ABSTRACT
Background: Laparoscopic ovarian drilling [LOD] has been commonly used for the treatment of clomiphene citrate [CC]-resistant women with polycystic ovarian syndrome [PCOS]. However, about 20-30% of anovulatory women with PCOS fail to respond to LOD. So, identifying factors that can predict the outcome of this modality of treatment may help the clinician for proper selection and counseling of those women about their chances for the success of WD
Objective: The aim of this study is to determine the clinical, endocrinologic, biochemical and ultrasonographic factors that can predict the success of treatment following LOD in CC-resistant women with PCOS. Design: A prospective designed study. Setting: Departments of Obstetrics and Gynecology, Mansoura and Benha University Hospitals
Patients and Methods: Sixty-seven CC-resistant PCOS patients were included in the study. Preoperative evaluation of the known clinical, endocrinologic, biochemical and ultrasongraphic factors associated with PCOS were done initially. Then, all patients included in the study underwent LOD using the triple-puncture technique. Post-operatively, all women were followed-up for the occurrence of either ovulation or pregnancy. Those with persistent anovulation after LOD were offered CC. The effect of the different pre-operative characteristics on the ovulation and pregnancy rates after LOD was assessed. Moreover, women were divided into two or three categories according to the severity of each of the known factors associated with PCOS. The success rates were compared between the categories of each factor. Multiple logistic regression analysis was used to identify independent predictors of success of LOD. Main outcome measure: Ovulation and pregnancy rates
Results: Of the 67 women, 36 [53.7%] ovulated spontaneously and a further 14 women ovulated after the addition of CC, giving an overall ovulation rate of 74.6% [50 out of 67]. From those ovulated spontaneously [36], 26 [38.8%] conceived spontaneously, and the overall pregnancy rate after the help of CC was 49.2% [33 out of 67]. Women with duration of infertility > 6 years, marked obesity [BMI 35 Kg / m[2]], marked hyperandrogenism [serum testosterone >/= 1.8 ng /dL], and insulin resistance [serum fasting insulin >/= 20 uU/ mL, and/or a fasting glucose insulin ratio 10 IU/L] did not reach statistical significance to affect the outcome, but once ovulation was achieved, it appeared to be associated with higher pregnancy rate
Conclusion: Longer duration of infertility, marked obesity, marked hyperandrogenism and marked insulin resistance seemed to be associated with high probability of LOD failure. On the other hand, a high pretreatment LH level appeared to be associated with a high probability of pregnancy once ovulation is achieved
ABSTRACT
This study was designed to evaluate the applicability of the pronuclear scoring system [2-score] alone, or in combination with maternal variables to predict embryo grade determined on day 3 from a large number of embryos derived from patients undergoing treatment with IVF and/or ICSI. The study included 92 couples assigned to undergo NF or ICSI for primary [66.3%] or secondary [33.7%] infertility due to male factor in 30.4%. female factor in 55.5% or unexplained infertility in 14.1 %. A total of 500 zygotes of a total of 611 oocytes were evaluated for 2-scoring at 16-1 8 hours after fertilization and followed for embryo grading on day 3 for evaluation of statistical relation between both and to determine the specificity and sensitivity of Z-score and certain maternal variables in such relation. There were 265, 172, 43 and 20 zygotes of 2-1, 2-2, 2-3 and 2-4 scores. Using regression analysis, 2-scoring showed highly significant [P=0.000] difference in comparison to other variables in prediction of the embryo grade on day 3 and showed high specificity as determined using the receiver operating characteristic [ROC] curve analysis. It could be concluded that the pronuclear scoring sys tern of zygotes is a specific predictor of the embryo grade on day 3 after n/F and/or ICSI and significantly aid for selection of top quality embryo
ABSTRACT
The objective of the present study was to evaluate the effect of immediate oral feeding on gastrointestinal functions in patients undergoing cesarean section [CS]. A prospective randomized study was conducted in which patients were randomly allocated in two study groups, the first group patients were allowed to feed immediately and in the second group, feeding was delayed. Results obtained showed a non-sign d between both studied groups with respect to the incidence of gastrointestinal symptom. We could conclude that immediate post-cesarean section oral feeding has no complications, furthermore it enhances early bowel activity as well as it is simple, convenient, safe and economic