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Biomedical subjects

Hassan N Sallam

Publications and source records attributed to Hassan N Sallam.

10 recordsLinked to original sources
PubMed2006

Progesterone supplementation to prevent recurrent miscarriage and to reduce implantation failure in assisted reproduction cycles.

Implantation failure has been questioned for many cases of recurrent miscarriage and unsuccessful assisted reproduction. The exact cause of implantation failure is not known, but luteal phase defect is encountered in many of these cases. Consequently, women with recurrent miscarriages have been treated with progesterone supplementation with various degrees of success, and a recent meta-analysis has shown trends for improved live birth rates in those women. Progesterone probably acts as an immunological suppressant blocking T-helper (Th)1 activity and inducing release of Th2 cytokines. Numerous studies have confirmed that ovarian stimulation used in assisted reproduction is associated with luteal phase insufficiency, even when gonadotrophin-releasing hormone antagonists are used. In those patients, advanced endometrial histological maturity and a decrease in the concentration of cytoplasmic progesterone receptors are observed. Progesterone supplementation results in a trend towards improved ongoing and clinical pregnancy rates, except in patients treated with human menopausal gonadotrophin-only regimens, in whom ongoing pregnancy rates increase significantly. More randomized controlled trials are needed to increase the power of the currently available meta-analyses to further evaluate progesterone supplementation in both conditions.

Abnormalities, Drug-Induced↗
PubMed2005

The use of the modified hypo-osmotic swelling test for the selection of immotile testicular spermatozoa in patients treated with ICSI: a randomized controlled study.

BACKGROUND: Various methods for the selection of viable sperm from among immotile testicular spermatozoa for use in ICSI have been described in non-randomized studies. We have conducted a randomized controlled study to compare the use of the modified hypo-osmotic swelling (HOS) test (50% culture medium + 50% Milli-Q grade water) with that of sperm selection on the basis of their morphology alone. METHODS: A total of 79 couples with immotile testicular spermatozoa treated with ICSI were randomly assigned into two groups. In the first group, spermatozoa used for injection were selected using the modified HOS test, while in the second group spermatozoa were selected on the basis of their morphology. RESULTS: The fertilization rate was significantly higher in the HOS test group (43.6%) compared with the no-HOS test group (28.2%) [odds ratio (OR) 2.494; 95% confidence interval (CI) 1.606-3.872]. The pregnancy and ongoing pregnancy rates were also higher in the HOS test group (27.3% versus 20.5%) compared with the no-HOS test group (5.7% versus 2.9%) (OR 6.188, 95% CI 1.282-29.860; and OR 8.743, 95% CI 1.050-72.783, respectively). CONCLUSIONS: The use of the modified HOS test for the selection of viable sperm from among immotile testicular spermatozoa for ICSI results in higher fertilization, pregnancy and ongoing pregnancy rates compared with morphological selection.

Adult↗
PubMed2005

Embryo transfer: factors involved in optimizing the success.

PURPOSE OF REVIEW: Embryo transfer is arguably the most critical step in assisted reproduction. The purpose of this article is to review the different aspects of the procedure in the light of recent evidence. RECENT FINDINGS: Randomized trials have shown that significantly higher pregnancy rates are obtained when embryo transfer is performed under ultrasound guidance, the embryos are deposited in the middle part of the uterine cavity, an atraumatic technique is used and when low-dose aspirin is routinely administered following the procedure. Blood in the catheter and leaving the embryos inside it for more than 120 s diminish the pregnancy rate significantly. Air in the catheter, immediate removal of the catheter, performing two transfers in the same cycle, prolonged bed rest, sexual intercourse after embryo transfer or the use of sildenafil do not affect the results. Based on currently available evidence, Cochrane reviews have concluded that the live birth rate is not increased by delaying embryo transfer from day two to three or to the blastocyst stage, and that single embryo transfer leads to lower live birth rates than the transfer of two embryos. The value of a mock transfer a few days before the actual procedure has been challenged as the position of the uterus may change. The effect of holding the cervix with a volsellum, routinely administering antibiotics and the superiority of one catheter over the others is still to be determined. SUMMARY: Recent studies confirm the importance of the various aspects of embryo transfer. More randomized studies are needed to further evaluate them.

Embryo Transfer↗
PubMed2003

Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials.

OBJECTIVE: To conduct a meta-analysis of randomized controlled studies to evaluate abdominal ultrasound-guided embryo transfer compared to the clinical touch method. DESIGN: Meta-analysis. SETTING: Four studies performed in academic research centers in Barcelona, Vizcaya, Hong Kong, and Madrid. PATIENT(S): A total of 2,051 patients: 1,024 received ultrasound-guided embryo transfers and 1,027 received clinical touch method transfers. INTERVENTION(S): Fourteen studies were retrieved from the literature, but only four of them fitted our selection criteria. The meta-analysis was conducted using the RevMan software with the Peto-modified Mantel-Haenszel method and the fixed effect model. MAIN OUTCOME MEASURE(S): The primary outcome measures were the clinical pregnancy and ongoing pregnancy rates. The secondary outcome measures were the incidences of ectopic pregnancies, miscarriage rate, multiple pregnancies, and difficult transfers. RESULT(S): Compared to the clinical touch method, abdominal ultrasound-guided transfer significantly increased the clinical pregnancy rate and the ongoing pregnancy rate. There was no effect on the incidence of ectopic pregnancy, multiple pregnancy, or miscarriage rate. CONCLSUION(S): Ultrasound-guided embryo transfer increases the clinical pregnancy and ongoing pregnancy rates significantly compared to the clinical touch method.

