Background Repeated implantation failure (RIF) is defined as the case whereby the transferred embryos fail to implant after several attempts of In vitro fertilization (IVF) which causes a profound impact on the quality of life and financial burden. Some clinical studies have confirmed that Granulocyte colony-stimulating factor (G-CSF) and human chorionic gonadotropin (HCG) can improve pregnancy outcomes and implantation rates. Hence, our study aims to compare the efficacy of G-CSF and HCG on pregnancy outcomes in RIF women who undergo intra-cytoplasmic sperm injection (ICSI). Methods This randomized, single-blinded study was conducted et al.-Azhar University Hospitals, Cairo, Egypt, between 10th October 2020 and 20th December 2020. The study included 100 women aged 20–43 years old undergoing ICSI cycles, with a history of RIF. Patients were divided randomly into two groups: group (1): included 50 patients injected with 500 IU of intrauterine HCG on embryo transfer day, and group (2): Included 50 patients injected with G-CSF on the embryo transfer day. Results In 100 RIF women, we found a significant improvement in pregnancy outcomes favoring G-CSF over HCG including implantation rate, chemical pregnancy, and clinical pregnancy (P < 0.0001, P = 0.0003, and P = 0.0006, respectively). Conclusion For the first time, we demonstrated a significant improvement in pregnancy outcomes favoring G-CSF over HCG in terms of implantation rate, chemical pregnancy, and clinical pregnancy. Trial registration The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202010482774275 and was approved on 2nd October 2020.
Background:The criteria for diagnosing delivery disorders in the first and second stages of labor remain controversial. It is generally accepted that an elevated position of the fetus in primigravidas during short-term labor may indicate a threat to normal progression of labor due to fetal-pelvic disproportion or obstruction of the fetal passage by tumor or placenta.Objective: To determine fetal outcome and vaginal delivery rates among primigravida with unengaged head at onset of labor.Patients and Methods: This study was conducted on 250 primigravidae with unengaged fetal head presented at term in active labor during the period from January 2019 to December 2019. Any solid indication for cesarean section whether in the mother or the fetus was excluded.These cases were given a full trial of labor and the progress of each was recorded on a partogram, The mode of delivery, the duration of labor (first and second stage), the weight of the new born and the Apgar score, were all recorded.Also maternal morbidity and mortality were recorded. Epidural anesthesia was given to the patients on demand, and the effect of it on the mode of delivery, the duration of the first and second stage and the Apgar score were reported.Results: Most of the patients included in the study delivered vaginally (82%) while only 18% delivered by cesarean section. The primigravida with unengaged fetal head at onset of labor, although at risk for C.S, most of them delivered vaginally when were given a full trial of labor and watched carefully. The length of the first and second stage of labor prolonged slightly in these patients. The need for oxytocin augmentation also increased in those patients.The Apgar score at 1 minute and 5 minutes also decreased in the new-born of these primigravidae. There were no differences in maternal morbidity among the primigravidas presented with unengaged fetal head and those presented with engaged fetal heads. The use of epidural anesthesia did not affect the rate of C.S. although it may lengthen the duration of the first and second stage of labor. In addition, Apgar score was not affected by the use of epidural. Conclusion:The primigravida with unengaged fetal head at onset of labor, although at risk for C.S., most of them delivered vaginally with a full trial of labor and watching carefully.
Objective: Due to the large increase in the number of reported cases and the impact of COVID-19 on public health, the European Society for Human Reproduction and Embryology (ESHRE) recommended the cessation of all activities related to assisted reproduction. There are many unknowns about the long-term effects of the virus on fertility and pregnancy. We conducted this study to offer some evidence-based guidance on the relationship between COVID-19 and IVF/ICSI cycle outcomes.Methods: This observational study included 179 patients who underwent ICSI cycles at the Albaraka Fertility Hospital, Manama, Bahrain and the Almana hospital, KSA. The patients were divided into two groups. Group 1 included 88 individuals with a history of Covid-19 and Group 2 included 91 subjects without a history of COVID-19.Results: Despite the higher pregnancy (45.1% vs. 36.4%, with p=0.264) and fertilization (52% vs. 50.6% with p=0.647) rates seen in patients without a history of COVID-19, the differences were not statistically significant.Conclusions: There is no clear evidence that exposure to COVID-19 significantly affects ICSI cycle outcomes.
Objective: to evaluate the role of second trimester uterine artery Doppler ultrasound velocimetry (UADV), maternal serum Inhibin-A andplacental growth factor (PLGF) concentrations and as predictors of preeclampsia. Study design: Cohort study. Methodology: This prospective study was conducted at Obstetrics & Gynecology department, Alazhar University hospitals, Cairo, Egypt between May 2012 and May 2014. Ninety low risk normotensive singleton pregnant women were recruited for the study. Blood samples were collected at 16-18 weeks, centrifuged to extract the serum then stored at-80 °C until tested for inhibin-A and free PLGF levels. At 22-24 weeks, bilateral uterine artery Doppler velocimetry were recorded. The primary outcome was preeclampsia defined as hypertension with proteinuria after 20 weeks gestation. Women who developed preeclampsia were compared against normotensive control group.Statistical analysis: Receiver operating characteristics (ROC) curves were used for detection of the sensitivity and specificity and cut off value for each predictor using SPSS version 21 for analysis (IBM Inc., Chicago, Illinois, USA). Results:Eight cases out of 90 had developed preeclampsia. Women who developed preeclampsia had significantly higher median uterine artery resistance index (UARI) (0.645 ± 0.3 vs. 0.485 ± 0.16, P = 0.009) and significantly lower median uterine artery pulsitility index (UAPI) (0.625 ± 0.24 vs. 1.0 ± 0.68 with P= 0.001) than normotensive control group.Maternal serum inhibin-A level was significantly higher in women with preeclampsia than the normotensive control group (1375 ± 1431 vs. 540 ± 1900 with P = 0.016) while level of PLGF was non-significantly lower in women with preeclampsia than the normotensive control group (275.5 ± 369 vs. 390 ± 583 with P = 0.156). ROC curves were analysed for cases and control groups, areas under the curve (AUC) was 0.709 (95% CI, 0.527-0.891, P = 0.016) for UARI with sensitivity of 87.5%, specificity 74% at cut off value ≥ 0.5650, AUC was 0.848 (95% CI, 0.742-0.955, P = 0.001) for UAPI with sensitivity of 80%, specificity 74% at cut off value ≤ 0.735, AUC was 0.758 (95% CI, 0.566-0.951, P = 0.016) for Inhibin-A with a sensitivity of 75%, specificity of 80% at cut off value of ≥ 832.5 pg/ml and finally AUC was 0.652 (95% CI, 0.447-0.858 and P = 0.165) for PLGF with a sensitivity of 74% and specificity of 50% at cut off value of ≤ 205 pg/ml. Conclusion: second-trimester uterine artery Doppler indices, serum Inhibin-A and PLGF and may be helpful as a predicting markers for preeclampsia.
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