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Article
Sub- Inguinal Varicocelectomy in the Treatment of Infertile Males with Varicoceles

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 323-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is a disease of puberty and is only rarely detected in boys less than ten years of age.OBJECTIVE:Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III varicoceles.METHODS:A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18 to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles. All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all of them were sexually competent. Physical examination was performed with no apparent other clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination, color Doppler ultrasound was done for further documentation of the patient's condition. Only patients with grade II and grade III primary varicoceles were included in the study with exclusion of those with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The patients were followed for one year.RESULTS:The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% ) developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6 % ) developed hydrocele .CONCLUSION:Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can be achieved with successful results and minimal complications without microsurgery as long as they are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non microscopic one, the later can be done successfully with shorter operative time


Article
Comparison between The Efficacy of Combined Metformin – Letrazole with Metformin – Clomiphene Citrate in Polycystic Ovarian Syndrome

Author: Shiemaa' Mohsen Mohammad Al-Khafaje
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2462-2469
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Adding Metformin to clomiphene citrate in clomiphene –resistant PCOS patients increases ovulatory response. However because of anti-estrogenic effects of clomiphene it may be associated with lower pregnancy rate. Offsetting the ovulation rate benefit, Letrazole is an aromatase inhibitor which induce ovulation without antiestogenic effects.Aim of Study: is to induce ovulation& increase the pregnancy rate and live birth rate in patient with PCOS using a new era of therapy with less side effects, less complications and better patient compliance.Materials and Methods: The study is a single – blind randomized clinical trial , 120 ovarian cycle were studied in 60 clomiphene – resistant patients with PCOS , who were chosen among 115 PCOS patients attending infertility clinic in Samawa city – Iraq during the years 2011 – 2012 Infertile women with PCOS were randomly divided into Metformin –Letrazole (29 patients) and Metformin – clomiphene groups (30 patients) after an initial 6 – 8 weeks of metformin.They received either Letrazole (5mg) from2nd to 7th day orclomiphene citrate (100mg)daily from 5th to 9th day of menstrualcycle . Estradiol (E2) level , number of follicles and endometrial thickness were measured on the day of HCG administration .The pregnancy rate of both groups also estimated.Results: Mean total E2 and E2per mature follicle were significantly higher in clomiphene group without a difference in mean number of follicles ≥ 18mm and ovulation rate .Endometrialthickness was significantly higher in Letrazole group .Thepregnancy rate in Letrazole group (10 patients, 34.50%) as compared with clomiphene group (5 patients 16.6%) did not show significant difference, whereas full – termpregnancies were higher in Letrazole group (10 patients 34.5%) versus 3 patients (10%).Conclusion: In clomiphene resistant PCOS, the combination of Letrazole and Metformin leads to higher full term pregnanciesas compared with clomiphene and Metformin .


Article
The level of 17-beta estradiol in follicular fluid for patients undergoes IVF as correlation with the pregnancy rate
مستوى هورمون 71 بيتا استراديول في السائل الجريبي للمريضات اللواتي خضعن لعمليات اطفال الانابيب و علاقته مع معدل الحمل

Authors: Salam S. Ahmed --- Mutaz S. Ahmeid --- Muhana O. Hussein
Journal: karbala journal of pharmaceutical sciences مجلة كربلاء للعلوم الصيدلانية ISSN: 70272221 Year: 2017 Issue: 12 Pages: 120-130
Publisher: Kerbala University جامعة كربلاء

