Assisted reproductive technology in Egypt, 2003–2004: Results generated from the Egyptian IVF registry

Objective: To summarize the results of ART procedures cycles initiated in Egypt during the years 2003–2004. Design: The forms, prepared by the International Committee Monitoring Assisted Reproductive Technologies (ICMART), were distributed to all IVF centers in Egypt. Participants: All IVF centers in Egypt were invited to voluntarily participate. Main outcome measures: The total number of standard IVF, ICSI, FET after standard IVF and ICSI cycles, incidence of clinical pregnancy, abortion, delivery, stillbirth and complications rates. Results: Data were anonymously received from 18 centers in 2003 and 15 centers in 2004, with a total of 16,862 reported cycles. ICSI constituted 91.9%; frozen-thawed embryo replacement cycles represented 7.0%, while IVF constituted only 1.0% of the total number of ART cycles. For ICSI, the clinical pregnancy rates per aspiration and per transfer were 38% and 42%, respectively. The distribution of singleton, twin, triplet and high-order deliveries for IVF, ICSI and FET combined was 62.5, 21.8, and 2.4, respectively. This gives a total multiple delivery rates of 24.2%. As a result of ART activities, 2656 neonates were reported born. Complications of ART were mainly ovarian hyperstimulation syndrome, complicating 1.75% of cycles; the occurrence of bleeding in 0.4% and infection in 0.03% of all aspiration cycles. Conclusions: These are the fourth and fifth consecutive reports of the activities of the Egyptian IVF registry for cycles initiated during the years 2003–2004. The clinical pregnancy rates were comparable with the previous reports. The multiple pregnancy rate is still higher than would be desired, as a result of the proportion of women receiving high number of embryos (⩾3 embryos) per transfer. OHSS is also high and therefore preventative measures must be stricter. More efforts are needed to complete data on deliveries and perinatal mortalities

EDITORIAL - Results of Assisted Reproductive Technology in 2001 generated from the Middle East IVF registry

Objective: To summarize the results of ART procedures cycles initiated in the Middle East during the year 2001. Design: Retrospective analysis. Materials and methods: The ‘World Report on ART’ forms, prepared by the International Committee for Monitoring Assisted Reproductive Technology (ICMART), were distributed to all IVF centers in the Middle East. Main outcome measures: The total number of standard IVF, ICSI, FET after standard IVF and ICSI, GIFT and OD cycles, incidence of clinical pregnancy, abortion, delivery, stillbirth and complications rates. Results: Data was received from thirty centers, with a total of 16,293 reported cycles. ICSI constituted 86.14%, IVF constituted 8.26%, while the frozen-thawed embryo replacement cycles represented only 5.28% of the total number of ART cycles. As for standard IVF, the clinical pregnancy rate per aspiration and per transfer was 29.70 and 30.71%, respectively. For ICSI, the corresponding rates were 29.25 and 31.32%. The distribution of singleton, twin, triplet and high-order deliveries for IVF, ICSI, FET GIFT and OD combined was 64.1, 24.4, and 3.9% respectively. This gives a total multiple delivery rates of 28.3%. As a result of ART activities, 3,911 neonates were reported born. Complications of ART were mainly ovarian hyperstimulation syndrome, complicating 1.82% of cycles; the occurrence of bleeding in 0.21% and infection in 0.06% of all aspiration cycles. Conclusions: This is the second consecutive report of the activities of the Middle East IVF registry for cycles initiated during the year 2001. The clinical pregnancy rates were comparable with the previous report. The multiple pregnancy rate is still high due to the transfer of >3 embryos. OHSS is also high and therefore in the future preventative measures must be stricter. More efforts are needed to complete data on deliveries and perinatal mortalities. Even more efforts are needed to include centers that did not provide their data

Assisted Reproductive Technology in Egypt, 2001: results generated from the Egyptian IVF registry

Objective: To summarize the results of ART procedures cycles initiated in Egypt during the year 2001. Design: The 'World Report on ART' forms, prepared by the International Committee for Monitoring Assisted Reproductive Technology (ICMART), were distributed to all IVF centers in Egypt. Materials and methods: All IVF centers in Egypt were invited to voluntarily participate. Main outcome measures: The total number of standard IVF, ICSI, FET after standard IVF and ICSI cycles, incidence of clinical pregnancy, abortion, delivery, stillbirth and complications rates. Results: Data was anonymously received from 16 centers, with a total of 6,757 reported cycles. ICSI constituted 91.4%, IVF constituted 4.4%, while the frozen-thawed embryo replacement cycles represented only 4.2% of the total number of ART cycles. As for standard IVF, the clinical pregnancy rate per aspiration and per transfer was 27.5 and 27.9%, respectively. For ICSI, the corresponding rates were 33.1 and 34.7%. The distribution of singleton, twin, triplet and high-order deliveries for IVF, ICSI and FET combined was 67.2, 29.1, and 3.6 respectively. This gives a total multiple delivery rates of 32.7%. As a result of ART activities, 1,914 neonates were reported born. Complications of ART were mainly ovarian hyperstimulation syndrome, complicating 2.2% of cycles; the occurrence of bleeding in 0.27% and infection in 0.07% of all aspiration cycles. Conclusions: This is the third consecutive report of the activities of the Egyptian IVF registry for cycles initiated during the year 2001. The clinical pregnancy rates were comparable with the previous reports. The multiple pregnancy rate is still high due to the transfer of >3 embryos. The practice of cryopreservation of embryos is still limited to only a few centers. OHSS is also high and therefore in the future preventative measures must be stricter. More efforts are needed to complete data on deliveries and perinatal mortalities

