Infertility and the provision of infertility medical services in developing countries

developing countrie

Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination

Background: Although the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI).Methods: A total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400x magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined.Results: Pregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.Conclusions: The present findings support the use of high-magnification microscopy both for selecting spermatozoa and as a routine method for analysing semen before performing IUI

Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation

Colour Doppler imaging of the orbital vasculature in Graves' disease with computed tomographic correlation

AIMS—To evaluate alterations in orbital blood flow parameters and their correlations with extraocular muscle enlargement, proptosis, and intraocular pressure in patients with Graves' disease.
METHODS—In this multicentre study blood flow parameters in the ophthalmic artery, superior ophthalmic vein, central retinal artery and vein were determined by colour Doppler imaging in 111 patients with Graves' disease in two groups (A and B) and 46 normal control subjects. Group A consisted of 42 patients with Graves' disease without ophthalmopathy; group B of 69 patients with Graves' disease with ophthalmopathy as detected by orbital computed tomographic scanning.
RESULTS—Peak systolic and end diastolic velocities in the ophthalmic artery, peak systolic velocity in the central retinal artery, and maximal and minimal velocities in the central retinal vein in patients in group B were statistically significantly higher than those in group A and the normal controls, whereas maximal and minimal velocities in the superior ophthalmic vein in patients in group B were statistically significantly lower than those in group A and the control subjects. Peak systolic and end diastolic velocities in the ophthalmic artery, peak systolic velocity in the central retinal artery, and maximal and minimal velocities in the central retinal vein also correlated with the sum of all extraocular muscle diameters in group B (r ⩾0.31, p⩽0.021). Blood flow parameters had no consistent correlation with proptosis or intraocular pressure (p>0.05). No statistically significant difference was found in resistivity indices between the groups (p>0.05). Reversed blood flow was noted in nine (13%) superior ophthalmic veins in group B.
CONCLUSION—Orbital blood flow velocities are altered in patients with Graves' ophthalmopathy and may be detected by colour Doppler imaging. Some of these changes also correlate with the enlargement of extraocular muscles. The increased blood flow velocities in arteries may be secondary to orbital inflammation.


Effect of sperm morphology on clinical outcome parameters in ICSI cycles

Objective: To assess the effect of isolated teratozoospermia with a normal sperm count and total motility by means of the fertilization rates, embryo quality and clinical pregnancy rate only in ICSI cycles. Materials and Methods: We retrospectively analyzed the records of patients who underwent ICSI at Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Fertility and Reproductive Endocrinology between July 2001 and January 2010. Only patients with normal sperm count and total motility were recruited. The remaining cycles were further divided into two groups according to their sperm morphology with respect to Kruger's strict criteria. In Group 1, 537 consecutive cycles were enrolled whose sperm morphology was < 4%. In Group 2, 118 cycles were identified with a morphology of ? 4%. Results: A total of 655 ICSI cycles were included in the final analysis. The fertilization rates were 72.0% and 70.8% in Groups 1 and 2, respectively. There were no differences regarding embryo quality, clinical pregnancy and implantation rates between the two groups. Conclusion: Our data suggest that detection of morphology defect has no value in the prediction of fertilization, embryo quality and clinical pregnancy in ICSI cycles

ICSI cycle outcomes in oligozoospermia

Aim: The aim of this study was to evaluate the sole effect of sperm concentration on fertilization, embryo quality and pregnancy rates in patients undergoing ICSI cycles. Materials and Methods: 560 ICSI cycles performed for male factor infertility were divided into four groups according to sperm concentration retrospectively. Group 1 consisted of 86 couples whose sperm concentration was less than 1 × 106, group 2 consisted of 169 couples whose sperm concentration ranged between 1 × 106 and 5 × 106, group 3 consisted of 95 couples whose sperm concentration ranged between 5 × 106 and 10 × 10 6 and group 4 consisted of 210 couples whose sperm concentration ranged between 10 × 106 and 20 × 106. Results: Fertilization rate was significantly lower in the first three groups compared to the last group (p &lt; 0.05). The first three groups were comparable with each other. There were no differences according to ovarian response to stimulation, embryo quality and clinical pregnancy rates between the four groups. Conclusion: Lower sperm concentration has detrimental effects on the outcomes of ICSI cycles. This situation is more evident in men with severe and extremely severe oligozoospermia

ICSI outcome of patients with severe oligospermia vs non-obstructive azoospermia

Objective: To compare the results of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles in men with severe oligoospermia and non-obstructive azoospermia. Materials and Methods: This study included 91 ICSI cycles performed due to male factor infertility. Patients are divided into two groups according to source of spermatozoa. Group 1 consisted of 38 cycles in which sperm was obtained from testicles (cases with non-obstructive azoospermia). In Group 2, 53 consecutive cycles were included in which ejaculated sperm was available for ICSI in spite of severe oligospermia (< 100,000/ml). Fertilization, embryo quality and clinical pregnancy rates were compared between the groups. Results: Although, the female age and mean number of oocytes retrieved were similar among the two groups, fertilization rate was significantly lower in the non-obstructive azoospermia (34.6%) group compared to group in which patients underwent ICSI with ejaculate spermatozoa (55.3%) (p < 0.05). However, there were no differences regarding mean number of available grade 1 embryos on day 3 and pregnancy rate between the two groups. Conclusion: Testicular sperm from non-obstructive azoospermia patients had significantly lower fertilization rates than the ejaculated spermatozoa from severe oligospermia patients in ICSI cycles. However, it did not bring about improved pregnancy rate