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Abstract

Estradiol (E2) is a steroid hormone produced mainly by the ovary and placenta and in small amounts by adrenals and testes. Estradiol is in equilibrium with estrone, which can be converted to estriol by the liver and placenta. Like for LH-FSH-progesterone, measurement of estradiol concentration is an essential biochemical tool for the investigation of fertility. So that this study was done to assess the follicular fluid E2 in early follicular phase as a predictor of pregnancy rate among females undergoing in vitro fertilization (IVF) in Iraqi patient. The study population consisted of women undergoing in vitro fertilization and aged between 18 - 45 years. The medical records of 56 infertile patients undergoing IVF in the program at center of Baghdad center in the period between February 2015 and July 2015.This study resulted in a pregnant women were 11 (20%) while the non-pregnant women were 45 (80%). The mean levels of E2 fluctuated among different age groups showing significantly with age >35 as compared with another group. The mean levels of E2 in follicular fluid fluctuated among different BMI groups showing that mid 30 year women had more chance to have pregnancy through IVF, and there's no significant between pregnant and non-pregnant. When related to BMI, IVF result showed that the chance of IVF success increased with decreased BMI. This implies that slim women had more chance to have pregnancy through IVF. Furthermore, level of E2 in follicular fluid couldn't be used in IVF as a predictor success of pregnancy.

هرمون استراديول ينتج أساسا من المبيض والمشيمة و كميات صغيرة منه من الغدة الكظرية والخصيتين. وهو في حالة منالتوازن مع إيسترن، التي يمكن تحويلها إلى استريول بالكبد والمشيمة. وهو مثل هورمونات LH-FSH- البروجسترون من حيثكون تركيز الاستراديول ضروري لتحقيق الخصوبة. في هذه الدراسة تم تقييم E2 في السائل الجريبي في مرحلة ما قبل التبويضكمنبئ لمعدل الحمل بين الإناث اللواتي تمر بالاخصاب في الأنابيب )اطفال الانابيب(لالمرضى العراقيين . هذه الدراسة اجريت- على النساء اللواتي تمر بالاخصاب في الأنابيب، والذين تتراوح أعمارهم بين 54 81 سنة. تم عمل مع عدد من المريضات 45. يعانين من العقم وخضعن لعمليات اطفال الانابيب في مركز بغداد للعقم في الفترة ما بين شباط 5184 وتموز 518411 %(. وان متوسط ( 51 في المائة( بينما كانت النساء غير الحوامل 54 ( وأسفرت هذه الدراسة ان النساء الحوامل يمثلن 88مستويات E2 تغيرت بين مختلف الفئات العمرية في السائل الجريبي إلى حد كبير مع التقدم في السن اكبرمن 54 سنة مقارنةبمجموعة أخرى.ولقد تذبذبت مستويات ال E2 فيم بين مختلف فئات مؤشر كتلة الجسم تبين أن المرأة لها منتصف السنة 51فرصة أكبر للحمل عن طريق التلقيح الاصطناعي وانه لا يوجد فرق ملحوظ بين النساء الحوامل وغير الحوامل. وعندما يقارنبمؤشر كتلة الجسم فقد أظهرت النتائج أن فرص نجاح عمليات اطفال الانابيب زاد مع انخفض مؤشر كتلة الجسم . وهذا يعني أنالمرأة ذات الوزن الاقل لها فرصة أكبر للحمل عن طريق اطفال الانابيب. وعلاوة على ذلك، لا يمكن استخدام مستوى ال E2في السائل الجريبي لعمليات اطفال الانابيب كعامل متنبئ بالحمل

Keywords

Follicular fluid --- E2 --- IVF --- Pregnancy rate


Article
Role of Endometrial Scratch in Enhancing Pregnancy Rate of ICSI Cycle Through Its Effect on TNF-α

Authors: Wasan A. Abdulhameed --- Manal T. AL-Obaidi --- Fadya K. AL-Jorani
Journal: Iraqi Journal of Embryos and Infertility Researches المجلة العراقية لبحوث الأجنة والعقم ISSN: eISSN: 26166984 / pISSN: 22180265 Year: 2018 Volume: 8 Issue: 2 Pages: 1-6
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

