cumulative pregnancy rate (PR) of 39.2% after the first 3 cycles. In group B, 9 pregnancies occurred in cycles 4-6, with a cycle fecundity of 5.6%, significantly lower than that of group A (P<.001). The cumulative PR rose to 48.5% by cycle 6, a further increase of only 9.3%. In the women undergoing IVF and ICSI in group C, 48 pregnancies occurred, with a cycle fecundity of 36.6% per cycle, significantly higher than that of group B (P<.001). CONCLUSION(S) In unexplained infertility, the cycle fecundity in the first three trials of COH and IUI was higher than in cycles 4-6, with a statistically significant difference. Patients should be offered IVF or ICSI if they fail to conceive after three trials of COH and IUI.

A prospective controlled study of karyotyping for 430 consecutive babies conceived through intracytoplasmic sperm injection.

OBJECTIVE To compare the karyotype of babies conceived through ICSI with that of naturally conceived babies. DESIGN Prospective controlled study. SETTING The Egyptian IVF-ET Center, Cairo, Egypt. PATIENT(S) Four hundred and thirty babies conceived through ICSI and 430 babies conceived naturally. INTERVENTION(S) ICSI and karyotyping. MAIN OUTCOME MEASURE(S) Abnormal karyotype. RESULT(S) Four hundred and thirty consecutive babies conceived through ICSI who were delivered in one hospital had 15 abnormal karyotypes (3.5%). Of the 15 babies, 7 were of female phenotype and 8 of male phenotype. Six babies had sex chromosome anomalies, 8 had autosomal anomalies, and 1 had combined sex chromosome and autosomal anomalies. A control group of 430 consecutive babies conceived naturally who were delivered in one hospital had no abnormal karyotype. The difference between the two groups was significant (P<.001). CONCLUSION(S) ICSI carries a small but significant increased risk of abnormal karyotyping to the offspring. This risk appears to be equally distributed between autosomal and sex chromosome anomalies.

Intracytoplasmic sperm injection using microsurgically retrieved epididymal and testicular sperm

OBJECTIVE To evaluate treatment of couples who are infertile due to unreconstructable obstructive azoospermia with microsurgical epididymal sperm aspiration or testicular sperm and intracytoplasmic sperm injection (ICSI). DESIGN Prospective. SETTING The Egyptian IVF-ET Center in association with Cairo University. PATIENTS Twenty-three couples who are infertile due to obstructive azoospermia in which reconstructive microsurgery failed or was not possible. INTERVENTIONS Microsurgical epididymal or testicular sperm retrieval and ICSI in 24 cycles. MAIN OUTCOME MEASURES Fertilization and pregnancies. RESULTS All 24 cycles had successful fertilization and reached the ET stage. In microsurgical epididymal sperm aspiration cases, fertilization rate per metaphase II oocyte was 63% (109/ 172). Six patients became pregnant, including one set of twins and one set of triplets. One pregnancy resulted from the use of cryothawed epididymal sperm. In testicular sperm aspiration cases, the fertilization rate was 59% (32/54) and four clinical pregnancies resulted. CONCLUSION The use of microepididymal sperm aspiration or testicular sperm aspiration in conjunction with ICSI provide a highly precise and efficient procedure for achieving pregnancy in cases of unreconstuctable obstructive azoospermia.

On the least‐squares residual anomaly determination

This paper discusses an approach to determine the least‐squares optimum order of the regional surface which, when subtracted from the Bouguer gravity anomaly data, minimizes distortion of the residual component of the field. The least‐squares method was applied to theoretical composite gravity fields each consisting of a constant residual component (sphere or vertical cylinder) and a regional component of different order using successively increasing orders of polynomial regionals for residual determination. The overall similarity between each two successive residual maps was determined by computing the correlation factor between the mapped variables. Similarity between residual maps of the lowest orders, verified by good correlation, may generally be considered a criterion for determining the optimum order of the regional surface and consequently the least distorted residual component. The residual map of the lower order in this well‐correlated doublet is considered the most plausible one and may be used...

