Publications by authors named "Mona Aboulghar"

23 Publications

  • Page 1 of 1

Prenatal delineation of a distinct lethal fetal syndrome caused by a homozygous truncating KIDINS220 variant.

Am J Med Genet A 2020 12 10;182(12):2867-2876. Epub 2020 Sep 10.

Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt.

Kinase D-interacting substrate of 220 kDa (KIDINS220) is a transmembrane protein playing integral role in growth mediating pathways in the nervous and cardiovascular systems. KIDINS220 heterozygous truncating variants that affect the protein's C-terminus have been associated with a phenotype, so far described only in few unrelated children, including spastic paraplegia, intellectual disability, nystagmus, and obesity. More recently, a homozygous, more N-terminal truncating variant in KIDINS220 gene was suggested to be associated with enlarged cerebral ventricles and limb contractures in three fetuses from a consanguineous family. We confirm the latter finding by presenting the first detailed prenatal identification of a fetal phenotype associated with novel homozygous deleterious frameshift variant in KIDINS220 gene in a consanguineous healthy Egyptian couple. History of unexplained seven miscarriages and a similar stillbirth were recorded. Prenatal ultrasonography revealed limb contractions and ventriculomegaly; in addition to previously unreported cerebellar anomalies, cardiac anomalies and hydrops fetalis. These findings represent an expansion of clinical and molecular spectrum associated with KIDINS220 variants and broaden our understanding of genotype-phenotype relationships in lethal congenital contractures syndromes and associated severe abnormal embryological development. More generally, our study adds KIDINS220 to the rare group of genes which may cause disease by either of two distinct mutational mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ajmg.a.61858DOI Listing
December 2020

Raine syndrome: Prenatal diagnosis based on recognizable fetal facial features and characteristic intracranial calcification.

Prenat Diagn 2020 12 14;40(12):1578-1597. Epub 2020 Sep 14.

Department of Clinical Genetics, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt.

Objective: The purpose of this study was to elucidate the facial morphology and the pattern of internal malformations in three fetuses with RS born to first cousins of Egyptian decent.

Methods: The fetal ultrasonography findings were highly suggestive of RS leading to targeted Sanger sequencing of FAM20C and postnatal assessment.

Results: The prenatal ultrasound findings of osteosclerotic skull, exorbitism, hypoplastic nose, midface hypoplasia, small mouth with down-curved corners, and a distinct and recognizable pattern of intracranial calcification were identified in three fetuses with RS. The calcifications were evident specifically around the corpus callosum and/or ventricular walls. Ectopic renal and hepatic calcifications, pulmonary hypoplasia, mild rhizomelic shortening of the upper limbs, intrauterine fractures, and cerebellar hypoplasia were also noted. Molecular analysis identified three novel homozygous variants, two frameshift: [c.456delC (p.Gly153Alafs*34)] in exon 1 and [c.905delT (Phe302Serfs*35)] in exon 4 and one nonsense mutation in exon 10, [c.1557C>G(p.Tyrs519*)]. The three variants were segregated with the phenotype. This is the first description of a phenotype associated with homozygous truncating variants of FAM20C.

Conclusion: RS has characteristic prenatal ultrasound findings which can improve the prenatal identification of this condition and help in guiding the molecular diagnosis and counseling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pd.5818DOI Listing
December 2020

Response to letter from Okoye JO and Ngokere AA "Are the prevalence of Trisomy 13 and the incidence of severe holoprosencephaly increasing in Africa?"

Prenat Diagn 2020 12 13;40(12):1618-1619. Epub 2020 Aug 13.

Human Cytogenetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pd.5804DOI Listing
December 2020

The effect of early administration of rectal progesterone in IVF/ICSI twin pregnancies on the preterm birth rate: a randomized trial.

BMC Pregnancy Childbirth 2020 Jun 9;20(1):351. Epub 2020 Jun 9.

The Egyptian IVF center Maadi, 3, St. No. 161-Hadayek El-Maadi, 11431, Cairo, Egypt.

