Egyptian Center

Maadi, Egypt

Egyptian Center

Maadi, Egypt
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Sullivan E.A.,University of New South Wales | Zegers-Hochschild F.,Diego Portales University | Mansour R.,Egyptian Center | Ishihara O.,Saitama University | And 3 more authors.
Human Reproduction | Year: 2013

Study Questio: NHave changes in assisted reproductive technology (ART) practice and outcomes occurred globally between 2003 and 2004? Summary Answer: Globally, ART practice has changed with an increasing prevalence of the use of ICSI rather than conventional IVF. In 2004, a small but increasing number of countries are incorporating single embryo transfer. There remain unacceptably high rates of three or more embryo transfers in select countries resulting in multiple births and adverse perinatal outcomes. What Is Known Already: World data on the availability, effectiveness and safety of ART have been published since 1989. The number of embryos transferred is a major determinant of the iatrogenic increase in multiple pregnancies and is highly correlated with the likelihood of multiple birth and excess perinatal morbidity and mortality.STUDY Design: , SIZE, DURATIONCross-sectional survey of countries and regions undertaking surveillance of ART procedures started in 2004 and their corresponding outcomes. Participants/Materials, Setting, Methods: Of total, 2184 clinics from 52 reporting countries and regions. Number of ART clinics, types of cycles and procedures, pregnancy, delivery and multiple birth rates and perinatal outcomes. Main Results and the Role of Chance: A total of 954 743 initiated cycles resulted in an estimated 237 809 babies born. This was a 2.3% increase in the number of reported cycles from 2003. The availability of ART varied by country and ranged from 14 to 3844 treatment cycles per million population. Over one-third (37.2%) of ART clinics performed <100 cycles per year with only 19.9% performing ≥500 cycles per year. Of all cycles, 60.6% were ICSI. Frozen embryo transfers (FETs) represented 31% of the initiated cycles. The overall delivery rate per fresh aspiration for IVF and ICSI was 20.2% compared with 16.6% per FET. The average number of embryos transferred was 2.35. Single (16.3%) and double embryo transfers accounted for 73.2% of cycles. The overall proportion of deliveries with twins and triplets from IVF and ICSI was 25.1 and 1.8%, respectively, but varied widely by country and region. The proportion of premature deliveries per fresh aspiration for IVF and ICSI was 33.7% compared with 26.3% per FET. The perinatal death rate was 25.8 per 1000 births for fresh aspiration for IVF and ICSI compared with 14.2 per 1000 births per FET.LIMITATIONS, REASONS FOR CAUTIONData are incomplete with seven countries not providing data to the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in 2004 that had in 2003. The validity of data reflects current data collection practice. In 2004, 79.3% of the clinics in participating countries reported to their national or regional registries and to ICMART. In addition, the number of ART cycles per million population is a measure which is affected by a country's government policy, regulation, funding and the number of service providers. Wider Implications of the Findings: ART practice, effectiveness and outcomes vary markedly internationally. Notably, the increasing proportion of cycles that are FET, the change in practice to single embryo transfer and the cessation of the transfer of three or more embryos in some countries has resulted in improved perinatal outcomes with minimal impact on pregnancy rates. Study Funding/Competing Interest: (S)ICMART receives financial support from ASRM, ESHRE, FSA, Japan Society for Reproductive Medicine, REDLARA, MEFS and SART. © 2013 The Author.

Nygren K.G.,Queen Sophia Hospital | Sullivan E.,University of New South Wales | Zegers-Hochschild F.,Unit of Reproductive Medicine | Mansour R.,Egyptian Center | And 3 more authors.
Fertility and Sterility | Year: 2011

Objective: To analyze information on assisted reproductive technologies (ART) performed globally. Design: Data on access, efficacy, and safety of ART were collected for the year 2003 from 54 countries. Setting: National and regional ART registries globally. Patient(s): Patients undergoing ART globally. Intervention(s): Collection and analysis of international ART registry data. Main Outcome Measure(s): Number of cycles performed in reporting countries and regions globally for different ART procedures with resulting pregnancy, live birth and multiple birth rates. Result(s): A total of 433,427 initiated cycles reported in this registry resulted in 173,424 babies born. This corresponded to a delivery rate per aspiration of 22.4% for in vitro fertilization (IVF), 23.3% for intracytoplasmic sperm injection (ICSI), and a delivery rate per transfer of 17.1% for frozen embryo transfer. Although there is wide variation among countries and regions, the overall proportion of deliveries with twins and triplets from IVF and ICSI was 24.8% and 2.0%, respectively. There were wide variations in access, and compared with the previous report (year 2002), there was a 3.9% increase in the number of reported cycles and a minor increase in the delivery rate per aspiration. There was also a marginal decline in the mean number of embryos transfered and in the rate of multiple births. Conclusion(s): ART access, efficacy, and safety varies greatly globally. Collection and analysis of data over time will benefit ART patients, providers, and policy makers. © 2011 by American Society for Reproductive Medicine.

