Prediction of ovarian hyperstimulation syndrome (OHSS). Estradiol level has an important role in the prediction of OHSS.

The cascade of events that leads to the development of ovarian hyperstimulation syndrome (OHSS) is almost always accompanied by elevated estradiol (E(2)) levels. The role of estrogen level in OHSS has not been confirmed; however, it was shown repeatedly in the literature that elevated levels of E(2) constitute a risk for OHSS. Monitoring E(2) was found to be effective in reducing the incidence of OHSS.

Pregnancy rate is not improved by delaying embryo transfer from days 2 to 3.

Objective: To compare the outcome of assisted reproduction in day 2 versus day three embryo transfer.

Design: Prospective study.

Participants: A total of 927 consecutive embryo transfers for IVF and ICSI cycles including 626 embryo transfers on day 2 and 301 on day 3.

Diagnosis and management of unexplained infertility: an update.

Unexplained infertility constitutes around 15% of patients presenting with infertility. A lack of agreement exists among infertility specialists with regard to the diagnostic tests to be performed and their prognostic value as well as criteria of normality. It seems that serum progesterone for detection of ovulation, hysterosalpingography and or laparoscopy for tubal patency and semen analysis are the basic tests for diagnosis of unexplained infertility.

The use of clomiphene citrate/human menopausal gonadotrophins in conjunction with GnRH antagonist in an IVF/ICSI program is not a cost effective protocol.

Objective: To evaluate the cost effectiveness of a clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/GnRH antagonist protocol versus a long-acting GnRH agonist/hMG protocol.

Participants And Methods: One hundred eighty nine couples having their first trial of ICSI for male factor infertility were divided into two groups. Group I (no = 33) received CC 100-150 mg/day for five days starting from day 2 of the cycle and 150 IU of hMG/day on days 6-10.

Meta-analysis of recombinant versus urinary-derived FSH: an update.

Background: The study aim was to analyse the results of randomized controlled trials (RCTs) comparing recombinant FSH and urinary-derived FSH gonadotrophins [hMG, urinary purified FSH (FSH-P) and highly purified FSH (FSH-HP)] in an IVF/ICSI programme.

Methods: All published truly RCTs using a long protocol of GnRH agonists for down-regulation, were reviewed. Data of pregnancy rate per started cycle were extracted, and odds ratios (OR) calculated using a fixed effect model.

Intravenous albumin for preventing severe ovarian hyperstimulation syndrome: a Cochrane review.

Background: The effectiveness of human albumin administration in prevention of severe ovarian hyperstimulation syndrome (OHSS) was reviewed using the Cochrane Menstrual Disorders and Subfertility Group literature search strategy.

Methods: Only randomized controlled trials (RCT) comparing the effect of human albumin with placebo or no treatment were included in this review. Seven RCT were identified, five of which met our inclusion criteria and enrolled 378 women (193 in the albumin-treated group and 185 in the control group).

A prospective controlled study of karyotyping for 430 consecutive babies conceived through intracytoplasmic sperm injection.

Objective: To compare the karyotype of babies conceived through ICSI with that of naturally conceived babies.

Design: Prospective controlled study.

Setting: The Egyptian IVF-ET Center, Cairo, Egypt.

Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials.

Objective: To investigate the optimum number of cycles of controlled ovarian hyperstimulation and intrauterine insemination in the treatment of unexplained infertility.

Design: Observational prospective study.

Setting: In vitro fertilization embryo transfer center.

Controversies in the surgical management of hydrosalpinx.

The surgical management of hydrosalpinges is a controversial subject. Chronic pathology of the fallopian tube with distal obstruction leads to the formation of a hydrosalpinx, and is associated with very poor pregnancy rates after surgery. In these cases, in-vitro fertilization has proved to be a much better alternative.

Elevated levels of interleukin-2, soluble interleukin-2 receptor alpha, interleukin-6, soluble interleukin-6 receptor and vascular endothelial growth factor in serum and ascitic fluid of patients with severe ovarian hyperstimulation syndrome.

Objective: To investigate the possible role of vascular endothelial growth factor, interleukin-2, soluble interleukin-2 receptor alpha, interleukin-6 and soluble interleukin-6 receptor in the pathogenesis of ovarian hyperstimulation syndrome.

Study Design: The study group consisted of 10 healthy women who developed severe ovarian hyperstimulation syndrome, group A (n=10), following ovarian stimulation by long GnRHa/hMG protocol for IVF. A control group B=10 patients underwent stimulation with the same protocol and did not develop OHSS.

Controversies in the modern management of hydrosalpinx.

The management of hydrosalpinx is a difficult clinical problem. Surgical treatment includes fimbrioplasty for patients with fimbrial obstruction and salpingostomy to fashion a stoma in the distal Fallopian tube in patients with a damaged fimbrial end. Surgery is only suitable for a small thin-walled hydrosalpinx with healthy mucosa.

Multifetal pregnancy reduction: modification of the technique and analysis of the outcome.

Objective: To modify the technique of multifetal pregnancy reduction and to study the outcome of reduced twins in comparison with nonreduced twins and high-order multiple gestations.

Design: Prospective controlled study.

Setting: The Egyptian IVF-ET Center, Cairo.

Complications of medically assisted conception in 3,500 cycles.

Objective: To investigate the incidence of complications in the use of assisted reproductive technology in the management of infertile couples.

Design: Retrospective study.

Setting: The Egyptian IVF & ET Center, Maadi, Cairo, Egypt.

Elevated concentrations of angiogenin in serum and ascitic fluid from patients with severe ovarian hyperstimulation syndrome.

This study was conducted to investigate the possible role of angiogenin in the pathogenesis of ovarian hyperstimulation syndrome (OHSS). The study group consisted of 10 healthy women who developed severe OHSS (group A) following ovarian stimulation by a long protocol of gonadotrophin-releasing hormone analogues/human menopausal gonadotrophin for in-vitro fertilization. A control group B (n = 10) underwent stimulation by the same protocol and did not develop OHSS.

Intracytoplasmic sperm injection: a state of the art technique.

Of the micromanipulation techniques developed in the twentieth century, intracytoplasmic sperm injection (ICSI) has been the major breakthrough in the field of assisted fertilization. This article reviews the indications for the use of ICSI, its clinical application, the establishment of an ICSI programme including protocol and the results obtained since the introduction of ICSI and the potential risks. In addition, intracytoplasmic spermatid injection is briefly discussed.

Intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia.

We compared the results of intracytoplasmic sperm injection (ICSI) in: (i) obstructive versus non-obstructive azoospermia, (ii) obstructive azoospermia using epididymal versus testicular spermatozoa and (iii) acquired versus congenital obstructive azoospermia due to congenital absence of the vas deferens (CAVD). A retrospective analysis was done of 241 consecutive ICSI cycles done in 103 patients with non-obstructive azoospermia and 119 patients with obstructive azoospermia. In the obstructive group, 135 ICSI cycles were performed.

Successful intracytoplasmic sperm injection without performing cytoplasmic aspiration.

Objective: To compare the effect of cytoplasmic aspiration versus no aspiration before intracytoplasmic sperm injection (ICSI) on the rate of oocyte damage, fertilization rate, and embryo quality.

Design: A randomized prospective study on sibling oocytes.

Setting: The Egyptian IVF-ET Center, Cairo, Egypt.