Background: The rate of multiple pregnancies in IVF/ICSI ranges from 20 to 30%. The incidence of preterm birth in multiple pregnancies is as high as 60% and is even higher in pregnancies conceived after IVF & ICSI. The effect of progesterone on prevention of preterm birth in twins is controversial. Our group has proven a positive effect in reduction of preterm birth, by starting progesterone from the mid-trimester, in exclusively IVF/ICSI singleton pregnancies but not twins. The purpose of our current study was to explore the effect of earlier administration of natural progesterone, in IVF/ICSI twin pregnancies starting at 11-14 weeks for prevention of preterm birth.

Methods: This is a double-blind, placebo controlled, single center, randomized clinical trial. Women with dichorionic twin gestations, having an IVF/ICSI trial were randomized to receive natural rectal progesterone (800 mg daily) vs placebo, starting early from 11 to 14 weeks. They also received oral and vaginal antimicrobial agents as part of our routine treatment for vaginitis and urinary tract infection. They were randomized regardless of cervical length and had no previous history of preterm birth or known Mullerian anomalies. The primary outcome was spontaneous preterm birth rate before 37 weeks. The secondary outcome was; spontaneous preterm birth before 34, 32, 28 weeks and neonatal outcome.

Results: A total of 203 women were randomized to both groups, final analysis included 199 women as 4 were lost to follow up. The base line characteristics as well as gestational age at delivery were not significantly different between the study and the placebo group (34.7 ± 3.6 vs 34.5 ± 4.5, P = 0.626). Progesterone administration was not associated with a significant decrease in the spontaneous preterm birth rates before 37 weeks (73.5% vs 68%, P = 0.551), before 34 (20.6% vs 21.6%, P = 0.649), before 32 (8.8% vs 12.4%, P = 0.46) & before 28 (4.9% vs 3.1%, P = 0.555) weeks.

Conclusions: Rectal natural progesterone starting from the first trimester in IVF/ICSI twin pregnancies did not reduce spontaneous preterm birth.

Trial Registration: The trial was registered on 31 January 2014 at www.ISRCTN.com, number 69810120.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-020-03033-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285559PMC
June 2020

Prenatal ultrasound findings of holoprosencephaly spectrum: Unusual associations.

Prenat Diagn 2020 04 10;40(5):565-576. Epub 2020 Feb 10.

Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt.

Objective: The objective of this study is to evaluate the prenatal diagnosis, postnatal characteristics, and the spectrum of associated findings in fetuses with holoprosencephaly (HPE).

Methods: Fetal neurosonograms, postnatal assessment, and chromosomal analysis were performed in a cohort of 25 fetuses with HPE.

Results: The prevalence of HPE in high-risk pregnancies was 4.4:10 000. The alobar subtype was the most frequently encountered, with 17 cases (68%). Interestingly, among them, four cases (16%) presented with the rare agnathia-otocephaly complex. Chromosomal abnormalities were detected in 11 cases (44%), the most frequent being trisomy 13 in seven cases (five alobar, one semilobar, and one lobar HPE), followed by trisomy 18 in two cases with semilobar HPE. One case of alobar HPE had 45, XX, t(18;22) (q10;q10), -18p karyotyping, and one case of semilobar HPE was associated with triploidy. Facial malformations in HPE spectrum ranged from cyclopia, proboscis, and arrhinia that were associated with the alobar subtype to hypotelorism and median cleft that were frequent among the semilobar and lobar subtypes. Associated neural tube defects were identified in 12% of cases.

Conclusion: Our study illustrates the clinical and genetic heterogeneity of HPE and describes different chromosomal abnormalities associated with HPE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pd.5649DOI Listing
April 2020

Fetal heart examination at the time of 13 weeks scan: a 5 years' prospective study.

J Perinat Med 2019 Oct;47(8):871-878

Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.

Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpm-2019-0222DOI Listing
October 2019

Does intrauterine injection of low-molecular-weight heparin improve the clinical pregnancy rate in intracytoplasmic sperm injection?

Clin Exp Reprod Med 2016 Dec 26;43(4):247-252. Epub 2016 Dec 26.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Egyptian IVF and ET Center, Cairo, Egypt.

