ABSTRACT
The most common cause of reduction in human embryo implantation afterin vitro fertilization and embryo transfer [IVF-ET] is the female age. The increase in the age of women results in reduction in the performance of the reproductive function. The aim of the present work was to determine the effect of age of women on intracytoplasmic sperm injection, in vitro embryo cleavage, embryo transfer rate, embryo implantation and pregnancy rates following intracytoplamic sperm injection and embryo transfer [ICSI-ET]. The male patients had asthenospermia with mean sperm motility of 17.15% and the mean sperm motility index was 31.21. The female patients were divided into three groups, group one, 145 women with age <31 years, group two, 129 women with age group from 31-40 years and group three, 49 women with age >40 years. The ovulation induction was induced by human menopausal gonadotropin [hMG] and human chorionic gonadotropin [hCG]. The baseline ofFSHand LH levels on cycle day 3 were significantly increased [P<0.05] in group 3 versus group 1 and 2. The estradiol concentration and the number of dominant follicles and thickness of endometrium were significantly decreased in group 3 compared to group 1 and 2 [P<0.01]. The number of the hMG ampoules was significantly [P< 0.01] higher in group 3 compared to group 1 and 2. The number of the matured oocytes per patient was significantly lower in group 3 compared to group I and 2 [P<0.05]. The ICSI rate was significantly higher in group I compared to group 2 and 3 [86.01% versus 79.07% and 75.68%, P<0.005]. Similar observations were reported in regard to embryo developmental rate and the number of embryo transferred per patient [P<0.05]. The differences between group 2 and 3 in regard to the number of embryo transferred per patient were also statistically significant. The percentage of transferable embryo quality was significantly higher in group I compared to group 2 and 3 P<0.05] and between group 2 and 3 [P<0.025]. The pregnancy rate per patient was significantly reduced in group 3 compared to group I [P<0.05]. The percentage of fetal sac development per implanted embryo was significantly reduced in group 3 compared to group 1 and 2 [25% versus 66.67%, 64.52%]. The percentage of fetal sac development per patient was significantly reduced in group three [>40 years] compared to group one [< 31 years] and group two [31-40 years]. It was concluded from the results of the present study that the advancing age of woman [more than 40 years] adversely affects ICSI, embryo transfer, embryo cleavage rates in addition to pregnancy rate. It also reduces embryo implantation and the development of viable gestation sac in the pregnant women. These effects may involve alterations in the function of the endometrium as well as the quality of the oocytes in aged women
ABSTRACT
The infertility affects about 20% to 28% of Iraqi population and the primary and secondary infertility cover 80% and 20% of infertility cases respectively. It has been shown that the major male infertility factors include oligospermia, astheno-spermia, teratospermia and azoospermia. The objective of this study was to compare the fertilizing capacity, in vitro embryonic developmental rate and embryo implantation following the use of epididymal, testicular, and ejaculated sperm in azoospermic and severely teratospermic men. The males in experiment one were divided into three groups, severely teratospermic group [STSG, n=44], azoospermic-epididymal group [ASEG, n=35] and azoospermic-testicular group [ASTG, n=40]. In experiment two the azoospermic patients were divided into two groups, obstructive [OASG, n=35] and non-obstructive [NASG, n=42]. Both groups were underwent testicular extraction and intracytoplasmic sperm injection [TESE-ICSI] treatments. Concentration of FSH, LH, prolactin was significantly higher in non-obstructive group compared to obstructive group [P<0.001]. The concentrations of testosterone and the volume of the testes were significantly higher in the obstructive group versus non-obstructive group [P <0.01]. Percentages of the fertilizable oocytes and the number of the transferred embryos per patient in the ASTG group were significantly lower compared to STSG and ASEG groups. The pregnancy and implantation rates were not significantly different in the STSG, A[S]SEG, and ASTG groups. ICSI rate and embryo developmental rate and the number of the transferred embryos per patient were significantly lower in the non-obstructive group [NASG] compared to the obstructive group [OASG] Pregnancy and viable fetus percentages were similar between both groups [P>0.05]. Sources of sperm retrieval found to have no effect on embryo implantation and pregnancy rates when viable sperm are available for ICSI. Pregnancy and viable gestation sac percentages were not affected by the etiology of azoospermia in either obstructive, or nonobstructive with focal areas of spermatogenesis were present in testes of azoospermic men
ABSTRACT
to evaluate the influence of selective metroplasty on reproductive performance of uterine fusional anomalies. Patients and this was a prospective study conducted at Baghdad University Hospital. There were 82 patients with congenital uterine fusional anomalies causing reproductive wastage. They were divided into 2 groups. Group I [n=75] had a total of 270 pregnancies and only 2 viable infants. Group II [n=7] had primary infertility. Hysterosalpingographies and diagnostic laparoscopies were done for all. Based on cavity shape/septal width and depth criteria, selection of the appropriate metroplastic procedure was made from the conventional and modified pool of option: Tompkin, Modified Tompkin, Strassmann, Baghdad, and Jones procedures. The main outcome measure was fetal survival rate. Group I: 63 patients carried term pregnancies, 39 after Baghdad, 9 after Jones, 6 after Strassmann, 5 after Tompkin, and 4 after modified Tompkin. Five continuted to abort, 2 after Jones, 1 after Tompkin, 1 after modified Tompkin, and 1 after Strassmann procedure. Seven failed to conceive, 5 after Baghdad, 1 after Tompkin, and 1 after Strassmann procedure. Group II: five patients delivered term babies, 3 after Baghdad, 1 after Jones and 1 after modified Tompkin Procedure. Two failed to conceive, 1 after Baghdad and 1 after Tompkin procedure. The overall fetal survival rate increased from 0.74% before metroplasty to 92.94% after selective repairs. selective metroplasty improves reproductive performance of congenital uterine fusional anomalies