Ahmed Badawy | American University in Cairo (original) (raw)

Papers by Ahmed Badawy

Fertility and Sterility, 2010

Objective: To investigate whether vaginal progesterone gel may result in similar or higher pregna... more Objective: To investigate whether vaginal progesterone gel may result in similar or higher pregnancy rates compared with all other vaginal progesterone forms when used for luteal-phase support. Design: Meta-analysis of randomized controlled trials using odds ratios (OR) and 95% confidence intervals (CI). Patient(s): Infertile women undergoing IVF or ICSI. Intervention(s): Vaginal progesterone gel 90mg once or twice daily versus any other vaginal progesterone form for luteal phase support. Main Outcome Measure(s): Clinical pregnancy rates. Result(s): Seven randomized controlled trials, involving 2,447 patients, were included in the analysis. No difference was observed in the overall clinical pregnancy rate when comparing vaginal progesterone gel with any other vaginal progesterone form. Moreover, clinical pregnancy rates were similar in protocols using only GnRH agonists and when comparing vaginal gel with the traditional treatment of 200 mg  3 vaginal progesterone capsules. Conclusion(s): This meta-analysis provides solid evidence that no significant difference exists between vaginal gel and all other vaginal progesterone forms in terms of clinical pregnancy rates.

Human Reproduction, 2011

To explore the molecular basis of clinically observed volume reduction in uterine leomyoma, expos... more To explore the molecular basis of clinically observed volume reduction in uterine leomyoma, exposed to mifepristone. Background: Treatment of uterine leiomyomas with a selective progesterone receptor modulator (SPRM) as an alternative to surgery is of considerable clinical interest. Steroid homone receptors are overexpressed in leiomyoma tumor tissue compared to adjacent myometrium and involved in the process of leiomyoma growth. Progesterone receptor modulators such as mifepristone are effective and well tolerated in reducing myoma volume and vaginal bleeding. In a previously reported study we observed a significant volume reduction in the dominant myoma in response to mifepristone, but with a wide individual variation (median-23%, range:-81 to + 19%) in response to treatment. Thus, a study was conducted to explore the molecular basis of good response to mifepristone treatment. Material and Methods: Premenopausal women with uterine leiomyoma (n = 12) received treatment with mifepristone 50 mg every other day for 12 weeks. Among them, eight women were sub grouped as good (N = 4, median-49%, range-64 to-31%) or poor (N = 4, median-22%, range-23 to-21%) respnders. At surgery, biopsies were taken from the periphery of the dominant leiomyoma and total RNA was extracted to study the gene expression by microarray. The result was further analysed by Ingenuity Pathway Analysis (IPA, Ingenuity® Systems, www.ingenuity.com) to explore the leading molecular pathway mediating the response to mifepristone. The result from the microarray was confirmed by real time-PCR. Proliferation marker MKI67 and apoptosis marker TP53 were analysed along with apoptotic index by TUNEL assay. Ethical permission for this study was obtained prior to start of the study. Results: Twenty one canonical pathways showed significantly different expression (p < 0,05) on comparing between good and poor responders. The most differently expressed pathway was Metabolism of Xenobiotics by Cytochrome P450 pathway. The second most significant pathway and the pathway more relevant to uterine leomyoma growth is the glutathione pathway harboring glutathione-s tranferases (p = 0.0001, ratio 5%). One of the genes was downregulated (GPX2-1.7 fold) and 4 genes belonging to this family were upregulated (GSTM1 + 8.0-fold), GSTM2(+ 1.5 fold), GSTM3(+ 2.3 fold), GSTM5(+ 2.2 fold) among the good responders. Further analysis by real time PCR showed GSTM1 was not detectable in biopsies from non responders. No correlations were seen for GSTM1, MKI67 or TP53 versus percentual myoma volume reduction. TUNEL analysis showed no difference in the degree of apoptosis between good or bad responders to mifepristone. Conclusion: Our findings indicate that glutothione pathway is involved in the action of mifepristone on leiomyoma volume reduction. GSTM1 positive fenotype is of importance for uterine leiomyoma volume reduction in response to mifepristone exposure in vivo. The mechanism behind the difference in growthregulation is still not clear, but could be suggested to interfere with proliferation or repression co-regulators related to the degree of metabolism of steroids regulated by GSTMs. The finding in the present study of a tentative prognostic marker for leiomyoma volume reduction during mifepristone treatment is of potential importance for the clinical management of millions of women suffering from symptoms from uterine leiomyomas.

