ABSTRACT
Background: more than 3 decades after the introduction of in vitro fertilization [IVF] and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands
Objective: to evaluate the role of laparoscopy+/-hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice
Materials and Methods: this case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014
Results: the causes of infertility as identified by laparoscopy+/-hysteroscopy were polycystic ovary syndrome [25.1%], tubal factor [30%], uterine cause [4%], and endometriosis [2.7%]. No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases [15.3%]. Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases [62%]. Sixty cases [10%] had intrauterine insemination and sixty four cases [10.7%] underwent in vitro fertilization [IVF] / intracytoplasmic sperm injection [ICSI] treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy [30%]. The most favorable outcome was recorded in women with unexplained infertility [36.7% of cases got pregnant] followed by women with polycystic ovary syndrome [27.8%]. Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis
Conclusion: laparoscopy still has an important role in the diagnosis and treatment of infertility
ABSTRACT
Background: Clomiphene citrate [CC] is the first line agent used for ovulation induction in patients with polycystic ovarian syndrome [PCOS]. However, there is marked discrepancy between the ovulation and pregnancy rates achieved, which may be attributed to the undesirable effect of CC on cervical mucus and endometrium
Objective:The aim of this study was to evaluate the effect of Isosorbid monoitrate [ISMN] as nitric oxide [NO] donors on the ovulation and pregnancy rates in an ovulatory women with PCOS treated with CC
Materials and Methods:Ninety patients with PCOS were randomly allocated into three groups. Patients in group A] were treated with 100 mg CC for five days starting from the fifth day of the cycle. Patients in group B] and C] received 10 mg and 20 mg of ISMN respectively in addition to CC, applied vaginally till the diagnosis of ovulation
Results:There was a significant increase in the ovulation and pregnancy rates in the patients treated with CC+ISMN as compared with patients treated with CC alone [p< 0.001]
Conclusion: Concomitant use of NO with CC seems to improve the ovulation and pregnancy rates in the patients with PCOS with no significant increase in side effects as compared with CC alone
ABSTRACT
Background: Implantation remains a limiting step in IVF/ICSI. Endometrial injury isa promising procedure aiming at improving the implantation and pregnancy rates after IVF/ICSI
Objective: The aim of this study was to evaluate the effect of endometrial injury induced in precedingcycle on IVF/ICSI outcome
Materials and Methods: Four hundred patients undergoing their first IVF/ICSI cycle in two IVF units in Minia, Egypt were randomly selected to undergo either endometrial injury in luteal phase of preceding cycle [intervention group] or no treatment [control group]. Primary outcome wasthe implantation and live birth ratesWhile the secondary outcome was clinical pregnancy, miscarriage, multiple pregnancy rates, pain and bleeding during and after procedure
Results: Implantation and live birth rates were significantly higher in intervention compared with control group [22.4% vs. 18.7%, p=0.02 and 67% vs. 28%, p=0.03], respectively. There was also a significant reduction in miscarriage rate in intervention group [4.8% vs. 19.7%, respectively, p<0.001]
Conclusion: Endometrial injury in preceding cycle improves the implantation rate and live birth rate and reduces the miscarriage rate per clinical pregnancy in patients undergoing their first IVF/ICSI cycle