AbstractBackground:The overall success rate of assisted reproductive techniques is onlyabout 30% due to certain limiting factors. Endometrial scratching could induceinflammatory response which manifested by the up-regulation of different cytokinesand chemokines with subsequent accumulation of immune cells in the injuredsite. One of the most important cytokine in this regard is TNF-α which wasfound to induce tissue remodeling by stimulating the production of many otherpro-inflammatory cytokines.Objectives:To investigate the role of endometrial injury during the luteal phasebefore ICSI cycles in the enhancement of pregnancy outcomes.Materials and Methods:This prospective study was undertaken in the High Instituteof Infertility diagnosis and Assisted Reproductive Techniques / Al-NahrainUniversity. All women were undergone ICSI cycles. Women in the intervensiongroup underwent endometrial scratching with a Pipelle catheter in luteal phasepreceding cycle. Blood sample was taken before scratch. All patients undergocontrolled ovarian hyperstimulation, oocyte retrieval and embryo transfer, anotherblood sample was taken at day of embryo transfer to measure level of TNF-α.Clinical pregnancy rate then evaluation after luteal support of two weeks.Results:The patients in scratch group has higher pregnancy rate (14/23) 60.9%than non intervention group (11/33) 33.3% although not significant (p value0.057).The results showed that the TNF-α after scratch (54.53±10.2) was significantlyhigher than before scratch (39.26±14.74) in the same group, as p value was( <0.001). In addition the TNF-α was significantly higher in scratch group(54.53±10.2) than control (25.91±9.08) as p value was (< 0.001) .Conclusion:Induced endometrial local injury is an easy, simple and cost-effectivetechnique that can be used to improve the uterine receptivity and enhanceembryo transplantation.


Article
Enhanced fertility after diagnostic hysterosalpingography using water-soluble contrast media
تعزيز الخصوبة بعد تشخيص الرحم باستخدام وسائل التباين القابلة للذوبان في الماء

Authors: Shawnm Nasih Dawood --- Aryan Xalis Jawad --- Media Ghazi Sedeq
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2015 Volume: 19 Issue: 1 Pages: 923-928
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objectives: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for more than half a century. The aim of this study was to evaluate the effect of flushing the fallopian tubes with water-soluble contrast medium during hysterosalpingography on subsequent pregnancy rates and to find out diagnostic findings of hysterosalpingography in infertile patients. Methods: A prospective study was conducted on 220 women. hysterosalpingography using water-soluble contrast media was done in a private clinic as part of their infertility work up from January 2012 to July 2012 in Erbil city, Kurdistan region, Iraq. The pregnancy rate was determined within six months from the procedure using water soluble contrast media and it was correlated with different hysterosalpingography findings. Results: The mean age (+SD) of the study population was 30.59 (+5) years. The clinical pregnancy rate was 23.2%. A statistically significant difference was found between the rate of pregnancy and hysterosalpingography results in which 27.2% of patients with normal hysterosalpingography and 6.8% of patients with abnormal hysterosalpingography got pregnant during six-month follow-up period after the procedure (P = 0.004). Conclusions: Flushing of the tubes with water-soluble contrast media during hysterosalpingography increases subsequent pregnancy rates in infertile patients.


Article
Efficacy of combined metformin- letrozole in comparison with metformin-laparoscopic ovarian diathermy in ovulation induction and reproductive outcome for women with clomiphene citrate resistant polycystic ovary syndrome

Author: Yasamin Hamza Sharif AL-Shibany ياسمين حمزة شريف
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 18 Pages: 183-191
Publisher: Al-Qadisiyah University جامعة القادسية

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Background and objective: polycystic ovary syndrome(PCOS) is a common cause of infertility and is associated with chronic anovulation and hyperandrogenism.The aim of current study is to compare the effect of combined letrozole-metformine to that of metformin-laparoscopic ovarian drilling (LOD) for ovulation induction in patients with PCOS.Materials and Methods: on the whole 138 ovarian cycles were studied in 60 patients with clomiphene citrate resistant PCOS in AL-Diwaniyah Maternity and Pediatrics Teaching Hospital during the period of June 2112-June 2114.All patients (n=60) received metformin 500mg /3times per day ,group A(n=30)received letrozole 5mg daily for 5 days repeated for 6 cycles, group B(n=30) underwent LOD and followed for six cycles. Outcome measures were ovulation rates, endometrialthickness, pregnancyrates, live birth rates and miscarriage rate.Results: ovulation rate was higher in group A than group B(63.33% versus 30.0%),a significant increase in endometrial thickness in group A than group B(9.9mm versus 9.03 mm).Live birth rate was higher in group A 83.33% compared to 33.33% in group B. There were no significant differences regarding miscarriage rates between both groups. No multiple pregnancy or ovarian hyper stimulation syndrome or congenital abnormality among live births were reported.Conclusions: Combinedletrozole-metformin seems to be a suitable second line ovulation inducing alternative to LOD in women with PCOS who do not respondwith clomiphene citrate.