Objective: Heparin can modulate proteins, and influence processes involved in implantation and trophoblastic development. This study aimed to assess the improvement of clinical pregnancy and implantation rates after local intrauterine injection of low-molecular-weight heparin (LMWH) in patients undergoing intracytoplasmic sperm injection (ICSI).

Methods: A randomised case/control design was followed in women scheduled for ICSI. The study arm was injected with intrauterine LMWH during mock embryo transfer immediately following the ovum pickup procedure, while the control arm was given an intrauterine injection with a similar volume of tissue culture media. Side effects, the clinical pregnancy rate, and the implantation rate were recorded.

Results: The pregnancy rate was acceptable (33.9%) in the LMWH arm with no significant reported side effects, confirming the safety of the intervention. No statistically significant differences were found in the clinical pregnancy and implantation rates between both groups (=0.182 and =0.096, respectively). The odds ratio of being pregnant after intrauterine injection with LMWH compared to the control group was 0.572 (95% confidence interval [CI], 0.27-1.22), while the risk ratio was 0.717 (95% CI, 0.46-1.13; =0.146). No statistical significance was found between the two groups in other factors affecting implantation, such as day of transfer (=0.726), number of embryos transferred (=0.362), or embryo quality.

Conclusion: Intrauterine injection of LMWH is a safe intervention, but the dose used in this study failed to improve the outcome of ICSI. Based on its safety, further research involving modification of the dosage and/or the timing of administration could result in improved ICSI success rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5653/cerm.2016.43.4.247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234286PMC
December 2016

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis.

BMJ 2016 Sep 6;354:i4353. Epub 2016 Sep 6.

Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AB, UK.

Objective: To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.

Design: Systematic review and meta-analysis.

Data Sources: Medline, Embase, and Cochrane databases (until December 2015).

Review Methods: Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks' gestation.

Results: 32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks' gestation (risk difference 1.2/1000, 95% confidence interval -1.3 to 3.6; I(2)=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I(2)=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (-12.4 to 17.4/1000; I(2)=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies.

Conclusions: To minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks' gestation; in monochorionic pregnancies delivery should be considered at 36 weeks.

Systematic Review Registration: PROSPERO CRD42014007538.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013231PMC
http://dx.doi.org/10.1136/bmj.i4353DOI Listing
September 2016

GnRH agonist plus vaginal progesterone for luteal phase support in ICSI cycles: a randomized study.

Reprod Biomed Online 2015 Jan 13;30(1):52-6. Epub 2014 Oct 13.

The Egyptian IVF Center, Maadi, Cairo, Egypt.

In this prospective randomized study, the effect of daily gonadotrophin-releasing hormone agonist (GnRHa) in the luteal phase on IVF and intracytoplasmic sperm injection (ICSI) outcomes was assessed. Women (n = 446) were counselled for IVF-ICSI, and randomized on the day of embryo transfer to group 1 (daily 0.1 mg subcutaneous GnRHa until day of beta-HCG) (n = 224) and group 2 (stopped GnRHa on day of HCG injection) (n = 222). Both groups received daily vaginal progesterone suppositories. Primary outcome was clinical pregnancy rate. Secondary outcome was ongoing pregnancy rate beyond 20 weeks. Mean age, oestradiol on day of HCG, number of oocytes retrieved, number of embryos transferred, and clinical and ongoing pregnancy rates were 28.9 ± 4.5 years, 2401 ± 746 pg/mL; 13.5 ± 6.0 oocytes; 2.6 ± 0.6 embryos, and 36.2% and 30.4% consecutively in group 1 compared with 29.7 ± 4.7 years, 2483 ± 867 pg/mL, 13.7 ± 5.5 oocytes, 2.7 ± 0.6 embryos, 30.6% pregnancy rate, and 25.7% ongoing pregnancy rate in group 2. No significant difference was found between the groups. Subcutaneous GnRHa during the luteal phase of long GnRHa protocol cycles does not increase clinical or ongoing pregnancy rates after IVF-ICSI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rbmo.2014.09.017DOI Listing
January 2015

Impact of antimüllerian hormone assays on the outcomes of in vitro fertilization: a prospective controlled study.

