Pre-Implantation Gender Selection: Family Balancing in Jordan.

PURPOSE: To find out whether couples with predominant female offspring have more chances to produce more female embryos during non-medical pre-implantation genetic diagnosis (PGD) for male sex selection. METHODS: A total of 125 couples who had three or more female offspring and underwent non-medical PGD for male sex selection between 2015 and 2019 were included. Nuclear DNA was analyzed by fluorescent in situ hybridization (FISH). Two-chromosome (X, Y), 3-chromosome (21, X, Y), and 5-chromosome (13, 18, 21, X, Y) probes were used for FISH. The standard protocol was followed for sperm processing and embryo culture for IVF and PGD. RESULTS: In 83.2% of the couples, the ratio of female embryos was higher than male embryos. Independent sample t-test showed that there is no significant difference between equal and unequal embryonic groups in patients' age, husbands' age, sperm count, sperm motility, total male embryos, total female embryos, normal male embryos, and normal female embryos. For patients with positive pregnancy outcome, 84.6% had unequal embryonic ratio while 15.4% had equal embryonic ratio. Similarly, patients who were treated by short protocol had 85% of unequal embryonic ratio and 15% had equal ratio. CONCLUSION: A greater variability in the female to male embryonic ratio is produced in couples having predominantly female offspring and seeking non-medical PGD for male sex selection.

Androgens and hirsutism score of overweight women with polycystic ovary syndrome improved after vitamin D treatment: A randomized placebo controlled clinical trial.

BACKGROUND & AIM: The objective of this study was to investigate the effect of vitamin D treatment on androgen levels and hirsutism scores in overweight women with PCOS. METHODS: A prospective, randomized, double-blind, placebo-controlled clinical study was conducted at King Abdullah University Hospital in Irbid, Jordan. Overweight Jordanian females aged 18-49 years with vitamin D deficiency and PCOS (n = 60) were assigned to two groups: the treatment group (n = 30) who received 50,000 IU per week of vitamin D3 and the control group (n = 30) who received a placebo. RESULTS: After receiving the treatment for 12 consecutive weeks, the levels of total testosterone, parathyroid hormone, free androgen index, and hirsutism score were significantly decreased (P < 0.001), and the levels of 25-hydroxyvitamin D (25(OH)D), sex hormone binding globulin, and phosphorus were significantly increased (P < 0.05). Furthermore, significant changes were observed in ovarian volume and follicle numbers and size ultrasonography, and in the regularity of the menstrual cycle (P < 0.001). In the placebo group, no significant changes were observed in either androgen levels, hirsutism score, or menstrual regularity. CONCLUSION: Vitamin D3 at a treatment dose of 50,000 IU per week improved 25(OH)D levels and decreased the hirsutism scores and androgen levels of overweight women with PCOS. These results could mean increased fertility and better reproductive health for overweight women with PCOS; the use of vitamin D3 as a treatment for these patients should be further investigated. CLINICALTRIALS. GOV REGESTRATION NUMBER: NCT02328404.

The practice of intracytoplasmic sperm injection in Jordan: A clinical outcome study.

OBJECTIVE: The lack of appropriate guidelines and justified practice in most developing countries is a serious limitation to efforts to qualify the services provided. In this paper, we evaluate and assess the clinical practice of an assisted reproductive technique of intracytoplasmic sperm injection (ICSI) in Jordan. METHODS: Retrospectively, we identified women who achieved a successful pregnancy by ICSI over a period of ten years. Information related to the ICSI procedure, foetus abnormalities, maternal complications and delivery outcomes were included. A control group of normal pregnancies were incorporated. RESULTS: In total, 291 cases were included as successful cases of ICSI with a success rate of 14.1%. For the control group, 466 pregnant women with normal pregnancies were included. No statistical difference was observed between both groups in foetus malformation. In normal pregnancy women, 42.1% delivered through caesarean section (CS) while 87.6% of ICSI patients underwent CS. Women with ICSI had significantly higher rates of multiple gestations, and their neonates were lower in birthweight. Women in the ICSI group tended to deliver females compared to the control group. Pregnancy-related hypertension was more commonly reported in the normal pregnancy group, while gestational diabetes, antepartum haemorrhage and preterm labour were more common in ICSI group. CONCLUSION: Services for the management of infertility are increasing in the Middle East. The clinical outcomes in Jordan is approaching that of other developed regions, although the success rate is lower than in other regions. Further studies and efforts should be carried out to maximize effective and successful practice in such low-income areas.