The effect of intramural fibroids on the outcome of IVF

Objective: To evaluate the effect of fibroids on outcome of IVF and study value of myomectomy prior to IVF. Design: Prospective controlled study. Setting: Private IVF center, The Egyptian IVF ET Center, Maadi, Cairo. Materials and methods: One hundred and eighty four patients were included. Sixty three patients with intramural fibroids were counseled for either myomectomy or no treatment prior to IVF and decision left to the patient. Group A, N=19 were treated by myomectomy, Group B, N=44 had no myomectomy. Group B were subdivided into B1, N=11 with fibroid at a distance < 5 mm from the endometrial lining and B2, N=33 at a distance of > 5 mm. Group C, N= 100 were an age-matched group of infertility patients. Group D included 11 submucous fibroids and 10 fibroid polyps that were all treated by hysteroscopic resection. Main outcome Measures: Size and distance of intramural fibroid to endometrial lining were recorded. Outcome of IVF was compared between fibroids at a distance > 5 mm and < 5 mm from endometrial lining. As well as outcome between group that performed myomectomy and that which did not undergo myomectomy. Results: Pregnancy rates achieved in the three groups A, B and C were; 50%, 27.5% and 36% respectively. This was found to be non significant. In subgroup B1 there was one pregnancy (9%) as compared to 10 pregnancies in subgroup B2 (30%). The difference was non significant. Following hysteroscopic resection 2 out of 6 patients with submucous fibroids and 6 out of 10 patients with fibroid polyps became pregnant after IVF. Conclusions: The distance between the intramural myomas and the endometrial lining did not affect the IVF outcome. An insignificant tendency towards improvement of IVF outcome was found in myomas at more than 5 mm from endometrial lining

Difficult embryo transfer: the impact of propofol anesthesia

Background: Difficult embryo transfers (ET) requiring general anesthesia are occasionally encountered in clinical practice. Little evidence is present in the literature as to the success rates when compared with difficult transfers not requiring anesthesia. Objective: To evaluate the impact of using Propofol anesthesia during difficult embryo transfers on the implantation and clinical pregnancy rates. Design: Retrospective patient chart review. Materials and methods: Women undergoing ICSI cycles in the Egyptian IVF-ET center, from January 2000 December 2002, and having difficult ET requiring general anesthesia (Group I = 99 women) were included. A matching group of women with difficult ET, without anesthesia (Group II = 99 women) were used as a control. Results: There were no significant differences in the patient demographics (e.g. age, period of infertility, number of oocytes retrieved, fertilization rate, embryo quality, number of embryos transferred. Moreover, there was no significant differences in implantation (Group I = 19.15%, Group II = 20.86%) or clinical pregnancy rates (Group I = 36.36%, Group II = 33.33%). Conclusion: The use of propofol general anesthesia during difficult embryo transfer does not seem to improve the implantation and pregnancy rates. Even though, prospective randomized trials are needed to confirm these findings

Three dimensional endometrial volume versus endometrial thickness measurement in prediction of IVF/ICSI outcome

Objective: To investigate the role of estimating endometrial volume and it's correlation with endometrial thickness, on the day of hCG, in prediction of IVF outcome. Design: A prospective clinical study. Materials and methods: Endometrial volume and endometrial thickness were measured in women undergoing an IVF/ICSI cycle, on the day of HCG, using the 3 D transvaginal ultrasound probe (Sonoace 9900 Medison -Kretz , korea). Patients were divided according to endometrial volume calculated into 3 subgroups; 4 ml, as well as according to endometrial thickness into 3 groups; <8mm, 8-12mm and >12mm. Pregnancy rates were compared between all groups. Results: The study included 103 women with no significant difference in background characteristics between all subgroups. The pregnancy rates between the three groups of endometrial volume; <2ml, 2-4ml, and >4 ml was; 42%, 36% and 48% respectively. Pregnancy rates between the three groups of endometrial thickness was 25%, 40% and 50 % for 12mm respectively. There was no significant difference in pregnancy rates between all groups in relation to both endometrial volume and endometrial thickness. Conclusion: Endometrial volume on day of hCG is not a better predictor than endometrial thickness for determining outcome of IVF/ICSI cycles