Reproductive BioMedicine Online, 2014

He is the author of many publications on endoscopic surgery, ovulation induction and various tech... more He is the author of many publications on endoscopic surgery, ovulation induction and various techniques of assisted reproduction. He has received many national and international awards and has given presentations at most of the international conferences in obstetrics and gynaecology.

Fertility and Sterility, 2010

Objective: To compare the effect of letrozole with combined metformin and clomiphene citrate (CC)... more Objective: To compare the effect of letrozole with combined metformin and clomiphene citrate (CC) for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS). Design: A randomized controlled trial. Setting: University teaching hospital and a private practice setting. Patient(s): Two hundred fifty anovulatory women (582 cycles) with CC-resistant PCOS. Intervention(s): Patients received 2.5 mg of letrozole daily (123 patients, 285 cycles) or combined metformin-CC (127 patients, 297 cycles) for three treatment cycles. Main Outcome Measure(s): Ovulation rate, number of follicles, serum E 2 , serum P, endometrial thickness, pregnancy, and miscarriage rates. Result(s): Ovulation occurred in 185/285 cycles (64.9%) in the letrozole group versus 207/297 cycles (69.6%) in the combined metformin-CC group, without statistically significant difference. The total number of follicles was significantly more in the combined metformin-CC group (4.4 AE 0.4 vs. 6.8 AE 0.3). A nonsignificant increase in endometrial thickness on the day of hCG administration was observed in the letrozole group (9.5 AE 0.2 mm vs. 9.1 AE 0.1 mm). No statistically significant difference regarding the pregnancy rate (PR) was observed between both groups (14.7% vs. 14.4%). Conclusion(s): Letrozole and combined metformin-CC are equally effective for inducing ovulation and achieving pregnancy in patients with CC-resistant PCOS.

Fertility and Sterility, 2006

Objective: To compare clomiphene citrate with N-acetyl cysteine vs. clomiphene citrate alone for ... more Objective: To compare clomiphene citrate with N-acetyl cysteine vs. clomiphene citrate alone for augmenting ovulation in management of unexplained infertility. Design: Prospective randomized double-blind controlled trial. Setting: Department of obstetrics and gynecology in a university medical faculty in Egypt. Patient(s): Four hundred four patients as a study group (clomiphene citrate plus N-acetyl cysteine group) and 400 patients as a control group (clomiphene citrate-alone group). All women had unexplained infertility. Intervention(s): Patients in the study group were treated with clomiphene citrate (50-mg tablets) twice per day and with N-acetyl cysteine (1,200 mg/d orally) for 5 days starting on day 2 of the cycle. Patients in the control group were treated with clomiphene citrate with sugar powder. Main Outcome Measure(s): The primary outcomes were number and size of growing follicles, serum E 2 , serum P, and endometrial thickness. The secondary outcome was the occurrence of pregnancy. Result(s): There were no statistically significant differences between the two groups in the number of follicles sized Ͼ18 mm, mean E 2 levels, serum P, or endometrial thickness. Pregnancy rate was comparable in both groups (22.2% vs. 27%). Miscarriage rate was comparable in both groups (6.7% in the study group vs. 7.4% in the control group). Conclusion(s): N-Acetyl cysteine is ineffective in inducing or augmenting ovulation in patients with unexplained infertility and cannot be recommended as an adjuvant to clomiphene citrate in such patients.

