Comfort, ease of use and practicality of the pen injector for follitropin α for assisted reproduction: an observational post-marketing study in Egypt.

OBJECTIVE: We evaluated the ease of use of a pen injector for follitropin α (recombinant human follicle-stimulating hormone [r-hFSH]) during assisted reproduction technologies (ARTs) in Egypt. METHODS: One hundred women undergoing ART completed a questionnaire in a non-interventional, observational study. The primary endpoint was patients' rating of the comfort associated with the injector. The main limitations of the study were the design and lack of knowledge regarding any impact of failure of ART on perceptions of treatment for a minority of patients. RESULTS: Patients rated the follitropin α pen injector as 'very comfortable' (61%), 'comfortable' (29%), or 'somewhat comfortable' (10%). Understanding instructions and using it were 'very easy' or 'easy' for 97-99%; 94% reported 'no' or 'minimal' difficulty with injections, 83% were 'very confident' about altering doses, 77% reported no interference with normal daily activities and 94% reported 'no' or 'minimal' stress using the device. Women with previous experience of ART rated the device as more practical than their previous injection system. Overall, 96% were 'very satisfied' or 'satisfied' with the device and 99% would recommend its use to others. Pregnancy rates were consistent with previous clinical experience. Injection site reactions occurred in 10% (all of mild severity except one moderate event). CONCLUSIONS: Positive perceptions of the follitropin α pen injector identify this device as suitable for use for Middle Eastern women undergoing ART.

Effect of metformin treatment on endometrial vascular indices in anovulatory obese/overweight women with polycystic ovarian syndrome using three-dimensional power doppler ultrasonography.

PURPOSE: Metformin has been shown to be an effective treatment for anovulatory polycystic ovary syndrome (PCOS) patients in terms of menstrual cyclicity, ovulation, and pregnancy, as well as reduction of early miscarriage rate. The aim of the study is to assess the effect of metformin on the endometrial vascular indices in anovulatory obese PCOS women using three-dimensional power Doppler sonography (3DPDUS). METHODS: A prospective study was set to determine the beneficial effects of metformin on PCOS patients. Fifty anovulatory obese PCOS patients were compared with another 50 healthy volunteers who were age- and body mass index-matched (control group). PCOS patients were treated with metformin (Glucophage; MerckSerono) 850 mg 3 times a day for 6 months. Assessment of the endometrial thickness and volume, uterine Doppler indices, and Doppler vascular indices of the endometrium and subendometrium in the periovulatory and midluteal phases were performed with 3DPDUS. RESULTS: There was a significant increase in the endometrial thickness, endometrial volume, and endometrial and subendometrial vascularity indices (vascularization index, flow index, vascularization flow index) after 6 months of metformin treatment in PCOS women, whereas there was no change in the resistance index and the pulsatility index of the uterine artery in both periovulatory and midluteal phases. CONCLUSIONS: Metformin, owing to its metabolic, endocrine, vascular, and anti-inflammatory effects, improves markers of endometrial receptivity.

Cervical twin ectopic pregnancy after in vitro fertilization-embryo transfer (IVF-ET): case report.

INTRODUCTION: Cervical twin ectopic pregnancy after IVF-ET is rare and catastrophic complication. However, here is no consensus on the best treatment strategy. PATIENT AND METHOD: Case report of cervical twin ectopic pregnancy after IVF-ET treated by transvaginal ultrasound guided aspiration plus systemic single injection of methotrexate, which followed by full-term delivery in next IVF-ET cycle. CONCLUSION: Transvaginal ultrasound-guided aspiration and systemic methotrexate administration can be safely and easily used to treat cervical ectopic pregnancies and to preserve the fertility of the patient without any major complications.

Non-mosaic Klinefelter syndrome and successful testicular sperm extraction-intracytoplasmic sperm injection procedure: case report.