اجريت الدراسة على مجموعه من النساء المصابات بمتلازمة تكيس المبيض و عددها 60 مريضة مع عدم استجابة لعقار الكلومفين في مستشفى الولادة و الاطفال التعليمي في الديوانية في شعبة العقم للفترة من حزيران 2012 و لغاية حزيران 2014 .اظهرت النتائج ان المجموعة الاولى و عددها 30 مريضة والتي اعطية عقار اللتروزول مع المتفورمين اعلى نسبة في التبويض63,33% مقارنة مع المجموعة الثانية و عددها 30 مريضة و التي اعطيت عقار المتفورمين واجريت لهن عملية تثقيب المبيض بالناظور الجراحي تحت التخدير العام 30,00% . وكانت اعلى نسبة للحمل في المجموعة الاولى 40,00% بالمقارنة مع المجموعة الثانية 16,67%.لا يوجد اختلاف في نسبة الاسقاطات ولا توجد حالات تشوهات خلقية لدى المواليد في المجموعتين.نستنتج :ان عقار اللتروزول مع المتفورمين يعتبر بديل فعال و سليم عن التداخل الجراحي وتثقيب المبيض بالناظور في حالات تكيس المبايض المقاوم لعقار الكلومفين.


Article
Induction of fertile estrus in Iraqi camel (camelus dromedarius) during seasonal anoestrus
أحداث الشبق الخصب في النوق العراقية أحادية السنام خارج موسم التناسل

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Abstract

This study was performed on 36 Iraqi she- camels aged between 5-8 years from Sept .2016 to Apr. 2017 in Al- Najaf province, these animals divided into three equal groups (12 for each one ) randomly according to the type of treatments , 1st group treated with CIDR (1.38gm progesterone ) intr-avaginaly for 10 days and 2000 I.U of PMSG /I.M injected withdrawal CIDR directly , 2nd group treated with CIDR for 14 days + 2000 I.U PMSG /I.M while 3rd group without treatment and represented the control group. The results in this study showed superior significantly (p<0.01) in 2nd group related with animals response compared with 1st and 3rd group as well as significantly between 1st and 3rd group, while the duration of response was recorded highly significantly (p<0.01)for the treated groups (1st&2nd) compared with control group( 3rd) . But the number of services per conception which recorded non significantly (p<0.01) between all groups, while the pregnancy rate was recorded 100%, 90% and 100% in 1st ,2nd and 3rd groups respectively with significantly (p<0.01) related with 1st and 3rd compared with 2nd group. Finally the days open recorded 94.13±7.01 , 97.24±6.78 and 153.57±12.64 in 1st, 2nd and 3rd groups respectively with highly significant for 1st and 2nd compared with 3rd group. In conclusion in this study that they used hormonal treatments (CIDR +PMSG ) for induction of fertile estrus was safe and effect for increasing pregnancy rate and reduction days open.