Mansour R.,Egyptian Center | Ishihara O.,Saitama University | Adamson G.D.,Palo Alto Medical Foundation Fertility Physicians of North California | Dyer S.,University of Cape Town | And 5 more authors.
Human Reproduction | Year: 2014

STUDY QUESTION What are the access, effectiveness and safety of assisted reproductive technology (ART) worldwide in 2006? SUMMARY ANSWER ART access, effectiveness and safety vary markedly among countries. Overall, there was an increase in the use of ICSI, single embryo transfer (SET) and frozen embryo transfer (FET). There was a decline in the multiple delivery rate (DR) and preterm birth rate. WHAT IS KNOWN ALREADY ART is widely practiced worldwide and there is a need for its continuous monitoring to improve the comprehensiveness and quality of ART data and services. STUDY DESIGN, SIZE, DURATION This is a retrospective, cross-sectional survey of ART cycles undertaken worldwide in 2006. PARTICIPANTS, SETTING, METHODS A total of 2352 clinics in 56 countries provided data. Data were analyzed at a country and regional level. The forms for data collection were developed by the International Committee Monitoring Assisted Reproductive Technologies (ICMART) and sent to each country or regional ART register. MAIN RESULTS AND THE ROLE OF CHANCE A total of >1 050 300 initiated cycles resulted in an estimated >256 668 babies. The overall pregnancy rates (PRs) and DRs per aspiration for IVF were 30.7 and 22.8%, respectively, and for ICSI 29.7 and 20.0%, respectively. The PRs and DRs for FETs were 26.4 and 17.8%, respectively. Multiple DR per PR were 22.2% for twins and 1.5% for triplets following fresh IVF/ICSI and 16.4% for twins and 0.8% for triplets for FETs. Ovarian hyperstimulation syndrome complicated >4585 cycles (0.6%). Access to ART varied from 11 to 3988 cycles per million population. ICSI comprised 66.0% of all initiated cycles, FET 27.4% and SET 20.7%. Perinatal mortality rate was 25.2 per 1000 births for fresh IVF/ICSI and 17.5 per 1000 for FETs. LIMITATIONS, REASONS FOR CAUTION 44.6% of the countries provided incomplete data. Quality of data varies among individual countries and is dependant on the policy of the local regulatory authority for monitoring ART clinics. Continuous efforts are needed to improve comprehensiveness and quality of data collected. WIDER IMPLICATIONS OF THE FINDINGS Adopting the policy of SET, FET and the cessation of transferring more than two embryos should be widely applied. ICMART will continue helping countries and regions to establish their own ART registries. STUDY FUNDING/COMPETING INTEREST(S) ICMART receives financial support from medical societies: European Society for Human Reproduction and Embryology (ESHRE), American Society for Reproduction Medicine (ASRM), Fertility Society of Australia (FSA), Japan Society for Reproductive Medicine (JSRM), Latin American Network for Reproductive Medicine (REDLARA) and Middle East Fertility Society (MEFS) and Society for Assisted Reproductive Technology (SART). All authors have no conflict of interest in relation to this work. We declare no support or financial relationship with any organizations or any activities that could appear to have influenced the submitted work. © 2014 The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Zegers-Hochschild F.,Diego Portales University | Mansour R.,Egyptian Center | Ishihara O.,Saitama University | Adamson G.D.,Palo Alto Medical Foundation Fertility Physicians of Northern California | And 3 more authors.
Fertility and Sterility | Year: 2014