INTRODUCTION: Klinefelter syndrome is the commonest chromosomal cause of non-obstructive azoospermia. Despite reports that these men can have children using assisted reproduction techniques, it is not common practice in the Egypt to offer sperm retrieval to these men. DESIGN: Case report. SETTING: Private IVF center (EIFC-IVF) and a university hospital. PATIENT: A 24-year-old woman and a 29-year-old man with non-mosaic Klinefelter syndrome. INTERVENTION: Testicular sperm extraction followed by intracytoplasmic sperm injection and embryo transfer (TESE-ICSI). RESULTS: Fifteen immotile sperms were found, five oocytes were injected, and three embryos were transferred. Now the pregnancy is progressing beyond 20 weeks. CONCLUSION: Spermatozoa from a patient with non-mosaic Klinefelter syndrome retrieved through TESE can lead to pregnancy.

Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles.

BACKGROUND: Gonadotropin-releasing hormone (GnRH) antagonist protocols for pituitary down regulation in in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) allow the use of GnRH agonists for triggering final oocyte maturation. Currently, human chorionic gonadotropin (HCG) is still the standard medication for this purpose. The effectiveness of triggering with a GnRH agonist compared to HCG measured as pregnancy and ovarian hyperstimulation(OHSS) rates are unknown. OBJECTIVES: To compare the effectiveness of a GnRH agonist with HCG for triggering final oocyte maturation in IVF and ICSI patients undergoing controlled ovarian hyperstimulation in a GnRH antagonist protocol followed by embryo transfer.  SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE , EMBASE, the National Research Register, the Medical Research Council's Clinical Trials Register, and the NHS Centre for Reviews and Dissemination database. We also examined the reference lists of all known primary studies and review articles, citation lists of relevant publications and abstracts of major scientific meetings. SELECTION CRITERIA: All randomised controlled studies (RCTs) reporting data comparing clinical outcomes for women undergoing IVF and ICSI cycles and using a GnRH agonist in comparison with HCG for final oocyte maturation triggering. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: We identified 11 RCTs (n = 1055). Eight studies assessed fresh autologous cycles and three studies assessed donor-recipient cycles. In fresh-autologous cycles, GnRH agonist was less effective than HCG in terms of the live birth rate per randomised woman (OR 0.44, 95% CI 0.29 to 0.68; 4 RCTs) and ongoing pregnancy rate per randomised woman (OR 0.45, 95% CI 0.31 to 0.65; 8 RCTs). For a group with a 30% live birth or ongoing pregnancy rate using HCG, the rate would be between 12% and 22% using an GnRH agonist. Moderate to severe ovarian hyperstimulation syndrome (OHSS) incidence per randomised woman was significantly lower in the GnRH agonist group compared to the HCG group (OR 0.10, 95% CI 0.01 to 0.82; 5 RCTs). For a group with a 3% OHSS rate using HCG the rate would be between 0% and 2.6% using GnRH agonist. In donor recipient cycles, there was no evidence of a statistical difference in the live birth rate per randomised woman (OR 0.92, 95% CI 0.53 to 1.61; 1 RCT). AUTHORS' CONCLUSIONS: We do not recommend that GnRH agonists be routinely used as a final oocyte maturation trigger in fresh autologous cycles because of lowered live birth rates and ongoing pregnancy rates. An exception could be made for women with high risk of OHSS, after appropriate counselling.

Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis.

BACKGROUND: Recently, dopamine agonists were proposed as a prophylactic treatment for ovarian hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles. METHODS: We conducted a systematic review and meta-analysis of randomized trials comparing the prophylactic effect of the dopamine agonist, cabergoline, versus no treatment in IVF/ICSI cycles. Primary outcome was OHSS incidence per randomized woman. Secondary outcomes were live birth rate, ongoing pregnancy rate, clinical pregnancy rate and miscarriage rate. Searches (until September 2009) were conducted in MEDLINE, EMBASE, Science Direct, Cochrane Library and databases of abstracts. RESULTS: Four randomized trials entailing 570 women were included. There was evidence of a statistically significant reduction in the incidence of OHSS in the cabergoline group (OR 0.41, 95% CI 0.25-0.66) with an absolute risk reduction of 12% (95% CI 6.1-18.2%), but there was no statistically significant evidence of a reduction in severe OHSS (OR 0.50, 95% CI 0.20-1.26). There was no evidence for a difference in clinical pregnancy rate (OR 1.07, 95% CI 0.70-1.62) and miscarriage rate (OR 0.31, 95% CI 0.03-3.07). CONCLUSION: Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence, but not the severity of OHSS, without compromising pregnancy outcomes.