Fertil Steril 2014 Jan 23;101(1):134-7. Epub 2013 Oct 23.

The Egyptian IVF Center, Cairo, Egypt.

Objective: To assess the value of routine antimüllerian hormone (AMH) assays in patients considered high risk for cancellation.

Design: Prospective controlled study.

Setting: A private IVF center, Cairo, Egypt.

Patient(s): In total 4,917 patients received counseling before starting IVF/intracytoplasmic sperm injection (ICSI). They were comprised of group A1 (n = 1,335), who were considered to be at risk for cancellation after ovarian stimulation, and group A2 (n = 3,582), who were considered low risk for cancellation. A control group, B (n = 4,639), included group B1 (n = 1,248) and group B2 (n = 3,391) based on the same criteria as groups A1 and A2.

Intervention(s): An AMH assessment was performed for group A1. All of the patients were stimulated using the long GnRH agonist protocol. Patients with low AMH levels received the flare-up protocol.

Main Outcome Measure(s): The cancellation of IVF/ICSI cycles before or after stimulation, as well as the pregnancy rates (PR) in relation to AMH levels.

Result(s): The group A1 patients (6.4%) did not start IVF due to low AMH, and some (6.6%) had their cycles canceled due to poor responses, compared with 2.6% in group A2 and 13.2% in group B1. The clinical PR was 42% in patients with normal AMH and 20% in patients with low AMH. The differences among these three groups were highly significant.

Conclusion(s): The AMH assays reduced the cancellations, cost, and stress experienced by couples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2013.09.028DOI Listing
January 2014

The use of vaginal natural progesterone for prevention of preterm birth in IVF/ICSI pregnancies.

Reprod Biomed Online 2012 Aug 3;25(2):133-8. Epub 2012 Apr 3.

The Egyptian IVF Center, Maadi, Cairo, Egypt; Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

The aim of this study was to evaluate the effect of vaginal natural progesterone on the prevention of preterm birth in IVF/intracytoplasmic sperm injection (ICSI) pregnancies. A single-centre prospective placebo-controlled randomized study was performed. A total of 313 IVF/ICSI pregnant patients were randomized into two groups for either treatment with daily 400 mg vaginal natural progesterone or placebo, starting from mid-trimester up to 37 weeks or delivery. Amongst the patients, there were 215 singleton and 91 twin pregnancies. There was no significant difference in risk of preterm birth among all patients (OR 0.672, 95% CI 0.42-1.0. There was a significantly lower preterm birth rate in singleton pregnancies in the natural progesterone arm (OR 0.53, 95% CI 0.28-0.97) and no significant difference between both arms in twin pregnancies (OR 0.735, 95% CI 0.36-2). In conclusion, the administration of 400 mg vaginal natural progesterone from mid trimester reduced the incidence of preterm birth in singleton, but not in twin, IVF/ICSI pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rbmo.2012.03.013DOI Listing
August 2012

Would gestational age and presence of brain anomalies affect interobserver reliability of fetal head biometry? Using off-line analysis of 3-D dataset.

Ultrasound Med Biol 2012 Jan 21;38(1):69-74. Epub 2011 Nov 21.

Fetal and Maternal Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.