Objective To analyze information on assisted reproductive technology (ART) performed worldwide and trends in outcomes over successive years. Design Cross-sectional survey on access, effectiveness, and safety of ART procedures performed in 53 countries during 2005. Setting A total of 2,973 clinics from national and regional ART registries. Patient(s) Infertile women and men undergoing ART globally. Intervention(s) Collection and analysis of international ART data. Main Outcome Measure(s) Number of cycles performed by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Result(s) Overall, 1,052,363 ART procedures resulted in an estimated 237,315 babies born. The availability of ART varied by country from 15 to 3,982 cycles per million of population. Of all initiated fresh cycles, 62.9% were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 19.6% and for frozen embryo transfer 17.4%, with a cumulative delivery rate of 23.9%. With wide regional variations, single embryo transfer represented 17.5% of cycles, and the proportion of deliveries with twins and triplets from fresh transfers was 23.6% and 1.5%, respectively. Conclusion(s) Systematic collection and dissemination of international ART data allows patients, health professionals, and policy makers to examine and compare the impact of reproductive strategies or lack of them as markers of reproductive health. © 2014 American Society for Reproductive Medicine, Published by Elsevier Inc.

Al-Inany H.G.,Egyptian Center | Van Gelder P.,PSCT BV
Reproductive BioMedicine Online | Year: 2010

Recent randomized trials, systematic reviews and cost-effectiveness analyses have demonstrated the relative efficacy, and in some cases superiority, of urinary gonadotrophins (uFSH, human menopausal gonadotrophin) compared with recombinant FSH (rFSH). However, the effectiveness of frozen-embryo transfers (FET) following ovarian stimulation with uFSH versus rFSH in the fresh cycle has not been well investigated. The objective of this study was to determine whether there are differences in clinical outcomes in women undergoing FET according to the type of gonadotrophin used during ovarian stimulation. Following a meticulous search, all published comparative studies of FET using ovarian stimulation were reviewed. Data on clinical outcomes were extracted and systematically presented. Using the agonist long protocol for down-regulation, five trials provided extractable data for live-birth and ongoing pregnancy rates following FET, as well as the cumulative live-birth, ongoing pregnancy and clinical pregnancy rates following fresh-embryo transfer and FET from the same cycle. There was no evidence of significant effect difference between the uses of uFSH versus rFSH regarding any of the outcomes. In conclusion there is insufficient evidence to determine whether the use of a certain type of gonadotrophin during ovarian stimulation affects the clinical outcomes in subsequent FET. Clinical efficiency in IVF procedures has been debated for years. Defining a unified goal, or endpoint, for IVF treatments has shown marked discrepancies among clinicians, regulatory bodies and organizations; with some regarding a clinical pregnancy, an ongoing pregnancy, a live-birth, or even a take-home baby as the primary outcome of IVF treatments. The objective of this systematic review was to determine the effectiveness of the use of urinary versus recombinant FSH on the results of frozen embryo transfers and the effect that this would have on the cumulative clinical results of IVF. This systematic review has shown that there is insufficient evidence to determine whether the use of a certain type of gonadotrophin during ovarian stimulation affects the clinical outcomes in subsequent frozen embryo transfers, such as live-birth rate, ongoing pregnancy rate, clinical pregnancy rate. With respect to cumulative rates, it is noted that no significant differences in live birth rate, ongoing pregnancy rate, and clinical pregnancy rate following fresh and frozen transfer cycles. It is concluded that well-designed and powered studies are needed to determine possible effects of the use of a certain type of gonadotrophin during ovarian stimulation on the clinical outcomes in subsequent frozen thawed embryo transfers. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Aboulghar M.,Cairo University | Aboulghar M.,Egyptian Center
Seminars in Reproductive Medicine | Year: 2010

Mild forms of ovarian hyperstimulation syndrome (OHSS) do not require treatment. Moderate OHSS should be followed up on an outpatient basis with no specific treatment. Severe OHSS requires proper evaluation. Investigations are done to evaluate hematocrit, electrolytes, and kidney and liver function. Conservative treatment with intravenous (IV) fluids and close monitoring is usually done. Intensive care admission is indicated in cases with severe respiratory distress or major electrolyte imbalance with elevated serum creatinine. Crystalloids in the form of IV saline and colloids as albumin or hydroxyethyl starch are commonly used to expand intravascular volume. Dopamine can be used to improve diuresis, and prophylactic heparin is administered to prevent venous thrombosis. Diuretics are generally contraindicated because they may further contract intravascular volume. Abdominal or vaginal aspiration of ascitic fluid results in marked improvement of symptoms, improved diuresis, and shortened hospital stay. The current trend to treat patients with IV fluids, albumin, and to perform aspiration of ascitic fluid on an outpatient basis has been found to be a more cost-effective protocol of treatment. Copyright © 2010 by Thieme Medical Publishers, Inc.