Factors that influenced pregnant women with one previous caesarean section regarding their mode of delivery.

BACKGROUND: During the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. MATERIAL AND METHODS: A cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. RESULTS: About 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients' choice that our study revealed was "being informed about the complications of TOLAC". The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. CONCLUSION: Proper counselling is a main factor that affected the patients' choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC.

Morbidly adherent placenta previa in current practice: prediction and maternal morbidity in a series of 23 women who underwent hysterectomy.

OBJECTIVE: To assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used. MATERIALS AND METHODS: This is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search. RESULTS: A total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group. CONCLUSION: MAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.

Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia.

BACKGROUND: We compared the efficacy of microdissection testicular sperm extraction (microdissection TESE) and conventional TESE in patients with non-obstructive azoospermia (NOA) and related the positive sperm recovery to certain variables: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, testicular volume and histology. METHODS: Sperm retrieval rates (SRR) in patients with NOA who underwent microdissection TESE (n = 65) or conventional TESE (n = 68) were compared and related to the different variables. RESULTS: SRR by microdissection TESE (56.9%) was significantly higher than conventional TESE (38.2%). There was a positive relation between the SRR and increased testicular volume or decreased FSH levels. No effect of Testosterone or Prolactin levels on SRR by using either technique was observed. Sperm were recovered from those with hypospermatogenesis in 84% and 92.9% by conventional and microdissection TESE, respectively (P = 0.3). In cases of maturation arrest the SRR was 27.3% and 36.4%, respectively (P = 0.6). In cases of Sertoli-cell-only syndrome (SCOS) the SRR was 6.2% and 26.9%, respectively (P = 0.03). No major operative complications occurred in any patient in either group, and no patient required post-operative hormone replacement to treat hypogonadism. CONCLUSIONS: Microdissection TESE significantly had twice better probability of success of SRR when compared to conventional TESE. No secure pre-operative prognostic elements of sperm recovery exist for NOA patients. Microdissection TESE appears to be recommendable in cases of atrophied testicles, high FSH concentration, or when SCOS with high FSH concentration can be predicted.

Attitudes of graduating medical doctors toward using sex selection techniques in Jordan in 2009.

OBJECTIVES: The aim of this study was to describe the attitude of graduating medical doctors toward the use of sex selection techniques in Jordan in 2009. MATERIALS AND METHODS (DESIGN): A self-administered questionnaire was used to assess attitude toward using sex selection. Demographic variables, gender preference of future children, and score on attitude toward using technology scale were used as independent variables. RESULTS: A total of 254 doctors (178 males, 76 females) completed the questionnaire. Forty-one (16.1%) doctors thought that sex selection as PGD should be strictly prohibited and 45 (17.7%) thought it should be allowed freely. More than half (54.7%) of them thought it should only be available for medical reason. Only 59 (23.2%) reported that they may consider the use of sex selection technology to choose their future children. Participants who preferred their firstborn child to be a boy or those who preferred their first born child to be a girl were more likely to use sex selection than those without preference. Christian participants were more likely to use sex selection technology than Muslim participants, 9 (47.4%) versus 50 (21.3%). For each one-point increase in Attitude score, the odds of using sex selection increased by 20%. CONCLUSIONS: The majority of graduating medical doctors believed that sex selection should be restricted and they were not willing to use it.

Jordanian obstetricians' personal preference regarding mode of delivery.

The personal preference of Jordanian obstetricians regarding mode of delivery in uncomplicated pregnancy with singleton cephalic presentation at term was surveyed by an anonymous structured questionnaire distributed at five conferences/scientific meetings on obstetrics and gynecology held in Jordan in 2007. The response rate was 70% (n=315), and 22 (7%) of the respondents chose elective cesarean section (CS). Respondents <45 years seemed to be more in favor of elective CS than those >or=55 years (14.1% vs. 3.7%). In multivariate analysis, increased age was inversely associated with the odds of choosing elective CS (OR = 0.93, 95% CI: 0.88-0.99, p=0.024) after adjusting for gender, sector, and duration of practice. The main reasons for preferring abdominal delivery were the fear of long-term sequel (stress incontinence and anal sphincter damage) and the wish to preserve sexual function (86.4 and 50.0%, respectively). The majority of Jordanian obstetricians and gynecologists preferred vaginal delivery in uncomplicated pregnancy for themselves or their wives.