Journal of reproduction & infertility, 2011

Failure to respond adequately to standard protocols and to recruit adequate follicles is called &... more Failure to respond adequately to standard protocols and to recruit adequate follicles is called 'poor response'. This results in decreased oocyte production, cycle cancellation and, overall, is associated with a significantly diminished probability of pregnancy. It has been shown that ovarian reserve tests, such as basal FSH, antimullarian hormone (AMH), inhibin B, basal estradiol, antral follicular count (AFC), ovarian volume, ovarian vascular flow, ovarian biopsy and multivariate prediction models, have little clinical value in the prediction of a poor response. Although recent evidence points that AMH and AFC may be better than other testsbut they still continue to be used and form the basis for the exclusion of women from fertility treatments. Despite the rigorous efforts made in this regard, a test that could reliably predict poor ovarian response in all clients that undergo IVF is currently lacking.

Gynaecological Endoscopy, 2002

ABSTRACT

Conditional cash transfer (CCT) programs, as one of the most efficient social protection programs... more Conditional cash transfer (CCT) programs, as one of the most efficient social protection programs, use large amount of public resources. Such programs are prone to leakage of public resources due to risks from error, fraud, and corruption. Countries in Latin America have implemented CCT programs since the early 1980’s and they have experienced leakages from error, fraud, and corruption (EFC) which requires use of mechanisms and a control system to tackle the risks of EFC. These mechanisms have been introduced in the World Bank toolkit on tackling error, fraud, and corruption. The recommended strategies to mitigate EFC address risks through three main strategies: prevention, detection strategies, and deterrence.
This study answers the main research question of what guidance does Egyptian and global experience provide as to what constitutes a proper control system for the implementation of conditional cash transfer programs to prevent error, fraud, and corruption? It provides a vision of what proper controls could be useful for implementing CCT in Egypt and other countries that share similar characteristics.
This broader perspective of protection mechanisms has been investigated through contacting global experts from different countries and local social inspectors who worked in the pilot project in Egypt. This combination takes advantage of global and local experiences recommend what could enable Egypt to have a proper control system to reduce EFC.
The study findings demonstrate that Egypt can apply proper administration and financial controls in its CCT program at each of its three main stages: eligibility, compliance, and cash disbursing. Recommended control mechanisms are developed around three building blocks of prevention; detection; and deterrence. Other recommendations are provided for CCT program in Egypt regarding interministerial cooperation, the required political support to CCT for program success, use of computerized systems in the verification processes, and a reconsideration of economic, political, and administrative challenges to CCT programs in Egypt.

Fertility and Sterility, 2010

Objective: To investigate whether vaginal progesterone gel may result in similar or higher pregna... more Objective: To investigate whether vaginal progesterone gel may result in similar or higher pregnancy rates compared with all other vaginal progesterone forms when used for luteal-phase support. Design: Meta-analysis of randomized controlled trials using odds ratios (OR) and 95% confidence intervals (CI). Patient(s): Infertile women undergoing IVF or ICSI. Intervention(s): Vaginal progesterone gel 90mg once or twice daily versus any other vaginal progesterone form for luteal phase support. Main Outcome Measure(s): Clinical pregnancy rates. Result(s): Seven randomized controlled trials, involving 2,447 patients, were included in the analysis. No difference was observed in the overall clinical pregnancy rate when comparing vaginal progesterone gel with any other vaginal progesterone form. Moreover, clinical pregnancy rates were similar in protocols using only GnRH agonists and when comparing vaginal gel with the traditional treatment of 200 mg  3 vaginal progesterone capsules. Conclusion(s): This meta-analysis provides solid evidence that no significant difference exists between vaginal gel and all other vaginal progesterone forms in terms of clinical pregnancy rates.