Follicular aspiration does not protect against the development of ovarian hyperstimulation syndrome

ObjectiveThe purpose of this study was to determine the effect of follicular aspiration on the incidence of ovarian hyperstimulation syndrome (OHSS).DesignA retrospective study was done on 219 IVF cycles that proceeded to follicular aspiration (group A) and they were compared with 189 cycles of ovulation induction for non-IVF cycles (group B). We compared the incidence of OHSS in regularly ovulating patients (subgroups A1 and B1) and anovulatory patients (subgroups A2 and B2) in both groups.SettingsThe study took place at The Egyptian IVF-ET Center.ParticipantsParticipants were 319 infertility patients.InterventionOvulation was induced and follicles were aspirated.Main Outcome MeasuresThe incidences of moderate and severe OHSS were the main outcome measures.ResultsThe incidence of OHSS in group B was significantly higher than that in group A (P =0.016). There was no significant difference in the incidence of OHSS between subgroup A1 and subgroup B1 or between subgroup A2 and subgroup B2.ConclusionsFollicular aspiration had no effect on the incidence of OHSS. In contrast, the higher incidence of OHSS in group B was related to the higher incidence of anovulatory infertility.

The use of clomiphene citrate/human menopausal gonadotrophins in conjunction with GnRH antagonist in an IVF/ICSI program is not a cost effective protocol

Acta Obstet Gynecol Scand 2003; 82: 48–52.

Increasing the dose of human menopausal gonadotrophins on day of GnRH antagonists administration: a randomized controlled trial

A significantly lower pregnancy rate following the gonadotrophin-releasing hormone (GnRH) antagonist protocol as compared with the long GnRH agonist protocol has been reported. The objective of this study was to investigate whether increasing the dose of gonadotrophins on the day of antagonist administration would increase the pregnancy rate. This study is an open labelled, randomized controlled trial and allocation was done using sealed envelopes. One hundred and fifty-one subfertile couples undergoing IVF/intracytoplasmic sperm injection (ICSI) cycles were included in the study. Ovarian stimulation was started on day 3 of the cycle, using 150-300 IU human menopausal gonadotrophin (HMG)/day. From day 8 onward, daily vaginal ultrasound and daily urinary LH estimation were performed. If a premature LH rise was detected, the cycle was cancelled. The antagonist (0.25 mg daily) was started when the leading follicle reached 15 mm in mean diameter and LH testing in urine was negative up to and including the day of human chorionic gonadotrophin (HCG) injection. Patients were randomized on the day of starting the antagonist into two groups: group A, 72 patients with no increase in HMG dose, and group B, 79 patients in whom the dose of HMG was increased by 75 IU on the day of antagonist administration, and continued till the day of HCG administration. The results showed no statistically significant difference between the groups regarding number of oocytes retrieved, embryos obtained, implantation rate, clinical pregnancy rate and multiple pregnancy rate. It was concluded that there is no clinical evidence for increasing the dose of HMG on the day of antagonist administration.

On: “A least-squares approach to depth determination from gravity data; discussion and reply

In his paper, Gupta was able to transform the problem of depth estimation of buried structures into a problem of finding a solution of a nonlinear equation in the form of f(z) = 0. Gupta also indicated that such a numerical approach is found to be capable of determining optimum depths particularly from residual anomaly profiles even if small segments of the gravity profiles are observed. No doubt this numerical approach has its point of view both in theory and practice over any other depth estimation techniques such as those defined by the half- g max rule (Nettleton, 1940, 1942; Telford et al., 1976). However, Guptas technique would be much more effective if applied not to residuals but to derivative anomalies, particularly when the regional field has few extrema in it; this is obviously due to the following.

Successful intracytoplasmic sperm injection without performing cytoplasmic aspiration**Presented in part at the II Annual Middle East Fertility Society meeting, Alexandria, Egypt, 1995. Winner of the Organon Middle East Fertility Society Prize.

OBJECTIVE To compare the effect of cytoplasmic aspiration versus no aspiration before intracytoplasmic sperm injection (ICSI) on the rate of oocyte damage, fertilization rate, and embryo quality. DESIGN A randomized prospective study on sibling oocytes. SETTING The Egyptian IVF-ET Center, Cairo, Egypt. PARTICIPANTS Fifty-eight patients who were infertile due to male factor who underwent 60 ICSI cycles. INTERVENTION Intracytoplasmic sperm injection was performed on randomly allocated metaphase II oocytes with cytoplasmic aspiration in group I and without cytoplasmic aspiration in group II before sperm injection. MAIN OUTCOME MEASURE Fertilization rate, oocyte damage rate, and embryo quality. RESULTS Normal fertilization rate per injected oocyte was 61.4% in group I compared with 62.5% in group II. The damage rate per injected oocyte was 16.8% in group I compared with 4.6% in group II. Grade I embryos were 24.5% in group I compared with 48.5% in group II. CONCLUSION Cytoplasmic aspiration before sperm injection in ICSI is not essential for oocyte activation. It did not improve the rate of normal fertilization. On the other hand, it increased the damaged oocyte rate and the rate of cytoplasmic fragments.