أجريت الدراسة على 63 ناقة عراقية تراوحت أعمارها ما بين 56102 في محافظة النجف ألاشرف،وقد تم تقسيم الحيوانات إلى ثلاثة مجاميع متساوية )ضمت كل مجموعة 06 ناقة (عشوائيا" طبقا" ل نوع المعاملة الهرمونية المستخدمة ،فقد عوملت المجموعة الأولى باستخدام السايدر لفترة عشرة أيامداخل المهبل وبجرعة 0،68 غ من البروجستيرون بالإضافة إلى حقن هرمون مصل الفرس الحامل بجرعة 6111وحدة دولية في العضل حال سحب آلة السايدر )اليوم العاشر( أما المجموعة الثانية فقد استخدم السايدر لفترة 01 يومأعقبها إعطاء نفس الجرعة من هرمون مصل الفرس الحامل فيما تركت المجموعة الثالثة بدون معاملة واعتبرتمجموعة سيطرة 1 أوضحت نتائج الدراسة إن هناك فارق إحصائي مهم بمستوى (p<0.01) في نسبة الاستجابة لصالح المجموعة الثانية مقارنة مع المجموعتين الأولى والثالثة إضافة إلى وجود فرق إحصائي مهم بين المجموعتين الأولىوالثالثة أما ما يخص فترة الاستجابة فقد تبين وجود فرق إحصائي بمستوى (p<0.01) لصالح المجوعتين الأولىوالثانية مقارنة مع مجموعة السيطرة أما عدد التلقيحات اللازمة لحدوث الإخصاب فلم يظهر فرق إحصائي في01 % و 011 % في المجاميع الأولى والثانية والثالثة على التوالي مع ، % المجاميع الثلاثة 1 نسبة الحمل سجلت 011فرق إحصائي مهم 1 (p<0.01) لصالح المجموعة الأولى والثالثة مقارنة مع المجموعة الثانية وأخيرا" فقد تم تسجيلفترة الأيام المفتوحة بفارق إحصائي مهم (p<0.01) في المجموعتين المعاملتين )الأولى والثانية( مقارنة مع مجموعةالسيطرة )الثالثة( نستنتج من هذه الدراسة بأن استخدام المعاملات الهرمونية التي تظم السايدر ومصل الفرس الحاملمؤثرة وأكثر أمان في زيادة نسبة الحمل واختزال فترة الأيام المفتوحة


Article
Correlation between in vitro sperm preparation techniques, endometrial thickness, hormonal profile and successful pregnancy rate following IUI: retrospective and prospective study
العلاقة بين تقنيات تنشيط النطف ,عدد الجريبات وحجمها, سمك بطانة الرحم , قياس الهرمونات وبرنامج تحفيز المبايض المستخدم في عملية التنمية داخل الرحم مع معدلات الحمل :دراسة استرجاعية ومستقبلية

Authors: مي عبد الكريم ابو رغيف --- saad s.aldujaily سعد صالح الدجيلي
Journal: Iraqi Journal of Embryos and Infertility Researches المجلة العراقية لبحوث الأجنة والعقم ISSN: eISSN: 26166984 / pISSN: 22180265 Year: 2012 Volume: 2 Issue: 4 Pages: 9-14
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:The intra uterine insemination (IUI) still an easy, simple and effective method to overcome the infertility that resulted from different causes. Although the equipments and methods of assisted reproductive technologies (ART) were highly developed, the percentage of successful IUI live-birth not exceed 20- 30%.Objective;The present study was aimed to elucidated the cut off values of in vitro sperm preparation technique, follicular number and size, endometrial thickness and hormonal profile that lead to successful pregnancy rate (PR)following IUI.Materials and Methods:In retrospective study, one hundred cases of infertile couples were in who were became pregnant following IUI at the Institute of Infertility Diagnosis and Assisted Reproductive Technologies, through the period from January 2007 to January 2010. Depending on the results of retrospective study, IUI was achieved for 100 infertile patients between August 2010and June 2011. The mean of significant prognostic variables were measured in both studies namely: age, type of infertility, type of sperm activation techniques, the protocol of ovulation induction medicine, the mean of hormonal status of Luteinizing Hormone (LH), Estradiol(E2), and number with diameter of follicles, endometrial thickness a cycle day before hCG injectionResults:The protocol of ovulation induction in IUI cycles by using clomiphene citrate(CC) and recombinant gonadotropin (rFSH) was significantly(p<0.05) improve the IUI results compared to CC alone or CC with Pergonal®. The mean values obtained by ultrasonography namely; two follicles, and dominant follicle of 19.5mm in size with endometrium thickness of >9.5mm were gave significantly successful IUI outcome compared to other values. In prospective study similar results were obtained .therefore the overall pregnancy rate was 37% per cycle. Conclusion:The calculated data of successful IUI outcomefrom retrospective study gave a best pregnancy rate in prospective study which was 37%.Consequently, these results can be considered as guideline for physician who interest in assisted reproduction to have a success in IUI.

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