Combination of zygote andembryo morphology scoring couldaccurately aid to predict the outcomeof intra-cytoplasmic sperm injectionprocedures

This study was designed to examine the relationship between zygoteand embryo morphology as judged by Z-scoring and Embryo scoring systems, and to test whether these scores could be used to predict accurate-ly the outcome of cycles of intracytoplasmic sperm injection[ICSI] judged by detection of chemical pregnancy. The study comprised 78 infertile couples that had undergone ICSI. After ICSI procedure, oocytes were cultured and assessed for the presence of pronuclei after 16-18 h of incubation. Zygotes were scored for the position of pronuclei, position and type of nucleoli and cytoplasmic morphology, each parameter was awarded a scoreof 5 points. Embryos were scored for the blastomere volume and synchrony of cleavage, the level of multinucleation and the extent of fragmentation, each of parameter was awarded a score of 5 points. Zygotes and embryos awarded score of 15 were categorized as Z1 or E1, those scored10-14 were categorized as Z2 or E2 and those scored <10 were Z3 or E3.The establishment of a chemical pregnancy was considered as a positive beta-hCG test >20 IU/L at 12 days after embryo transfer and was consid-ered for evaluation of the predictability of the outcome of ICSI procedure. The mean number of oocytes retrieved was 7.1+/-2.6_patient and succeeded fertilization was reported in 422 of a total of 536 oocytes [80.6%].There were 113 zygotes [26.16%] of Z1 score, 186 zygotes [43.06%] of Z2 score and 133 zygotes [30.78%] of Z3 score; whereas, 101 embryos [23.38%] were of E1 score, 187 embryos [43.29%] were of E2 score and144 embryos [33.33%] were of E3 score. There was a positive significant correlation between the determined zygote and embryo scores, [p<0.001].Pregnancy was diagnosed in 19 patients [24.35%], 10 females [52.63%] had embryos morphologically graded Z1E1, 4 females [21.05%] had embryos' graded Z2E2, 2 females [10.52%] had embryos graded Z1E3 and the other 3[15.79%] had their embryos graded Z1E2, Z2E1 and Z3E1, respectively. Morphological scoring depending on both zygote and embryo scoring could predict the outcome of ICSI with specificity 91.77% and ac-curacy rate of 90.05%, while depending on zygote score alone the specificity and accuracy rates were 75.79% and 73.15%, respectively and depending on embryo score only specificity and accuracy rates were 78.4%and 77.77% with a significant difference in the predictability depending on combined scores compared to that depending on either zygote score[p<0.001] or embryo score [p<0.01]. It could be concluded that morphological scoring using combination of zygote and embryo scores aid to predict accurately the outcome of ICSI procedures

Shortened exposure of oocytes tospermatozoa in in-vitro fertilization :comparative study with standard exposure

Objective: To compare the outcomes of short and standard durationsof co-incubation of gametes in in-vitro fertilization [IVF]

Study design: This study was carried out on 2 groups of female pa-tients [Group A and B], complaining of 1ry or 2 ry infertility due to tubalfactor and need treatment with IVF. Each group composed of 25 patients.Group A, Oocytes - spermatozoa exposure time was short [IH.] and groupB, standard exposure time [16 H]. Both groups were compared as re-gards:[1] Fertilization rate and incidence of polyspermia, [2] Cleavagerate, [3] Embryo quality and [4] Clinical pregnancy and implantationrates

Results:The fertilization rate and incidence of polyspermia showeda non - significant differences between the 2 groups. The fertilization ratewas [66.79%] in group A and [67.40%] in group B and incidence of poly-spermia were [1.60% and 2.17%] in group A and B respectively. As re-gards cleavage rate, there was a significant difference between both ex-posure groups, showed [91.44%] in short exposure group A and [80.43%]in standard exposure group B. Embryo quality showed a significant in-crease in percentage of Grade I embryos in short exposure group A[52.63%], versus [27.70%] in standard exposure group B. Finally, theachieved clinical pregnancy was significantly higher in short exposuregroup A [24%], compared to standard exposure group B [12%]. The im-plantation rate was also significantly higher in short exposure group A[9.33%], than in standard exposure group B [4%]

Conclusion:Short co-incubation of gametes for 1H. results in signifi-cantly improved embryo quality and pregnancy and implantation rates compared to standard exposure time. This short time achieves the samefertilization rate without having to deal with the consequences of theharmful effects normally associated with oxidative stress in standardtime.

use of oral and rectal misoprostol in management of third stage of labor

To compare the effectiveness of oral and rectal misoprostol versus combined intramuscular oxytocin and ergometrine in the management of third stage of labor. Women with low risk for post-partum haemorrhage in the 3[rd] stage of labor were allocated to review either oral misoprostol [600 ug, n = 100], or rectal misoprostol [400 ug, n = 100], or intramuscular syntometrine [5/U oxytocin and 0.5mg eryometrine, n = 100]. Clinical and hematological parameters were compared. Oral and rectal misoprostal had similar outcome variables the duration of the 3rd stage of labor and rate of manual separation of the placenta were less in misoprostol users. They also had lower 3rd stage blood loss, needed less ecobolics and none of them needed blood transfusion compared to syntometrine user. Post-partum Hb and Hct levels were significantly lower in syntometrine group than misoprostol groups. Post-partum hypertension seen more with syntometrine, while in misoprostol women had more shivering. Oral and rectal misoprostol can be used safely in the management of the 3[rd] stage of labor

Treatment strategies for luteal phase defect based on pelvic sonograghy

The objective of this study is to assess the value of transvaginal ultra-sonography in luteal phase defect / infertility patients in detection of the underlying defect, suggestion of proper treatment and to follow up the efficacy of treatment and pregnancy rate. A total of 78 infertility patients with luteal phase defect, according to premenstrual endometrial biopsies and with normal other infertility works up, were studied. All patients underwent serial pre-treatment transvaginal ultrasonography to detect the underlying follicular and endometrial defects. In subsequent cycles, treatment was given in the form of clomiphene citrate or human menopausal gonadotropin for cases of luteal phase defect with immature follicles, progesterone supplement for cases of luteal phase defect with mature follicles and clomiphene citrate or human menopausal gonadotropin for cases of luteal phase defect with luteinized immature folliclessupplement for cases of luteal phase defect with mature follicles and clomiphene citrate or human menopausal gonadotropin for cases of luteal phase defect with luteinzed unruptured follicle syndrome Follow up was done for six cycles by ultrasonography to detect the efficacy of treatment and pregnancy rate. Luteal phase defect with immature follicles was found in thirty-nine patients [50%], with mature follicles in thirty-two patients [41.03%] and with luteinized unruptured follicles in seven patients [8.97%]. Cases of luteal phase defects with immature follicles showed inadequate endometrial late proliferative and inadequate mid-late secretory growth. Cases of luteal phase defect with mature follicles and luteinized unruptured follicle syndrome showed inadequate endometrial late secretory growth. In those cases with adequate response to treatment [71 out of 78 cases], the pregnancy rate was 87.32%. It was 88.88% with clomiphene citrate and human menopausal gonadotropin in cases of luteal phase defect with immature follicles, 90% with progesterone supplement in cases of luteal phase defect with mature follicles and 60% with clomiphene citrate and l human menopausal gonadotropin in cases of luteinized unruptured follicle syndrome. The overall pregnancy rate was 79.49%. Transvaginal ultrasonography represents an easy and non-invasive method for evaluation and management of luteal phase defect. It provides immediate results for diagnosis and choice of line of treatment with improved pregnancy rate