Experience of testicular sperm aspiration in intracytoplasmic sperm injection cycles at prince Rashed Bin Al-Hassan Hospital

To determine the reproductive outcome after the application of intracytoplasmic sperm injection treatment with testicular sperms obtained by fine needle aspiration. Between August 2005 and December 2007, a total of 55 infertile women [age 21-41 years] underwent intracytoplasmic sperm injection treatment due to male factor. All male partners [age 25-71 years] were azoospermic. Duration of infertility ranged from two to 17 years. The demographic, hormonal and treatment data of both male and female partner along with the reproductive outcome were analyzed. Of the 55 male partners, 12 [21.2%] men had obstructive azoospermia, and 43 [78.8%] had non-obstructive azoospermia. After intracytoplasmic sperm injection treatment, the fertilization and implantation rates were 68.8% and 21.1%, respectively. Twenty-eight of 55 [50.9%] women achieved pregnancy. Seven women of 28 [25%] had multiple pregnancy. Delivery took place in 23 women [41.8%] of which 16 [69.6%] were full-term and seven [30.4%] were preterm pregnancies [<37 weeks]. Abortion occurred in five women [17.8%]. No complications after the testicular fine needle aspiration procedure were encountered. Intracytoplasmic sperm injection treatment is associated with high pregnancy rate after testicular fine needle aspiration of sperms from patients with obstructive and non-obstructive azoospermia. The procedure is simple, noninvasive, repeatable with no/or minimal complications

Dietary intervention versus metformin to improve the reproductive outcome in women with polycystic ovary syndrome a prospective comparative study

To compare the clinical results and reproductive outcome in obese women with polycystic ovary syndrome [PCOS] following dietary intervention or treatment with metformin. Forty-six patients with PCOS were studied prospectively in Prince Rashed Hospital, Irbid, Jordan, between January 2003 and April 2005. The women were randomly divided into 2 groups: Group 1 [n=24] was prescribed with 1200-1400 kcai/day diet [25% proteins, 25% fat, and 50% carbohydrates plus 25-30 gm of fiber per week]. Group 2 [n=22] was assigned to take 850 mg of metformin twice in a continuous manner. Both treatments continued for 6 months. Clinical and biochemical data, before and after both treatments along with the reproductive outcome were compared between the 2 groups. There were no significant differences between the 2 groups in terms of age, body mass index [BMI] and duration of infertility. Both groups had a significant improvement after treatment in the menstrual cyclicity [66.7% and 68.2% versus 12.5% and 18.2%] and significant reduction in BMI [mean of 27.4 and 27.8 versus 32.2 and 31.9], luteinizing hormone levels [7.9 +/- 1.7 and 6.9 +/- 1.8 versus 11.8 +/- 2.2 and 11.5 +/- 1.8], and androgen [testosterone, audrosteuedione, dehydroepiatidrosterone sulfate] concentration. The clinical, biochemical, and reproductive outcome including menstrual cycle pattern, ovulation, and pregnancy rates were similar in both groups after treatment. Amelioration of hyperinsulinemia and hyperandrogenemia with dietary intervention or metformin treatment improves significantly the clinical features and reproductive function in overweight PCOS women

Multiple cesarean section. the impact on maternal and fetal outcome

To evaluate the complications, and to determine maternal and fetal risks in women who undergo 3 or more cesarean sections [CS], compared to those with one or 2 cesarean deliveries. A retrospective analysis of 2276 CS performed between 1 January 2003 and 31 April 2005. We divided patients into 3 groups: Group 1 = with 1 previous CS [n=1183]; Group 2 = 2 previous CS [n=781]; and Group 3 = >3 previous CS [n=312]. Compared to women with one or 2 cesarean deliveries, women who had >3 CS show significant increase in terms of prolonged operative time, uterine scar dehiscence, uterine rupture, placenta previa, placental adherence, and mild adhesion formation. We found no significant differences between the 3 study groups in terms of injury to surrounding structures, need for blood transfusion, anesthesia complications, hematoma formation, thromboembolism, and incisional hernia. Apgar score >7 at one and 5 minutes, neonatal intensive care unit, multiple pregnancy rate, premature delivery rate and perinatal death rate, all were similar in the 3 groups. Women with multiple CS [>3] are significantly prone to have uterine scar rupture and abnormal placentation in the subsequent pregnancies compared to those with one or 2 previous cesarean deliveries. Despite that, maternal and neonatal outcome did differ from patients with lower-order cesarean sections

Omphalocele containing bowel, liver and spleen. A case report

In this case report, we describe a case of large omphalocele in which spleen was one of the contents in addition to the liver and bowel

Frequency of scrotal abnormalities detected by ultrasound in infertile men at King Hussein medical center

To determine the frequency of ultrasonographically detected intra-and extra-testicular abnormalities and the significance of oligospermia and azoospermia in men compared with that in normospermic controls. One hundred fifty six infertile men [117 oligospermia, sperm count <10x 10 [6] /ml, and 39 azoospermia, study group] aged 23-52 years [mean +/- SD, 27 +/- 7.3] and 100 control group aged 24-56 years [mean +/- SD, 26 +/- 8.4] were evaluated for the presence of scrotal abnormalities using high-frequency transducers and color Doppler imaging. Testicular volume, semen parameters, and hormonal levels were recorded. Fisher's exact test was used to determine difference between the two groups. One hundred thirty three of 156 [85.3%] patients in the study group had abnormal findings at scrotal ultrasonography compared with 30% of the controls. This difference was statistically significant [p<0.001]. These included varicocele in 53.8% vs 31% [p<0.01], testicular microlithiasis in 28.2% vs 2% [p<0.001], hydrocele in 46.2% vs 33% [p<0.05], epididymal cyst in 11.5% vs 3% [p<0.05], and epididymal enlargement in 10.3% vs 3% [p<0.05]. Utrasound shows a significantly higher frequency of intra- and extra-testicular abnormalities in oligospermia and azoospermia patients compared with the normospermic controls. Detection of these abnormalities by ultrasound may reflect their fertility status

Cesarean section rate: a comparative retrospective study

this study was conducted to determine the Jordanian cesarean rate and to examine the related indications for cesarean section in comparison with some international rates. Setting seven military hospitals of Jordan. patients and methods during the period from January 1997 to December 1998, a total of 44055 deliveries that took place were evaluated retrospectively for mode and conduction of delivery. 4229 cesarean sections were performed. According to the indications, cesarean deliveries were classified into five categories: breech presentation, dystocia, repeat cesareans, fetal distress, and "other". out of 44055 deliveries conducted during the study period, 4229 cesarean sections were performed with incidence 9.6%. breech presentation accounts for 22% of cesarean sections, followed by repeat cesarean section 21.5%, dystocia 19.5%, fetal distress 14% and the category "other" 23%. the study showed a lower cesarean rate in Jordan as compared with the international rates, which is attributed to the lower frequencies of cesarean section for dystocia and repeat cesarean section. Policies, such as active management of of labor, trial of scar will achieve acceptable cesarean rate

Didelphys uterus associated with haematocolpos and ipsilateral renal agenesis presented as acute abdomen

Malformation of the female genital tract can be associated with various urinary tract anomalies, but double uterus with partially or completely obstructed vagina, and ipsilateral renal aplasia is quite rare. The clinical presentation varies, depending on the utero- vaginal relationship which may obscure the true diagnosis. Because menses in patients with this syndrome are rarely regular, the physician can easily overlook the possibility of this diagnosis. We describe a case of didelphys uterus associated with haematocolpos and ipsilateral renal agenesis presented as acute abdomen