Human Reproduction, 2011

To explore the molecular basis of clinically observed volume reduction in uterine leomyoma, expos... more To explore the molecular basis of clinically observed volume reduction in uterine leomyoma, exposed to mifepristone. Background: Treatment of uterine leiomyomas with a selective progesterone receptor modulator (SPRM) as an alternative to surgery is of considerable clinical interest. Steroid homone receptors are overexpressed in leiomyoma tumor tissue compared to adjacent myometrium and involved in the process of leiomyoma growth. Progesterone receptor modulators such as mifepristone are effective and well tolerated in reducing myoma volume and vaginal bleeding. In a previously reported study we observed a significant volume reduction in the dominant myoma in response to mifepristone, but with a wide individual variation (median-23%, range:-81 to + 19%) in response to treatment. Thus, a study was conducted to explore the molecular basis of good response to mifepristone treatment. Material and Methods: Premenopausal women with uterine leiomyoma (n = 12) received treatment with mifepristone 50 mg every other day for 12 weeks. Among them, eight women were sub grouped as good (N = 4, median-49%, range-64 to-31%) or poor (N = 4, median-22%, range-23 to-21%) respnders. At surgery, biopsies were taken from the periphery of the dominant leiomyoma and total RNA was extracted to study the gene expression by microarray. The result was further analysed by Ingenuity Pathway Analysis (IPA, Ingenuity® Systems, www.ingenuity.com) to explore the leading molecular pathway mediating the response to mifepristone. The result from the microarray was confirmed by real time-PCR. Proliferation marker MKI67 and apoptosis marker TP53 were analysed along with apoptotic index by TUNEL assay. Ethical permission for this study was obtained prior to start of the study. Results: Twenty one canonical pathways showed significantly different expression (p < 0,05) on comparing between good and poor responders. The most differently expressed pathway was Metabolism of Xenobiotics by Cytochrome P450 pathway. The second most significant pathway and the pathway more relevant to uterine leomyoma growth is the glutathione pathway harboring glutathione-s tranferases (p = 0.0001, ratio 5%). One of the genes was downregulated (GPX2-1.7 fold) and 4 genes belonging to this family were upregulated (GSTM1 + 8.0-fold), GSTM2(+ 1.5 fold), GSTM3(+ 2.3 fold), GSTM5(+ 2.2 fold) among the good responders. Further analysis by real time PCR showed GSTM1 was not detectable in biopsies from non responders. No correlations were seen for GSTM1, MKI67 or TP53 versus percentual myoma volume reduction. TUNEL analysis showed no difference in the degree of apoptosis between good or bad responders to mifepristone. Conclusion: Our findings indicate that glutothione pathway is involved in the action of mifepristone on leiomyoma volume reduction. GSTM1 positive fenotype is of importance for uterine leiomyoma volume reduction in response to mifepristone exposure in vivo. The mechanism behind the difference in growthregulation is still not clear, but could be suggested to interfere with proliferation or repression co-regulators related to the degree of metabolism of steroids regulated by GSTMs. The finding in the present study of a tentative prognostic marker for leiomyoma volume reduction during mifepristone treatment is of potential importance for the clinical management of millions of women suffering from symptoms from uterine leiomyomas.

Reproductive BioMedicine Online, 2014

He is the author of many publications on endoscopic surgery, ovulation induction and various tech... more He is the author of many publications on endoscopic surgery, ovulation induction and various techniques of assisted reproduction. He has received many national and international awards and has given presentations at most of the international conferences in obstetrics and gynaecology.

Fertility and Sterility, 2010

Objective: To compare the effect of letrozole with combined metformin and clomiphene citrate (CC)... more Objective: To compare the effect of letrozole with combined metformin and clomiphene citrate (CC) for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS). Design: A randomized controlled trial. Setting: University teaching hospital and a private practice setting. Patient(s): Two hundred fifty anovulatory women (582 cycles) with CC-resistant PCOS. Intervention(s): Patients received 2.5 mg of letrozole daily (123 patients, 285 cycles) or combined metformin-CC (127 patients, 297 cycles) for three treatment cycles. Main Outcome Measure(s): Ovulation rate, number of follicles, serum E 2 , serum P, endometrial thickness, pregnancy, and miscarriage rates. Result(s): Ovulation occurred in 185/285 cycles (64.9%) in the letrozole group versus 207/297 cycles (69.6%) in the combined metformin-CC group, without statistically significant difference. The total number of follicles was significantly more in the combined metformin-CC group (4.4 AE 0.4 vs. 6.8 AE 0.3). A nonsignificant increase in endometrial thickness on the day of hCG administration was observed in the letrozole group (9.5 AE 0.2 mm vs. 9.1 AE 0.1 mm). No statistically significant difference regarding the pregnancy rate (PR) was observed between both groups (14.7% vs. 14.4%). Conclusion(s): Letrozole and combined metformin-CC are equally effective for inducing ovulation and achieving pregnancy in patients with CC-resistant PCOS.