Abortion, Spontaneous↗
PubMed2003

Impact of technical difficulties, choice of catheter, and the presence of blood on the success of embryo transfer--experience from a single provider.

PURPOSE: To investigate the impact of technical difficulties, choice of catheter, and the presence of blood during embryo transfer on the results of in vitro fertilization and ICSI. METHODS: A cohort of 784 consecutive cycles in 655 in vitro fertilization and ICSI patients were studied. RESULTS: Negotiating the cervix, using the volsellum, presence of blood on the catheter wall or on the cervix did not affect the results. Changing the catheter and blood on the catheter tip reduced the pregnancy (P < 0.05 and P < 0.05) and implantation rates (P < 0.001 and P < 0.01). The Ultrasoft catheter produced higher pregnancy (P < 0.0005) and implantation rates (P < 0.01) compared to the more rigid Frydman catheter. CONCLUSIONS: Negotiation of the cervix, the use of a volsellum, and the presence of blood on the catheter wall or on the cervix do not affect the results. Changing the catheter and blood on the catheter tip significantly diminish the pregnancy and implantation rates. Soft catheters perform better.

Blood Loss, Surgical↗
PubMed2003

Assisted hatching--a meta-analysis of randomized controlled trials.

PURPOSE: To conduct a meta-analysis of randomized controlled trials (RCTs) on assisted hatching. METHODS: One hundred sixty-five studies were retrieved from the literature, but only 13 of them fitted our selection criteria. The meta-analysis was conducted using the RevMan software with the Peto-modified Mantel-Haenszel method. RESULTS: Assisted hatching increases the pregnancy [OR (+/-95% CI) = 2.51 (1.91-3.29)], implantation [OR (+/-95% CI) = 2.38 (1.87-3.03)], and ongoing pregnancy rates [OR (+/-95% CI) = 2.65 (1.85-3.79)] significantly in poor prognosis patients undergoing IVF or ICSI. For patients with repeated IVF failures, the OR (+/-95% CI) were 2.84 (1.99-4.06) for pregnancy, 2.53 (1.85-3.47) for implantation, and 3.51 (2.12-5.82) for ongoing pregnancy rates, in favor of assisted hatching. CONCLUSIONS: Assisted hatching increases the pregnancy, implantation, and ongoing pregnancy rates significantly in patients with a poor prognosis undergoing IVF or ICSI, particularly those with repeated failures.

Female↗
PubMedDate not supplied

Sperm velocity and morphology, female characteristics, and the hypo-osmotic swelling test as predictors of fertilization potential: experience from the IVF model.

OBJECTIVE: To determine, among the following variables, the predictors of sperm fertilization potential of a given semen sample: sperm count, eight sperm velocity characteristics determined by computer-assisted semen analysis, the sperm morphology score determined by strict criteria, and the hypo-osmotic swelling (HOS) test, using the IVF model. DESIGN: Data from 58 couples attending the assisted conception unit for conventional IVF treatment were analyzed retrospectively by simple linear regression and multiple stepwise regression analysis, taking the fertilization rate as the dependent factor. RESULTS: The mean sperm velocity and the strict sperm morphology assessment were the only parameters showing significant correlation with the fertilization rate. A minimum sperm velocity of 13 microm/s and a minimum strict sperm morphology of 2% were necessary to achieve fertilization in 50% of the oocytes. The results of the HOS test did not correlate with the fertilization rate. An equation was devised to calculate the expected fertilization rate based on the mean sperm velocity and the strict morphology score, and can be used to counsel patients prior to assisted conception. CONCLUSIONS: The mean sperm velocity and strict sperm morphology evaluation are good predictors of fertilization potential, but the HOS test is not.

Adult↗
PubMedDate not supplied

Defining poor responders in assisted reproduction.

OBJECTIVE: The aim of this study was to establish an objective definition of "poor responders" for patients undergoing treatment with assisted reproduction. METHODS: A total of 782 infertile couples treated with assisted reproduction were studied by retrospective analysis of the data. Simple linear regression was performed between the number of oocytes retrieved and the clinical pregnancy rate. The sensitivity and specificity were then calculated and the receiver-operator characteristic (ROC) curves were drawn in order to determine a critical number of oocytes retrieved below which the clinical pregnancy rate was significantly diminished. RESULTS: An excellent correlation was found between the number of oocytes retrieved and the clinical pregnancy rate (r = 0.90). The clinical pregnancy rate started to become significantly lower when fewer than 5, 6, and 8 oocytes were retrieved from patients treated with ICSI, IVF, or TeSE/ICSI, respectively. CONCLUSIONS: The definition of poor responders in assisted reproduction depends on the treatment modality. Poor responders are patients undergoing treatment with ICSI, IVF, or TeSE/ICSI from whom fewer than 5, 6, or 8 oocytes are retrieved, respectively.

Adult↗