Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial.

OBJECTIVE: The aim of the study was to compare 6 month expulsion rates of the copper-bearing intrauterine device (IUD) inserted after delivery of the placenta or at the 6 week postpartum visit in women undergoing caesarean section. METHODS: A parallel-group randomised trial was conducted in an Egyptian university hospital between February 2016 and December 2018. Participants were randomised to either post-placental IUD insertion or IUD insertion at the 6 week postpartum visit. Participants were followed for 12 months. Primary outcomes were IUD expulsion and the proportion of women using an IUD at 6 months. A secondary outcome was the cumulative pregnancy rate at 12 months. RESULTS: Five hundred participants were enrolled in each group. At 6 months the total expulsions were 58/416 (13.9%) in the post-placental group and 4/214 (1.9%) in the puerperal group; IUD use at 6 months was 416/478 (87.0%) in the post-placental group and 214/232 (92.2%) in the puerperal group. Data collected by phone at 12 months showed a higher cumulative pregnancy rate in the puerperal group (84/500, 16.8%) vs the post-placental group (22/500, 4.4%). IUD continuation at 12 months was higher in the post-placental group. CONCLUSION: Participants in the post-placental group had a higher expulsion rate at 6 months, but more IUDs were placed in this group and fewer pregnancies had occurred at 12 months compared with the puerperal group. TRIAL REGISTRATION: Clinicaltrials.gov NCT02679820.

Current contraceptive trends among married Egyptian women: a cross-sectional survey.

OBJECTIVE: The aim of our study was to assess the knowledge and attitudes of married Egyptian women towards the different methods of contraception, examining the role of employment and education in modulating contraceptive behaviour. METHODS: A cross-sectional survey was conducted among 2360 Egyptian women between 15 and 45 years of age who were attending outpatient clinics at a university hospital in Cairo between August 2017 and January 2018. The survey collected sociodemographic data as well as information on education, employment, knowledge about contraceptive methods, current and previous use of contraception, source of family planning advice and side effects from previous contraceptive use. RESULTS: The response rate was 90.2%. Current use of a contraceptive method was 38.3%. The intrauterine device (IUD) was the leading contraceptive method (50.7%), followed by oral contraceptives (OCs) (23.6%). Contraceptive prevalence was significantly higher among working women (p < .001), whose primary choice was OCs, while IUD use was significantly higher among non-working women (p < .001). Contraceptive prevalence was highest among women with secondary school education or higher (41.6%). CONCLUSION: Both employment status and educational level of the surveyed women played a significant role in their contraceptive behaviour.

Ultrasound-guided intrauterine device insertion: a step closer to painless insertion: a randomized control trial.

AIM OF STUDY: To reduce the pain and duration of the intrauterine device (IUD) insertion procedure through minimizing instrumentation and using trans-abdominal sonography (TAS). METHODS: This randomized control trial was conducted in a university hospital and included 102 eligible females, fulfilling the inclusion criteria. They were randomly assigned into two groups via 1:1 computer-based randomization program; the trans-abdominal guided IUD insertion group (n = 51), and the traditional IUD insertion group (n = 51). The main outcomes were the pain experienced during the procedure as scored by the visual analogue score and the duration of the procedure. RESULTS: The trans-abdominal guided IUD insertion was found to be statistically superior to the traditional technique for IUD insertion regarding the pain scores (according to the Visual Analogue Scale, from 0 to 10) recorded by the candidates (2.4 ± 2.1 vs. 5.0 ± 1.7, p < .001) as well as the time (in seconds) taken for IUD insertion procedure (32.2 ± 14.8 vs. 77.7 ± 30.6, p < .001). CONCLUSIONS: Due to the decrease in pain and time taken for IUD insertion, the trans-abdominal guided technique can be used as a modified technique for IUD insertion. ClinicalTrials.gov Identifier: NCT02582268.

Association of the luteinizing hormone/choriogonadotropin receptor gene polymorphism with polycystic ovary syndrome.

