adel helal | Mansoura University (original) (raw)

Papers by adel helal

Research paper thumbnail of SCIENTIFIC PAPER Uterine Artery Occlusion for Treatment of

Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy ver... more Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy versus embolization as a treatment modality for symptomatic uterine fibroids. Methods: Ninety-six premenopausal women with symptomatic uterine leiomyomata were studied. None of them desired further pregnancy. They were randomized to treatment either by laparoscopic occlusion (group 1) or by radiologic embolization of uterine arteries (group 2). The primary outcome measure was patient satisfaction as regards menstrual blood loss compared with pretreatment loss. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: Ninety women were followed for 1, 3, 6, and 12 months after both procedures. The primary outcome was comparable between the 2 groups (86.7 % after laparoscopic occlusion versus 88.8 % after embolization, with no statistically significant difference). After 12 months of follow-up, more patients resumed heavy periods in...

Research paper thumbnail of Permanent Occlusion of Uterine Arteries in Management of Abnormal Uterine Bleeding

International journal of Gynecology, Obstetrics and Neonatal Care, 2016

Objectives: To assess the effectiveness of permanent bilateral occlusion of uterine arteries as a... more Objectives: To assess the effectiveness of permanent bilateral occlusion of uterine arteries as a treatment modality of abnormal uterine bleeding. Design: prospective single arm study. Setting: Done in Mansoura university hospital, department of Obstetrics and gynecology and private center (Mansoura Integrated Fertility Center-MIFC) Mansoura-Egypt from October 2011to October 2015 including the study and follow up period. Patients: The study includes One hundred eighteen (118) premenopausal patients followed up for thirty six months. All of them completed their families and needing to preserve their uteri. 68.6 % of them experienced failed medical treatment. Intervention: permanent bilateral uterine arteries occlusion in management of abnormal uterine bleeding. Measurements: The primary outcome measures were patient satisfaction, Quality of life and improvements of pain and bleeding compared with pretreatment one. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: One hundred and nine patients completed follow up for three years 109/118 (92.4%) reported their satisfaction as indicated by reduction in days of menstrual flow per cycle (3.7 ± 2.8 vs. 8.8 ± 6.2 days, p < 0.0001) also, significant improvement in quality of life scores (9 ± 1.2 vs. 2.6 ± 1.8 p < 0.0001). with a variable failure rate varies from 5.6% at 6 months to 3.9% at 36 months follow up. Conclusion: permanent bilateral uterine arteries occlusion may be a good alternative to radical surgery in management of abnormal uterine bleeding.

Research paper thumbnail of Uterine Arteries Occlusion for Treatment of Symptomatic Uterine Myomas

Journal of Minimally Invasive Gynecology, 2010

Research paper thumbnail of Extended culture of cleavage embryo to blastocyst embryo is among the good predictors of successful outcome in vitrified-thawed ICSI cycles

Middle East Fertility Society Journal

Background Previous studies showed that top-quality embryo transfer (ET), number of transferred e... more Background Previous studies showed that top-quality embryo transfer (ET), number of transferred embryos, endometrial preparation with natural cycles or mild stimulation, and female BMI independently affected the outcome in frozen-thawed ET. However, the effect of culturing thawed cleavage embryos to blastocyst stage on the outcome was not sufficiently elucidated. Our objective is to evaluate the role of this extended culturing as predictor of cycle outcome in vitrified-thawed ICSI cycles. Materials and methods One thousand forty-two consecutive cycles of vitrified-thawed ET done in a single IVF unit [Mansoura Integrated Fertility Centre (MIFC)] were reviewed during a period from 2014 to 2017. Endometrial preparation methods were natural, stimulation by antiestrogen and/or gonadotropins, or replacement using sequential estradiol (E2) and progesterone (P4). The primary outcome was the clinical pregnancy rate while the secondary outcome was the chemical and ongoing pregnancy rate. Resu...

Research paper thumbnail of Rising Rates of Caesarean Delivery at Mansoura University Hospital: A Reason for Concern

Gynecology & Obstetrics, 2013

Research paper thumbnail of Paraumbilical Hernia Repair During Caesarean Section; Maternal and Neonatal Outcomes

Design & Objectives : A prospective study to evaluate the outcome of combined caesarean section a... more Design & Objectives : A prospective study to evaluate the outcome of combined caesarean section and paraumbilicalhernia repair in tertiary referral university hospital.Patients and methods: 48 patients undergoing caesarean section combined with paraumbilical hernia repair versus 100patients undergoing caesarean section alone.Main Outcome Measures: Operation time, Apgar Score, blood loss, uterine atony, breast feeding initiation, painsensation, peripartum complications, prolonged lochia (more than 42 days), deep venous thrombosis, hospital stay,hernia recurrence, and patient choice.Results: The combined procedure consumed significantly longer time than caesarean section alone in the meshhernioplasty subgroup. There were no major complications. Apgar Score, uterine atony, initiation of breastfeeding,prolonged lochia, wound infection and hospital stay did not differ significantly from those of controls. Pain at herniasite repair in two patients, one hernia recurred in the primary repai...

