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Ghanem M.E.,Mansoura Integrated Fertility Center | Bakre N.I.,Mansoura University | Emam M.A.,Mansoura Integrated Fertility Center | Al Boghdady L.A.,Mansoura Integrated Fertility Center | And 3 more authors.
Human Reproduction | Year: 2011

Background: Controlled ovarian hyperstimulation with intrauterine insemination (COH/IUI) is an established tool in medically assisted conception for many infertility factors. However, the proper timing of IUI after hCG trigger and the frequency of IUI are still debated. We aimed to examine the association between the cycle pregnancy rate (CPR) and: (i) single IUI timed at 36 ± 2 h post-hCG (pre- or post-ovulation) (ii) the number of IUI (single or double) for pre-ovulatory cases both aims in male, anovulatory and unexplained infertility. Methods The study included a total 1146 first-stimulated cycles in infertile couples due to male factor, anovulation or unexplained infertility. Cycles were stimulated by clomiphine citrate (CC) or sequential CChMG or hMG and monitored by transvaginal ultrasound. When the leading follicle reached <18 mm mean diameter, 10000 IU hCG was given to trigger ovulation and IUI was timed for 36 ± 2 h later. Semen was processed and ovulation was checked at the time of IUI. Post-ovulatory cases received single IUI, while pre-ovulatory cases were sequentially randomized to receive either single or double IUI. The end-point of the cycle was CPR. Results Overall CPR in the whole cohort was 10.1. When ovulation was present before IUI, CPR was 11.7 compared with 6.7 when ovulation was absent [OR (95 CI): 1.85 (1.123.06), P 0.015]. When this OR was computed according to infertility etiology, it was 1.26 (0.522.95) (P 0.82) for male factor infertility and 2.24 (1.234.08) (P 0.007) for non-male factor infertility. Comparing the CPR for double versus single IUI in pre-ovulatory cases, the OR for all cycles was 1.9 (0.764.7) (P 0.22), but according to etiology, it was 4.667 (0.924.13) (P 0.06) in male factor and 1.2 (0.433.33) (P 0.779) for non-male factors. Conclusions Single IUI timed post-ovulation gives a better CPR when compared with single pre-ovulation IUI for non-male infertility, whereas for male factors, pre-ovulation, double IUI gives a better CPR when compared with single IUI. © 2011 The Author. Source

Ghanem M.E.,Mansoura Integrated Fertility Center | Elboghdady L.A.,Mansoura Integrated Fertility Center | Hassan M.,Mansoura Integrated Fertility Center | Helal A.S.,Mansoura Integrated Fertility Center | And 3 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2013

Purpose: The aim of this study was to examine the effect of clomiphene citrate [CC] co-administration during the use of exogenous low-dose urinary FSH [uFSH] for induction of ovulation in CC-resistant infertile PCOS women. Methods: In a randomised controlled setting, 174 CC-resistant infertile PCOS women were randomized into two parallel groups; Group I received CC 100 mg/day for 5 days plus uFSH 37.5 IU/day while group II received only uFSH 37.5 IU /day. Subsequent increments of uFSH by 37.5 IU/day were made according to response. Primary outcome was ovulation rate. Secondary outcomes were clinical pregnancy rates, number of follicles, endometrial thickness, and gonadotropins consumption. Results: Our results have demonstrated that group I compared to group II had significantly higher ovulation rate per intention to treat [ITT] [72.4 % vs. 34.2 %, p < 0.001]. Clinical pregnancy and live birth rates were comparable between the two groups. Group I consumed significantly lower total FSH dose and needed significantly shorter stimulation duration compared to group II. Conclusion: CC co-administered during low dose HP uFSH versus uFSH for CC-resistant PCOS yields significantly higher ovulation rate and less consumption of FSH. © 2013 Springer Science+Business Media New York. Source

Ghanem M.E.,Mansoura Integrated Fertility Center | Ragab A.E.,Mansoura University | Alboghdady L.A.,Mansoura Integrated Fertility Center | Helal A.S.,Mansoura Integrated Fertility Center | Bahlol I.A.,Mansoura Integrated Fertility Center
Middle East Fertility Society Journal | Year: 2016

Objective: To compare the impact of individual elements of difficult embryo transfer (D-ET): cervical traction (Cx-Tr), blood on outer sheath (Bl-OS), blood on transfer catheter (Bl-TC) and sounding (Snd) individually and in combination on clinical pregnancy rate (CPR) and implantation rates (IR) of ICSI cycles. Methods: A retrospective cohort study included 744 ICSI cycles. Easy embryo transfer (E-ET) was diagnosed if no resistance on passing the preloaded TC and the sheath through the cervix. Difficult transfer was defined if Cx-Tr and/or Snd was needed, and Bl-OS or Bl-TC was present. Cycle outcome was compared for E-ET and D-ET as a whole and individually with subgroups using Odds Ratio and 95% CI. Results: CPR for E-ET (45.6%) and D-ET (39.8%) is not statistically significantly different. Comparing E-ET with Cx-Tr, Bl-OS or Bl-TC, Snd showed significantly lower CPR with Bl-TC and Snd subgroups only. Although IR showed no significant difference between E-ET and over all components of D-ET it tended to be lower for Bl-TC and Snd subgroups. Conclusion: Cx-Tr and/or Bl-OS do not compromise CPR or IR. Only when Bl-TC and/or Snd the uterus at the time of ET is the CPR significantly undermined and IR tends to be impaired. © 2015 The Authors. Production and hosting by Elsevier B.V. Source

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