The objective was to assess interobserver reliability of fetal head biometry using archived three-dimensional (3-D) volumes and the impact of gestational age and presence of brain anomalies on examiners' performance. Seventy nine 3-D volume datasets of fetal head were examined: 27 were normal and 52 had brain abnormalities. Off-line analysis was done by three fetal medicine experts (E1, E2 and E2), all were blinded to history and patient details. Measurements of the biparietal diameter (BPD), head circumference (HC), lateral ventricle (Vp) and transcerebellar diameter (TCD) were compared between examiners and to two-dimensional (2-D) measurements. Comparisons were made at two gestational age groups (≤22 and >22 weeks) and in presence and absence of brain anomalies. The intraclass coefficient showed a significantly high level of measurement agreement between 3-D examiners and 2-D, with values >0.9 throughout (p < 0.001). Bias was evident between 3-D examiners. E2 produced smaller measurements. The mean percentage difference between this examiner and the other two in BPD, HC, Vp and TCD measurements was significant, of 1.6%, 1%, 4.9% and 1.8%, respectively. E1 measured statistically larger for HC and TCD. E3 measured significantly larger for only BPD. The presence of anomalies was of no influence on the 3-D examiners' performance except for E3 who showed bias in BPD measurements only in cases with brain anomalies. Unlike other examiners, bias of E2 was only seen at gestational age group ≤22 weeks. Limits of agreement in measurements between observers were narrow for all parameters but were widest for the Vp measurements, being ±23% of the mean difference. Despite the above bias, the actual mean difference between examiners was small and unlikely to be of any clinical significance. Off-line measurement of fetal head biometry using 3-D volumes is reliable. In our study, presence of brain anomalies was unlikely to influence the reproducibility of measurements. Gestational age seemed to be of an impact on examiners' bias. Among experts this bias may be of no clinical significance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2011.10.016DOI Listing
January 2012

Prospective, randomized study comparing highly purified urinary follicle-stimulating hormone (FSH) and recombinant FSH for in vitro fertilization/intracytoplasmic sperm injection in patients with polycystic ovary syndrome.

Fertil Steril 2010 Nov 26;94(6):2332-4. Epub 2010 Feb 26.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

In a randomized study comparing purified urinary FSH with recombinant FSH for IVF/intracytoplasmic sperm injection in patients with polycystic ovary syndrome, there was no significant difference between the mean total dose of FSH used, duration of stimulation, number of retrieved oocytes, number of mature oocytes, number of embryos transferred, or the ongoing pregnancy rate between the two groups. However, there were significantly more fertilized oocytes, a higher fertilization rate, more top-quality embryos, and more cryopreserved embryos in the urinary FSH group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2010.01.051DOI Listing
November 2010

Prospective randomized study for hydrotubation versus no hydrotubation before intrauterine insemination in unexplained infertility.

Reprod Biomed Online 2010 Apr 11;20(4):543-6. Epub 2010 Jan 11.

Faculty of Medicine, Cairo University, Cairo, Egypt.

The purpose of the study was to investigate the value of hydrotubation before intrauterine insemination (IUI). In 228 patients with the diagnosis of unexplained infertility, ovarian stimulation was performed before IUI, using 100mg of clomiphine citrate for 5 days from day 3 of the cycle and one ampoule of human menopausal gonadotrophin for 5 days from day 6 of the cycle. Folliculometry and determination of LH concentration in urine were performed daily until LH became positive, then randomization for hydrotubation before IUI versus no hydrotubation was performed. Fifteen patients were cancelled from the study due to poor response or stimulation of three or more follicles. A total of 213 patients were randomized as follows: 103 patients undergoing hydrotubation using 50 ml of saline and 110 patients with no hydrotubation. IUI was performed the following day and ongoing pregnancy occurred in 13 patients (12.6%) in the hydrotubation group and nine patients (8.2%) in the non-hydrotubation group with no significant difference (OR 1.66; 95% CI 0.62-4.63). In conclusion, hydrotubation before IUI does not improve pregnancy rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rbmo.2010.01.003DOI Listing
April 2010

Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above.

Fertil Steril 2010 Oct 6;94(5):1707-12. Epub 2009 Nov 6.

Al Azhar University, Cairo, Egypt.

Objective: To estimate the live-birth and miscarriage rates in 1-year age increments for women aged ≥40 years undergoing in vitro fertilization or intracytoplasmic sperm injection (ICSI-IVF) with autologous oocytes.

Design: Retrospective database and chart analysis.

Setting: Egyptian IVF and embryo transfer center.

Patient(s): One thousand six hundred forty-five women aged ≥40 years undergoing 2004 fresh nondonor IVF-ICSI cycles.

Intervention(s): ICSI-IVF using ejaculate or surgically retrieved sperm.