This study aimed at evaluating possible associations of the single nucleotide polymorphism (SNP) in luteinizing hormone/choriogonadotropin receptor (LHCGR) gene G935A and polycystic ovary syndrome (PCOS) phenotype. The study included 100 PCOS female patients and 60 healthy female control subjects. The patients were recruited from the Gynecology out-patient clinic, Kasr Al-Aini Hospital, Cairo University. All candidates underwent full history taking and clinical examination with calculation of body mass index. Serum and EDTA samples were collected from each patient after a written consent. A hormonal profile was done for each patient as well as DNA analysis of the G935A polymorphism of LHCGR gene. In PCOS group, 26% were homozygous (AA), 27% were heterozygous (GA) and 47% were wild genotype (GG), while in controls 30% were heterozygous and 70% were wild genotype (OR: 2.25; CI: 1.16-4.386; p value: 0.012). The homozygous 935A individuals were at higher risk to develop PCOS than controls (OR: 1.80; CI: 1.54-2.09; p value < 0.001).We found a genetic variant, which is associated with PCOS in a sample of the Egyptian population. These results may provide an opportunity to test this SNP at the LHCGR gene in fertile or infertile women with family history to assess their risk of PCOS.

Knowledge, attitudes, and practices of Female Genital Mutilation / Cutting among healthcare providers in two public hospitals in Egypt: A cross-sectional study.

Female Genital Mutilation / Cutting (FGM/C), also known as female circumcision, is a human rights violation and is still happening to date. Every woman or girl has the right to be protected from this harmful practice. Egypt has adopted a multi-layered strategy to end FGM/C nationwide. Even though considerable progress has been made throughout the country, the practice and inequality still exist. In 2021, The Egyptian Family Health Survey results showed a decrease in the prevalence of circumcision among ever-married women, reaching about 86%, compared to 92% in the latest public estimate of the Demographic Health Survey 2015, where 87% of all women between 15 and 49 years old are circumcised, of which 42.4% reported being circumcised by a healthcare professional (HCP) compared to a reported 47% in 2021. This study aimed to assess healthcare providers' knowledge, attitudes, and practices in two public hospitals in 2 governorates in Egypt using a validated questionnaire conducted among HCPs in Cairo (Urban) and Gharbia (Rural) governorates. A pre-tested questionnaire comprising 38 close-ended questions was used. The study population included 223 HCPs in Cairo and Gharbia governorates, of which 63.7% were women and 36.3% were men, with an average age of 42 years (42±5). 49.8% of the respondents are from an urban area. In the knowledge domain, the highest consequence identified was reduced sexual feelings. In attitudes, almost 63% believed that FGM/C should continue, while 65% agreed that the HCPs have a role in eliminating FGM/C. Almost 4% of our respondents have performed an FGM before, 45% had FGM in their household, and 62% would perform FGM on their daughters. HCPs' integration within the communities allows them to play a crucial role in preventing the practice. It is of utmost importance to compensate for the gap in the curricula of medical schools through informal learning activities and continuing medical education programs for sexual and reproductive health and rights and human rights, as legislation and law enforcement alone cannot eliminate FGM/C from society.

The addition of growth hormone adjuvant therapy to the long down regulation protocol in poor responders undergoing in vitro fertilization: Randomized control trial.

