Infertility and the provision of infertility medical services in developing countries

developing countrie

Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction? A comparative analysis.

Contains fulltext : 88855.pdf (publisher's version ) (Closed access)OBJECTIVE: To compare the outcomes of intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia and normal spermatogenesis, according to the use of epididymal or testicular spermatozoa and the cause of obstruction. DESIGN: Retrospective study. SETTING: Private infertility center. PATIENT(S): A detailed chart review of a cohort of 1,121 men with obstructive azoospermia who underwent intracytoplamic sperm injection (ICSI) was performed. INTERVENTION(S): Patients were grouped according to the origin of spermatozoa: epididymal (n=331) or testicular (n=790). They were further classified into two subgroups according to the cause of obstruction: congenital bilateral absence of vas deferens (CBAVD; n=434), and other causes of obstruction (n=687). MAIN OUTCOME MEASURE(S): Fertilization, clinical pregnancy, and miscarriage rates. RESULT(S): Fertilization (64.2% vs. 68.0%), clinical pregnancy (42.3% vs. 43.2%), and miscarriage (17.6% vs. 18.4%) rates did not differ between epididymal spermatozoa and testicular spermatozoa, respectively. Fertilization, clinical pregnancy, and miscarriage rates were also similar in the patients with CBAVD or due to other causes of obstruction. CONCLUSION(S): The source of sperm used for ICSI in cases of obstructive azoospermia and the etiology of the obstruction do not affect the outcome in terms of fertilization, pregnancy, or miscarriage rates.1 november 201

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