Main Outcome Measure(s): Pregnancy and live-birth rates per initiated cycle based on 1-year age increments.

Result(s): The overall live-birth rate per initiated cycle was 6.7% (range: 10% to 0.5%). The pregnancy loss rate was 44.8% (range: 39.0% to 75.0%). The cutoff age was 43 years, when the pregnancy rate became statistically significantly lower. The live-birth rate per initiated cycle was statistically significantly higher for women <43 years old, 132 out of 1766 (7.4%) compared with women ≥43 years old, 7 out of 620 (1.1%). The miscarriage rate was 127 out of 295 (43.1%) compared with 15 out of 23 (65.2%) for the two age groups, respectively.

Conclusion(s): The success rate of ICSI-IVF as measured by live-birth rate per initiated cycle was statistically significantly higher for women aged <43 years as compared with women aged ≥43 years. Once women have attained age 43 years, alternative methods such as oocyte donation cycles or previously cryopreserved embryos are likely to be more effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2009.09.044DOI Listing
October 2010

Ultrasound cervical measurement and prediction of spontaneous preterm birth in ICSI pregnancies: a prospective controlled study.

Reprod Biomed Online 2009 Feb;18(2):296-300

The Egyptian IVF-ET Centre, No.3, St 181, Hadaek El Maadi, Maadi, Cairo, Egypt.

A prospective controlled study was performed in which transvaginal ultrasound measurement of cervical length was compared in 222 twin ICSI pregnancies, 122 singleton ICSI pregnancies and 51 spontaneous singleton pregnancies. Preterm birth was defined as
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s1472-6483(10)60269-6DOI Listing
February 2009

Prospective randomized study comparing luteal phase support for ICSI patients up to the first ultrasound compared with an additional three weeks.

Hum Reprod 2008 Apr 11;23(4):857-62. Epub 2008 Feb 11.

The Egyptian IVF-ET Centre, 3 St. 161 Hadaek El-Maadi, Maadi, Cairo 11431, Egypt.

Background: There is a consensus that administration of progesterone to women after IVF for luteal phase support (LPS) is associated with a higher ongoing pregnancy rate. However there are few studies, including only one randomized study, which have examined the optimal duration of LPS.

Methods: A questionnaire concerning details of LPS was returned from 21 leading IVF centres. We then randomized 257 women, who were pregnant after ICSI on day of first ultrasound, into two groups: to continue LPS for three more weeks or to stop on the day of ultrasound.

Results: The duration of LPS in the questionnaire varied from the day of positive pregnancy test up to 12 weeks of pregnancy in different centres. In the randomized study, 132 patients in Group A continued LPS for 3 weeks after first ultrasound, whereas 125 patients in Group B stopped LPS on day of first ultrasound. After confirming pulsations, the miscarriage rate up to 20 weeks of gestation was 4.6% (6/132) in group A and 4.8% (6/125) in group B [odds ratios (OR) = 0.94; 95% confidence intervals (CI) = 0.3-3.1]. Bleeding episodes were 15.9% in Group A compared with 20.8% in group B (OR = 0.72; 95% CI = 0.38-1.36).

Conclusions: There is no international consensus about the duration of LPS; our single-centre randomized trial did not support extending the LPS beyond the day of first ultrasound demonstrating echoes and pulsations. Trials registry number-ISRCTN: 88722916.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/humrep/den012DOI Listing
April 2008

A prospective randomized study comparing coasting with GnRH antagonist administration in patients at risk for severe OHSS.

Reprod Biomed Online 2007 Sep;15(3):271-9

The Egyptian IVF-ET Centre, 3 St 161, Hadaek El Maadi, Maadi, Cairo 1143, Egypt.