OBJECTIVE: to detect the impact of growth hormone (GH) co-treatment to the long down regulation protocol, on the outcomes of IVF/ICSI cycles in poor responders. STUDY DESIGN: this parallel open label randomized control trial was conducted in a university hospital. It included 240 females satisfying the bologna criteria for poor responders. The enrolled females were randomized into 2 groups: A (long/GH) receiving GH adjuvant therapy to the long protocol and group B (control) receiving the long protocol alone. The main outcome measure was the live birth rate (fresh, frozen and cumulative). RESULTS: GH supplementation improved the number of collected oocytes (5.4 ± 1.7 vs. 4.3 ±â€¯2.1), MII oocytes (4.1 ±â€¯2.1 vs. 2.1 ±â€¯1.4), fertilized oocytes (4.0 ±â€¯2.2 vs. 2.0 ±â€¯1.2), transferred embryos (2.4 ±â€¯0.9 vs. 1.6 ±â€¯1.1) and cryopreserved (0.5 ±â€¯0.7 vs. 0.2 ±â€¯0.5). There was no significant difference in the live birth rate whether fresh (17.5% vs. 14.1%) or cumulative (18.3% vs. 14.7%). CONCLUSIONS: Further studies are needed to know the true impact of adding GH to the induction protocols in poor responders, as there was no difference in the live birth rates between the study groups, indicating a lack of trend toward benefit from GH supplementation in poor responders. CLINICAL TRIAL REGISTRATION: NCT02338206.

Randomized trial of combined cabergoline and coasting in preventing ovarian hyperstimulation syndrome during in vitro fertilization/intracytoplasmic sperm injection cycles.

OBJECTIVE: To assess the efficacy of coasting alone, cabergoline alone, or combining both interventions for preventing ovarian hyperstimulation syndrome (OHSS) among high-risk patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles. METHODS: The present randomized controlled trial was conducted at the IVF unit of a university hospital in Cairo between October 28, 2013, and July 31, 2015. Patients undergoing IVF/ICSI considered at risk of OHSS were randomly allocated to coasting, cabergoline, or combined coasting and cabergoline. The primary outcome was the rate and degree of symptomatically assessed OHSS. Data were analyzed on a per-protocol basis. RESULTS: There were 100 patients recruited to each group. The occurrence of early OHSS was lowest in the combination group compared with the other groups (P=0.002). CONCLUSION: Combining coasting and cabergoline was associated with a lower OHSS rate compared with either therapy alone. CLINICALTRIALS.GOV: NCT01984320.

Does the addition of growth hormone to the in vitro fertilization/intracytoplasmic sperm injection antagonist protocol improve outcomes in poor responders? A randomized, controlled trial.

OBJECTIVE: To evaluate the effectiveness of the addition of growth hormone (GH) to the antagonist protocol in IVF/intracytoplasmic sperm injection cycles in poor responders. DESIGN: Parallel randomized, controlled, open-label trial. SETTING: University hospital. PATIENT(S): A total of 141 patients (GH, n = 68; gonadotropins only, n = 73) were enrolled. Twenty-five patients had their cycles cancelled. Analysis was performed per cycle start as well as per ET. INTERVENTION(S): Patients received the antagonist protocol with or without GH supplementation. MAIN OUTCOME MEASURE(S): Mean number of cumulus complexes, metaphase II oocytes retrieved and fertilized, chemical and clinical pregnancy rates, early miscarriage rate, ongoing pregnancy and live birth rates. RESULT(S): The addition of GH significantly lowered duration of hMG treatment, duration of GnRH antagonist treatment, and dose of gonadotropin. It significantly increased mean E2 levels on the day of hCG administration, number of collected oocytes (7.58 ± 1.40 vs. 4.90 ± 1.78 [mean ± SD]), number of metaphase II oocytes (4.53 ± 1.29 vs. 2.53 ± 1.18), number of fertilized oocytes (4.04 ± 0.96 vs. 2.42 ± 1.03), and number of transferred embryos (2.89 ± 0.45 vs. 2.03 ± 0.81). There was no significant difference in the clinical pregnancy rate per cycle (22.1% vs. 15.1%) or live birth rate per cycle (14.7% vs. 10.9%). CONCLUSION(S): Growth hormone as an adjuvant treatment in IVF/intracytoplasmic sperm injection cycles for poor responders should be cautiously used with the antagonist protocol, because there is still no identified impact on pregnancy outcomes. However, evaluation of the clinical pregnancy and live birth rates in our data was limited by low statistical power. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT02195947.

Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h following cesarean section? A prospective randomized observational study on 2998 patients.