Firm versus soft embryo transfer catheters under ultrasound guidance: does catheter choice really influence the pregnancy rates?

In contrast to the previously published evidence, under ultrasound guidance, individual catheter choice does not statistically significantly affect the clinical pregnancy rate in a modern clinical IVF practice. This may be as a result of decreasing the incidence of difficult transfers and endometrial injury with ET under ultrasound guidance.

Clinical outcome following stimulation with HMG versus highly purified HMG in patients undergoing ICSI.

Current purification processes allow the production of highly purified human menopausal gonadotrophin (HP-HMG), with human chorionic gonadotrophin (HCG) constituting most of its LH-like activity. This retrospective study aimed to compare the effectiveness of HP-HMG to the widely used traditional human menopausal gonadotrophin (HMG) preparation. A total of 174 women undergoing intracytoplasmic sperm injection cycles were allocated to either HMG or HP-HMG for ovarian stimulation. The number of mature oocytes was significantly higher in the HP-HMG group (14.72 +/- 7.81) than in the HMG group (12.15 +/- 11.07) (P < 0.05). However, the number of good quality embryos was not significantly different between both groups (HMG: 1.65 +/- 1.54; HP-HMG: 1.78 +/- 1.41). Similarly, there was no statistically significant difference in number of embryos transferred per woman (HMG: 3.95 +/- 1.87; HP-HMG: 4.27 +/- 1.60). The pregnancy rate per woman was 38.39% versus 51.79% in the HMG- and HP-HMG-treated groups respectively. These findings suggest that HP-HMG produces more mature oocytes than ordinary HMG, but similar pregnancy rates.

Metformin reduces abortion in pregnant women with polycystic ovary syndrome.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are considered to be at increased risk of miscarriage. Since metformin has beneficial effects on the risk factors contributing to first-trimester abortion in PCOS patients, we hypothesized that metformin - owing to its metabolic, endocrine, vascular and anti-inflammatory effects - may reduce the incidence of first-trimester abortion in PCOS women. MATERIALS AND METHODS: A prospective cohort study was set up to determine the beneficial effects of metformin on PCOS patients during pregnancy. Two hundred non-diabetic PCOS patients were evaluated while undergoing assisted reproduction. One hundred and twenty patients became pregnant while taking metformin, and continued taking metformin at a dose of 1000-2000 mg daily throughout pregnancy. Eighty women who discontinued metformin use at the time of conception or during pregnancy comprised the control group. RESULTS: Both groups were similar with respect to all background characteristics (age, body mass index, waist/hip ratio, follicle-stimulating hormone, luteinizing hormone, estradiol and dehydroepiandrosterone sulfate levels). Rates of early pregnancy loss in the metformin group were 11.6% compared with 36.3% in the control group (p < 0.0001; odds ratio = 0.23, 95% confidence interval 0.11-0.42). CONCLUSIONS: Administration of metformin throughout pregnancy to women with PCOS was associated with a marked and significant reduction in the rate of early pregnancy loss.

Use of metformin for prevention of ovarian hyperstimulation syndrome: a novel approach.

In the present study, which includes 287 participants, metformin has been used by women undergoing IVF/intracytoplasmic sperm injection for more than 5 weeks before and during treatment and during luteal phase. There was no significant difference in number of gonadotrophins used, days of stimulation, number of oocytes retrieved, and number of embryos replaced. There was no significant difference in clinical pregnancy rate between both groups but there was significant reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) in the group taking metformin. Metformin is a safe, cheap drug that can help in prevention of OHSS.