Effect of sperm DNA fragmentation on pregnancy rate after intracytoplasmic sperm injection

To evaluate the degree of DNA fragmentation in human sperm used for ICSI to determine the effect of sperm DNA fragmentation on fertilization rate, embryo cleavage rate, embryo quality and biochemical pregnancy rates after ICSI. Design: Prospective, analytic descriptive study. Settings: Tertiary care fertility clinic. Patient[s]: Fifty couples undergoing ICSI treatment due to male factor infertility. Intervention[s]: The percentage of spermatozoa with DNA fragmentation was determined using the method f terminal deoxynucleotidyl transferase mediated UTP- biotin end- labeling [TUNEL] Main Outcome Measure[s]: The percentage of spermatozoa with DNA fragmentation was correlated with semen analysis parameters, ICSI fertilization rate, embryo cleavage rate, embryo grades and biochemical pregnancy rate. Result[s]: The mean [ +/- SD] percentage of spermatozoa with DNA fragmentation was 30.2 +/- 13.8%. A significant negative correlation was found between the percentage of sperm with DNA fragmentation and the concentration and motility of the ejaculated sperm. In addition, a significant negative association was found between the percentage of sperm with DNA fragmentation and fertilization rate, embryo cleavage rate, embryo quality and biochemical pregnancy rate. Conclusion[s]: Detection of DNA fragmentation in human sperm could provide additional information about the biochemical integrity of sperm and may explain fertilization failure after ICSI. By learning more about the fundamental mechanisms that cause sperm DNA fragmentation, it should be possible to develop more precise tests to describe defects and then to develop new therapeutic modalities designed to overcome these specific defects

Validity of the " modified triple test " in the first trimester screening for congenital fetal malformations in the high risk group

To assess the clinical effectiveness of the combined test using fetal nuchal translucency [NT], maternal serum free beta subunit of human chorionic gonadotrophin [beta -HCG] and pregnancy associated plasma protein -A [PAPP-A] levels during gestational weeks 10 to 14 for screening of congenital fetal malformations. Settings: Department of Obstet. and Gyn., Minia University Hospital in co-operation with Feto-Maternal Unit, Am Shams University Hospital. Study Design: One thousand pregnant women [between. 10-14 weeks' gestation] at high risk for fetal malformations were recruited. They were subjected to detailed clinical evaluation, A three-generation family history, nuchal translucency, maternal serum PAPP-A and free beta -HCG. Amniocentesis was done only for 17 cases. Ninty-four malformed fetuses were picked up out of 1000 studied high-risk pregnant women [9.4%]. The most common congenital anomalies diagnosed were the cerebrospinal anomalies [48.7%], gastrointestinal anomalies [35.4%], and cardiac anomalies [15.8%]. Anomalies detected during the first scan were 49 out of 158 [DR 31.01%, Sensitivity 41.38%, specificity 98.63%].Anomalies detected during, the second scan were 125 out of 158 [DR 86.5%, sensitivity 81.6%%, specificity 99.31%]. Amniocentesis has been done for 17 cases [DR 94.1%]. Nuchal translucency had a detection rate [DR] of 80.2% compared with 52%, 43% for free beta - HCG and PAPP-A respectively. NT + free beta -HCGhad a better DR of 86%. The sensitivity of NT in comparison with amniocentesis was 73% whereas the sensitivity of the biochemical markers [PAPP-A and free beta-hCG] was 68%, 64% respectively. When NT and the biochemical markers were combined together, the sensitivity rose up to 89.5% in relation to amniocentesis. Nuchal translucency screening for fetal malformations together with serum screening has been given grade B recommendation by the RCOG working party. As a result of advances in U/S technology; visualization of the first trimester fetus has been markedly improved. By examining fetal anatomy and NT measurement at 10-l4wk, the majority of structural [68%] and chromosomal abnormalities [79%] can be diagnosed in early pregnancy. Adding the serum markers to the age and U/S will improve detection to 90% with a 5% false positive rate

Helicobacter pylori seropositivity: its correlation with vomiting disorders during pregnancy

To evaluate the relationship between Helicobacter pylori [H. pylori] infection and vomiting disorders during pregnancy. Helicobacter pylori IgG antibodies were determined in three groups of pregnant women by ELISA. Group I included 25 pregnant women with hyperemesis gravidarum [HG], group II included 60 pregnant women with emesis gravidarum [EG] and group III included 60 asymptomatic pregnant women [NP] of matched age and parity. The percentage of IgG seropositivity and the mean IgG liter in each group were determined and analysed. El-Minia University Hospital. The prevalence of seropositivity for H. pylori IgG antibodies among patients with [HG] [21 out of 25 = 84%] was higher than those with [EG] [34 out of 60 = 56.67%] and also higher than that in asymptomatic pregnant women [32 out of 60 = 53.33%]. This difference was statistically significant [P < 0.05]. Also the mean liter in the first group was [55.64 +/- 7.2 Au/ml] compared to [40.41 +/- 18.2 Au/ml] and [31.52 +/- 11.34 An/ml] in the second and third groups respectively. This difference in the mean titer was statistically significant [P < 0.05]. Helicobacter pylori infection appears to be significantly associated with [HG] and accordingly, serologic testing for this infection will be of great help in the management of these patients

Laparoscopic management of suspicious adnexal masses

To evaluate the role of operative laparoscopy in the management of suspicious adnexal masses. Department of Obst. and Gyn., Al-Minya University Hospital. Fifty patients with suspicious adnexal masses were recruited. They were subjected to detailed clinical evaluation, transvaginal sonographic scoring, CA 125 assay and then operative laparoscopic intervention was carried out. In 5 cases, the initial procedure was completed by laparotomy. Preoperative transvaginal sonographic scoring revealed a statistically highly significant difference between benign and malignant lestons, their score were 7.89 +/- 2.7 and 12.5 +/- 2.5 respectively. Serum CA 125 at a cut off 194 u/ml aided by transvaginal sonographic scoring were found helpful in selecting patients with suspicious adnexal masses who may benefit from operative laparoscopy. Laparoscopic intervention was successful in 90% of cases. Procedures done included ovarian cystectomy in 44%, oophrectomy in 16%, excision of cyst wall and aspiration in 12%, adnexectomy in 12% and destruction of cyst wall in situ in 6% of cases. The mean duration of laparoscopic procedure was 67.64 +/- 20.71 min. compared to 102 +/- 7.51 min. following laparotomy. Also the hospital stay was 44.62 +/- 19.96 hrs following laparoscopy versus 76.8 +/- 26.29 hrs following laparotomy. The difference was statistically significant in these two aspects. Laparoscopy is safe and effective in management of adnexal pathologies with minimal hospital stay, when care is taken to avoid rupture and spillage of cyst contents, and thorough inspection of the mass and abdominal cavity is made possible. Thorough preoperative sonographic scoring, tumor markers assay are essential