This work evaluated possible advantages of gonadotrophin-releasing hormone (GnRH) antagonist administration as an alternative to coasting in prevention of severe ovarian hyperstimulation syndrome (OHSS) in women undergoing IVF/ intracytoplasmic sperm injection. A prospective randomized study comparing coasting (group A) (n = 96) and GnRH antagonist administration (group B) (n = 94) in patients at risk of OHSS was performed. The primary outcome measure was high quality embryos. The secondary outcome measures were days of intervention, number of oocytes, pregnancy rate, number of cryopreserved embryos and incidence of severe OHSS. There were significantly more high quality embryos (2.87 +/- 1.2 versus 2.21 +/- 1.1; P < 0.0001), and more oocytes (16.5 +/- 7.6 versus 14.06 +/- 5.2; P = 0.02), in group B as compared with group A. There were more days of coasting as compared with days of antagonist administration (2.82 +/- 0.97 versus 1.74 +/- 0.91; P < 0.0001). In conclusion, GnRH antagonist was superior to coasting in producing significantly more high quality embryos and more oocytes as well as reducing the time until HCG administration. There was no significant difference in pregnancy rate between the two groups. No OHSS developed in either group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s1472-6483(10)60339-2DOI Listing
September 2007

Among women undergoing embryo transfer, is the probability of pregnancy and live birth improved with ultrasound guidance over clinical touch alone? A systemic review and meta-analysis of prospective randomized trials.

Fertil Steril 2007 Aug 7;88(2):333-41. Epub 2007 Jun 7.

The Egyptian IVF-ET Center, Cairo, Egypt.

Objective: To investigate the theory that ultrasound guidance during ET improves clinical outcomes.

Design: Systematic review of prospective, randomized, controlled trials comparing ultrasound with clinical touch methods of embryo catheter guidance.

Setting: Infertility centers.

Patient(s): 5,968 ET cycles in women.

Intervention(s): Embryo transfer with or without ultrasound guidance.

Main Outcome Measure(s): Meticulous electronic (e.g., PubMed, EMBASE, CENTRAL) and hand searches were performed to locate trials. Primary outcome measures were the live-birth, ongoing pregnancy, and clinical pregnancy rates. Secondary outcome measures were the implantation, multiple pregnancies, and miscarriage rates. In addition, the incidences of ectopic pregnancies and difficult transfers were evaluated.

Result(s): Twenty-five studies were retrieved, of which five were excluded. Meta-analysis of the remaining studies (5,968 ET cycles in women) was conducted by using the Mantel-Haenszel method (fixed-effect model). There was a significantly increased chance of a live birth (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.19 to 2.67), ongoing pregnancy (OR = 1.51, 95% CI = 1.31 to 1.74), clinical pregnancy (OR = 1.50, 95% CI = 1.34 to 1.67), embryo implantation (OR = 1.35, 95% CI = 1.22 to 1.50), and easy transfer rates after ultrasound guidance (OR = 0.68, 95% CI = 0.58 to 0.81). There was no difference in multiple pregnancy, ectopic pregnancy, or miscarriage rates.

Conclusion(s): Ultrasound-guided ET significantly increases the chance of live birth and ongoing and clinical pregnancy rates compared with the clinical touch method.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2006.11.161DOI Listing
August 2007

Paternal age and outcome of intracytoplasmic sperm injection.

Reprod Biomed Online 2007 May;14(5):588-92

The Egyptian IVF- ET Centre, No. 3, St. 181, Hadaek El Maadi, Maadi, Egypt.

In a retrospective study, the outcome of intracytoplasmic sperm injection (ICSI) in two age groups of men was studied. Couples with male partners aged 50 years and over (group A) (n = 227) with mean age of 53 +/- 5 years were compared with couples with younger age-group male partners (group B) (n = 227) with a mean age of 38.4 +/- 5.8 years. The control group of younger men was selected so that the women's age matched between the two groups. There was no significant difference in pregnancy rate between the two groups (37.9 versus 36.6%; OR = 1.06, 95% CI = 0.72-1.55). There was also no significant difference in the pregnancy rate between men aged 60 years and over as compared with men aged 50 to 59 years (OR = 1.00, 95% CI 0.74-1.37). However, the long-term outcome of these pregnancies needs further investigation. Semen analysis showed significantly lower motility in group A (37.4 +/- 20.4) versus group B (46.4 +/- 15.5; P < 0.0001). There was a significantly higher fertilization rate in younger men (P < 0.0001; OR = 1.36, 95% CI = 1.19-1.55), but this did not affect the pregnancy rate. In conclusion, it appears that paternal age has no effect on the pregnancy rate after ICSI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s1472-6483(10)61050-4DOI Listing
May 2007

Intrauterine insemination catheters for assisted reproduction: a systematic review and meta-analysis.