A male phenotype (XY) hermaphrodite treated for seminoma, fathered a healthy child by IVF-ICSI technique.

OBJECTIVE: To report a successful delivery of a healthy infant fathered by an infertile 46, XY true hermaphrodite who suffered from a seminoma. DESIGN: Case report SETTING: IVF unit in University hospital. PATIENT(S): Male 41 years (true hermaphrodite), his wife 35 years. MAIN OUTCOME MEASURES: Laboratory, pathology tests and ultrasound tests. RESULTS: The above patient treated and cured from seminoma, the couple had in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) using frozen testicular sperm and had a healthy baby. CONCLUSION: This is the first case report of a successful delivery of a healthy infant fathered by an infertile 46, XY true hermaphrodite who suffered from a seminoma. Once treated and cured, the couple had IVF and ICSI using frozen testicular sperm and had a healthy baby.

Emergency peripartum hysterectomy in Northern Jordan: indications and obstetric outcome (an 8-year review).

OBJECTIVE: To review cases of emergency peripartum hysterectomy regarding their incidence, risk factors, indications and complications and their results were carefully analysed. MATERIALS AND METHODS: A retrospective study of cases of emergency peripartum hysterectomy which were performed in the period between February 1994 and February 2002 at the Princess Badeea Teaching Hospital in Northern Jordan. Demographic and clinical data were extracted and closely interpreted RESULTS: In the study period there were a 70,252 deliveries and 61 cases of emergency peripartum hysterectomies. The overall incidence was 0.87 peripartum hysterectomies per 1,000 deliveries. There were 50 cases (82%) delivered by caesarean section and 11 cases (18%) were delivered vaginally. Caesarean hysterectomy was performed in 50 cases and postpartum hysterectomy was performed in 11 cases. Total hysterectomy was performed in 39 cases (64%) and subtotal hysterectomy was performed in 22 cases (36%). The main indications for hysterectomy were morbidly adherent placenta (47.5%), ruptured uterus (27.9%) and uncontrollable haemorrhage from uterine atony (21.3%). There were two maternal deaths and 7 cases of stillbirths and 4 cases of early neonatal deaths. CONCLUSION: Peripartum hysterectomy is a dramatic with high risk but a life saving operation. It is usually associated with significant maternal and fetal morbidity and mortality. Obstetricians should identify patients at risk and anticipate the procedure and complications, as early intervention and proper management facilitate optimal outcome.

Luteal phase support in ovarian induction cycles using human chorionic gonadotropin or oral progestagens.

OBJECTIVE: To determine the efficacy of luteal phase support with human chorionic gonadotropin (hCG) or oral progesterone during human menopausal gonadotropin (hMG) ovulation induction. METHODS: Between September 1999 and March 2001, a total of 91 couples with infertility were recruited at Al-Hammadi Hospital, Riyadh, Kingdom of Saudi Arabia and Badeea Hospital, Jordan. In this prospective trial 46 couples were allocated to luteal phase support with hCG injections, while 45 couples were allocated to Duphaston (oral progestogens) as luteal support. RESULTS: In the group of hCG luteal support, 46 patients completed 46 cycles of hMG therapy, and 8 pregnancies (5 ongoing pregnancies) ensued, with a general total pregnancy rate of 17.4%. In the progesterone (Duphaston) luteal support group, 45 patients with the similar indications to the previous group were studied and 8 pregnancies (5 ongoing pregnancies) were reported with a general total pregnancy rate of 17.8%. Only one spontaneous abortion occurred among the patients in a cycle supported with supplemental hCG, while 2 abortions occurred in the Duphaston supported group. CONCLUSION: Despite theoretical reasons to use luteal phase support during hMG-stimulated cycles, our data showed no improvement in pregnancy rates from such treatment.