Fertility and Sterility, 2006

Objective: To compare clomiphene citrate with N-acetyl cysteine vs. clomiphene citrate alone for ... more Objective: To compare clomiphene citrate with N-acetyl cysteine vs. clomiphene citrate alone for augmenting ovulation in management of unexplained infertility. Design: Prospective randomized double-blind controlled trial. Setting: Department of obstetrics and gynecology in a university medical faculty in Egypt. Patient(s): Four hundred four patients as a study group (clomiphene citrate plus N-acetyl cysteine group) and 400 patients as a control group (clomiphene citrate-alone group). All women had unexplained infertility. Intervention(s): Patients in the study group were treated with clomiphene citrate (50-mg tablets) twice per day and with N-acetyl cysteine (1,200 mg/d orally) for 5 days starting on day 2 of the cycle. Patients in the control group were treated with clomiphene citrate with sugar powder. Main Outcome Measure(s): The primary outcomes were number and size of growing follicles, serum E 2 , serum P, and endometrial thickness. The secondary outcome was the occurrence of pregnancy. Result(s): There were no statistically significant differences between the two groups in the number of follicles sized Ͼ18 mm, mean E 2 levels, serum P, or endometrial thickness. Pregnancy rate was comparable in both groups (22.2% vs. 27%). Miscarriage rate was comparable in both groups (6.7% in the study group vs. 7.4% in the control group). Conclusion(s): N-Acetyl cysteine is ineffective in inducing or augmenting ovulation in patients with unexplained infertility and cannot be recommended as an adjuvant to clomiphene citrate in such patients.

Journal of reproduction & infertility, 2011

Failure to respond adequately to standard protocols and to recruit adequate follicles is called &... more Failure to respond adequately to standard protocols and to recruit adequate follicles is called 'poor response'. This results in decreased oocyte production, cycle cancellation and, overall, is associated with a significantly diminished probability of pregnancy. It has been shown that ovarian reserve tests, such as basal FSH, antimullarian hormone (AMH), inhibin B, basal estradiol, antral follicular count (AFC), ovarian volume, ovarian vascular flow, ovarian biopsy and multivariate prediction models, have little clinical value in the prediction of a poor response. Although recent evidence points that AMH and AFC may be better than other testsbut they still continue to be used and form the basis for the exclusion of women from fertility treatments. Despite the rigorous efforts made in this regard, a test that could reliably predict poor ovarian response in all clients that undergo IVF is currently lacking.

Gynaecological Endoscopy, 2002

ABSTRACT

Conditional cash transfer (CCT) programs, as one of the most efficient social protection programs... more Conditional cash transfer (CCT) programs, as one of the most efficient social protection programs, use large amount of public resources. Such programs are prone to leakage of public resources due to risks from error, fraud, and corruption. Countries in Latin America have implemented CCT programs since the early 1980’s and they have experienced leakages from error, fraud, and corruption (EFC) which requires use of mechanisms and a control system to tackle the risks of EFC. These mechanisms have been introduced in the World Bank toolkit on tackling error, fraud, and corruption. The recommended strategies to mitigate EFC address risks through three main strategies: prevention, detection strategies, and deterrence.
This study answers the main research question of what guidance does Egyptian and global experience provide as to what constitutes a proper control system for the implementation of conditional cash transfer programs to prevent error, fraud, and corruption? It provides a vision of what proper controls could be useful for implementing CCT in Egypt and other countries that share similar characteristics.
This broader perspective of protection mechanisms has been investigated through contacting global experts from different countries and local social inspectors who worked in the pilot project in Egypt. This combination takes advantage of global and local experiences recommend what could enable Egypt to have a proper control system to reduce EFC.
The study findings demonstrate that Egypt can apply proper administration and financial controls in its CCT program at each of its three main stages: eligibility, compliance, and cash disbursing. Recommended control mechanisms are developed around three building blocks of prevention; detection; and deterrence. Other recommendations are provided for CCT program in Egypt regarding interministerial cooperation, the required political support to CCT for program success, use of computerized systems in the verification processes, and a reconsideration of economic, political, and administrative challenges to CCT programs in Egypt.