Hum Reprod 2006 Aug 4;21(8):1961-7. Epub 2006 May 4.

The Egyptian IVF-ET Center, Cairo, Egypt.

Background: Intrauterine insemination (IUI) is the oldest and most practised form of assisted reproduction worldwide. We systematically reviewed the literature so that we could evaluate the use of soft versus firm catheters in subfertile women undergoing IUI.

Methods: Extensive searches were conducted for full-text manuscripts, conference abstracts, ongoing and unpublished trials. Primary outcomes were clinical pregnancy (CPR) and ongoing pregnancy (OPR)/live birth rates (LBRs) per woman. Secondary outcomes were multiple pregnancy rate (MPR) per clinical pregnancy, difficulty cannulating the cervix, bleeding and patient discomfort. Meta-analysis was performed using the Peto-modified Mantel-Haenszel fixed-effect model.

Results: Seven randomized trials were identified, and four were excluded. No significant differences were noted for CPR and LBR per woman [OR = 0.96, 95% CI = 0.70-1.32 and OR = 0.82, 95% CI = 0.43-1.58, respectively]. As for the secondary outcomes, MPRs per cycle were also not significantly different. More difficulty was noted with soft catheters and more patient discomfort with firm catheters. Bleeding following the procedure was similar between the two groups.

Conclusions: Catheter choice during IUI does not seem to be a detrimental factor for success, as in other assisted reproduction techniques (ART). More studies are warranted to draw definitive conclusions and support the results of this systematic review.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/humrep/del139DOI Listing
August 2006

Pregnancy rate is not improved by delaying embryo transfer from days 2 to 3.

Eur J Obstet Gynecol Reprod Biol 2003 Apr;107(2):176-9

The Egyptian IVF-ET Center 3, 161 Street, Hadaek Al Maadi, Maadi, Cairo 11431, Egypt.

Objective: To compare the outcome of assisted reproduction in day 2 versus day three embryo transfer.

Design: Prospective study.

Participants: A total of 927 consecutive embryo transfers for IVF and ICSI cycles including 626 embryo transfers on day 2 and 301 on day 3.

Intervention: IVF and ICSI.

Outcome Measure: Clinical pregnancy rate.

Results: There is no significant difference in the pregnancy rate between ET on day 2 (50.9%) and ET on day 3 (50.5%).

Conclusion: Embryo transfer could be done on days 2 or 3 according to the convenience of the patient and the medical team.

Condensation: Embryo transfer could be done on days 2 or 3 according to the convenience of the medical team with similar results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0301-2115(02)00400-1DOI Listing
April 2003

The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study.

Am J Obstet Gynecol 2003 Feb;188(2):371-5

Egyptian IVF-ET Center, Hadaek Al Maadi, Cairo, Egypt.

Objective: This study was undertaken to evaluate the outcome of in vitro fertilization (IVF) in patients with advanced pelvic endometriosis and previous surgical treatment.

Study Design: A case controlled study was performed.

Results: Patients with the diagnosis of stage IV endometriosis with previous surgical treatment were treated by IVF (group A = 85). An age-matched group of patients (group B = 177) with tubal factor infertility were treated with the same protocol of IVF. In group A, cycle cancellation because of poor response occurred in 29.7% compared with 1.1% in the control group (relative risk 26.03, 95% CI 6.02-112.45). There were 13 (15.3%) clinical pregnancies per stimulated cycle in group A compared with 93 (52.5%) clinical pregnancies in the control group, P <.0001 (odds ratio 0.29, 95% CI 0.15-0.55).

Conclusion: The outcome of IVF in stage IV endometriosis with previous surgery was significantly lower compared with an age-matched group of tubal factor infertility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1067/mob.2003.13DOI Listing
February 2003