OBJECTIVE: To compare the incidence of postpartum maternal and neonatal complications and hospital readmission in patients discharged 24 versus 72 h after cesarean section. METHODS: Using randomization, 1495 patients were discharged after 24 h and 1503 patients were discharged after 72 h. All patients fulfilled the discharge criteria. Patients were assessed 6 weeks after delivery, any maternal or neonatal problems or hospital readmissions during this time interval were reported. RESULTS: There was no difference in maternal hospital readmission between the two groups, but there was a significantly higher neonatal readmission rate in the 24-h group mainly due to neonatal jaundice. As for the complications reported after 6 weeks, the only two significant outcomes were initiating breast feeding, being significantly higher in the 72-h group [OR and 95% CI 0.77 (0.66-0.89)] and the mood swings being significantly lower in the 72-h group [OR and 95% CI 2.28 (1.94-2.68)]. CONCLUSION: Our recommendation is still in favor of late discharge, after cesarean delivery. Bearing in mind, that an early 24-h discharge, after cesarean delivery is feasible, but with special care of the neonate, with early visit to the pediatrician and early establishment of effective lactation.

Addition of growth hormone to the microflare stimulation protocol among women with poor ovarian response.

OBJECTIVE: To assess the efficacy of adding growth hormone (GH) to the microflare stimulation protocol among women with poor ovarian response. METHODS: A parallel, open-label, randomized controlled trial was conducted among patients with poor ovarian response who attended a center in Cairo, Egypt, between July 10 and December 31, 2014. Participants were randomly assigned using a computer program (random block size of 4-8) to undergo the microflare protocol with or without GH. Primary outcomes were the mean numbers of mature oocytes retrieved and fertilized. Analyses were done per protocol: women with cycle cancellations were excluded. RESULTS: The analysis included 72 women in the GH group and 73 in the microflare only group. The mean number of oocytes collected was 7.2±1.5 in the GH group versus 4.7±1.2 in the microflare only group (P<0.001). The mean number of metaphase II oocytes was 5.2±1.2 in the GH group and 2.8±1.0 in the microflare only group (P<0.001). The mean number of fertilized oocytes was higher in the GH group (4.2±1.1) than in the microflare only group (2.5±0.7; P<0.001). CONCLUSION: Addition of GH to the microflare stimulation protocol provided some potential benefits to women with poor ovarian response. However, further studies are required before it could be recommended for routine clinical use. ClinicalTrials.gov:NCT02185326.

Is intracytoplasmic sperm injection (ICSI) associated with higher incidence of congenital anomalies? A single center prospective controlled study in Egypt.

OBJECTIVE: To compare the incidence of congenital anomalies by ultrasound in intracytoplasmic sperm injection (ICSI) pregnancies and in spontaneous pregnancies with correlation to the neonatal outcome. METHODS: This is a prospective comparative study carried out in Kasr Al Aini Hospital Cairo University from January 2010 to December 2012, comparing 739 pregnant women conceived through ICSI and 843 pregnant women conceived spontaneously as regard to incidence of congenital anomalies, multiple pregnancy, preterm labor, cesarean section and neonatal outcome. RESULTS: The number of anomalies diagnosed by antenatal ultrasound in ICSI group was 14 (1.62%) while in spontaneous group was 13 (1.51%). The number of anomalies detected by postnatal examination in ICSI group was 20 (2.31%) while in spontaneous group was 16 (1.86%) (Odds ratio [OR] 1.438; 95% confidence interval [CI] 0.739-2.796). ICSI group was associated with higher incidence of twins 12.7% (p < 0.001), preterm labor 3.8% (p 0.022), preterm premature rupture of membranes 4.6% (p 0.001), cesarean section 74.1% (p < 0.001) and neonatal deaths 10.4% (p < 0.001). CONCLUSION: ICSI was associated with higher incidence of multiple pregnancy and cesarean section, with no difference in the incidence of congenital anomalies compared to spontaneous conception.