Fauser B.C.J.M.,University Utrecht | Serour G.I.,Egyptian Center | Serour G.I.,Al - Azhar University of Egypt
Fertility and Sterility | Year: 2013

This Views and Reviews series concerning future developments in in vitro fertilization will highlight various aspects of in vitro fertilization from the global perspective. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.

Aboulghar M.,Egyptian Center | Aboulghar M.,Cairo University
Fertility and Sterility | Year: 2012

The use of GnRH-a in ovarian stimulation permitted stronger stimulation resulting in an increased incidence of OHSS. The first Cochrane review comparing GnRH agonist and GnRH antagonist protocols for ovarian stimulation showed no significant difference in OHSS rate between the two protocols, however, a recent Cochrane review showed a highly significant decrease in the incidence in OHSS rate in the antagonist protocol. Coasting is a commonly used procedure for preventions of OHSS. The optimum time to start coasting is when the lead follicle reaches 16 mm in diameter and hCG should be given when E2 level drops below 3000 pg/ml. Coasting may act by diminishing the functioning granulosa cell cohort. Administration of daily GnRH antagonist in high risk patients for OHSS who were down-regulated by GnRH-a resulted in rapid drop of E2 and decrease in incidence of OHSS. A series of patients who developed early OHSS were treated by daily GnRH antagonist injections, all embryos were cryopreserved. No progression to severe OHSS was observed. © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.

Mansour R.,Egyptian Center | Tawab N.,Egyptian Center | Kamal O.,Egyptian Center | El-Faissal Y.,Egyptian Center | And 3 more authors.
Fertility and Sterility | Year: 2011

Objective: To investigate the value of intrauterine injection of human chorionic gonadotropin (hCG) before embryo transfer (ET). Design: Prospective randomized study. Setting: The Egyptian IVF-ET Center. Patient(s): Infertility patients younger than 40 years undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI). Intervention(s): The study group (n = 167) received either 100 IU of hCG (n = 83), or 200 IU of hCG (n = 84) via intrauterine administration before ET. The control group (n = 93) underwent ET without hCG. After the interim analysis, the modified study group (n = 107) received intrauterine injection of 500 IU of hCG, and the control group (n = 105) underwent ET without hCG. Main Outcome Measure(s): Clinical pregnancy rate (PR) and implantation rate (IR). Result(s): The IR and PR were statistically significantly higher in the 500 hCG group (41.6% and 75%, respectively) as compared with the control group (29.5% and 60%, respectively). The IR and PR were 26.6% and 54% in the 100 hCG group, 28.3% and 57% in the 200 IU hCG group, and 29.4% and 60% in the control group, respectively, with no statistically significant difference. Conclusion(s): Intrauterine injection of 500 IU of hCG before ET statistically significantly improved the implantation and pregnancy rates in IVF/ICSI. Copyright © 2011 American Society for Reproductive Medicine.

News Article | September 28, 2016

Two years after launching a concerted effort to sharply reduce subsidy programs that had proven unsustainable to the country's government, Egypt has announced significant progress in the reduction effort, reporting a 28.7% drop in spending during the 2015-2016 fiscal year. According to a Reuters report, the country's Petroleum Minister Tarek El Molla said that the reported reduction represented a larger decline than previously announced. Coupled with myriad other financial challenges facing the country, energy subsidies have proven especially difficult to manage or reduce in recent years, creating an enormous challenge for the government’s attempts to draw down its daunting debt. According to Sherif El Diwany, Executive Director of the Egyptian Center for Economic Studies in Cairo, government subsidies made up about one-third of the government’s budget in 2014 and 75% of that amount is set aside for energy sector subsidies. However, the government's recent efforts have shown signs of success, with the most recent decline exceeding previous expectations. According to the report, energy subsidies had declined thanks in part to lower energy prices. The country has also been assisted by a series of recent hydrocarbon discoveries, allowing some optimism about Egypt's capability to address domestic demand requirements. Egypt has a long history of energy challenges, though they have grown especially daunting over the last four years. With the collapse of the long-standing government of Hosni Mubarak, the country of over 80 million found itself economically isolated, which served to reduce its foreign reserves and with it, the ability to keep up payments to oil and gas importers. However, more recently, exploration efforts by international firms like Italy's have opened the door to the possibility of significant strides in domestic production efforts. According to the Reuters report, Egypt has made 38 new petroleum discoveries during the 2015-2016 fiscal year, with 24 for crude oil and 14 for natural gas.

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