Research paper thumbnail of Is adding estradiole (E2) to progesterone (P) luteal support in high responder long GNRH agonist ICSI cycles detrimental to outcome? : randomized controlled trial (RCT)

Fertility and Sterility, 2015

To determine whether antim€ ullerian hormone (AMH) predicts good quality supernumerary blastocyst... more To determine whether antim€ ullerian hormone (AMH) predicts good quality supernumerary blastocyst cryopreservation. DESIGN: Retrospective study. MATERIALS AND METHODS: First, fresh IVF cycles (n¼247) from two fertility ceneters, grouped as follows: women < 35 years with AMH < 1 ng/mL (n¼40) or AMH R 1 ng/mL (n¼77); women R 35 years with AMH < 1 ng/mL (n¼62) or AMH R 1 ng/mL (n¼68). AMH level was measured prior to IVF. Ovarian stimulation protocols based on patient age and AMH level included short Gonadotropin Releasing Hormone (GnRH) agonist, GnRH antagonist, or GnRH agonist microdose flare. Supernumerary good quality blastocysts were cryopreserved on days 5 or 6 post-retrieval. Primary outcomes measure was supernumerary good quality blastocyst cryopreservation in relation to AMH levels. Logistic regression was used for statistical analyses. RESULTS: Among women < 35 years of age, there was a significant difference in supernumerary good quality blastocyst cryopreservation between groups of AMH < 1 ng/mL and AMH R 1 ng/mL (30.0 % vs 58.4 %) when adjusted for age. Among women R 35 years of age, there was a significant difference in supernumerary good quality blastocyst cryopreservation between groups of AMH < 1 ng/mL and AMH R 1 ng/mL (16.1 % vs 42.6 %), when adjusted for age. CONCLUSIONS: Low AMH levels are associated with a significantly lower likelihood of blastocyst cryopreservation as compared to higher AMH levels. This effect was seen among women < 35 years of age and those R 35 years of age. Patient counseling should include realistic expectations for the probability of good quality supernumerary blastocyst cryopreservation.

Research paper thumbnail of Difficult embryo transfer (ET) components and cycle outcome in ICSI/IVF-cycles: which is more harmful?

Fertility and Sterility, 2015

in blastocyst development, aneuploidy, pregnancy or implantation rate between patients with Low o... more in blastocyst development, aneuploidy, pregnancy or implantation rate between patients with Low or High BMI. CONCLUSIONS: The impact of maternal BMI on the kinetics of embryo development, determined by time-lapse image analysis, is dependent on maternal age. Maternal BMI does not influence the success of ART in patients 35 years or older, possibly due to the overriding negative impact of maternal age on oocyte quality.

Research paper thumbnail of Does the time of starting progesterone (P4) luteal support (LS) affect the ease of embryo transfer (ET) in long agonist protocol down-regulated IVF cycles? A randomized controlled trial

Fertility and Sterility, 2017

Research paper thumbnail of Difficult embryo transfer (ET) components and cycle outcome. Which is more harmful?

Middle East Fertility Society Journal, 2016

The perfect electromagnetic conductor (PEMC) is a paradigmatic medium in electromagnetics. It was... more The perfect electromagnetic conductor (PEMC) is a paradigmatic medium in electromagnetics. It was introduced, using differential forms, as a truly isotropic medium. In this paper we will show, using spacetime algebra, that the PEMC is just an extreme case of a more general class of Tellegen media that are truly isotropicthat of Minkowskian isotropic media (MIM). A PEMC is shown to be a MIM that corresponds to an ideal electromagnetic conductor.

Research paper thumbnail of Conservative laparoscopic electrocoagulation adenomyolysis for the management of symptomatic adenomyosis

Gynecological Surgery, 2015

The objective of the study was to assess the safety and efficacy of conservative laparoscopic ele... more The objective of the study was to assess the safety and efficacy of conservative laparoscopic electrocoagulation adenomyolysis (CLEA) in the management of women with symptomatic adenomyosis. The study design is prospective observational study. The setting was Department of Obstetrics and Gynecology, Mansoura University Hospital. Thirty-nine premenopausal women, complaining of chronic pelvic pain and/or menorrhagia, were diagnosed to have adenomyosis by transvaginal ultrasonography (TVS) and/or magnetic resonance imaging (MRI), between June 2008 and June 2011. They were subjected to laparoscopic multiple uterine unipolar electrocoagulation diathermy punctures aiming at adenomyolysis. Women were evaluated before and at 3, 6, and 12 months after the procedure. Main outcome is the magnitude of pain by using the visual analog scale (VAS) and the overall patient self satisfaction as assessed by short form 36 (SF-36) questionnaires; secondary outcome is the uterine volume as measured by TVS. At 3-, 6-, and 12-month follow-up visits, there was a gradual, yet a significant, reduction in the median VAS scoring system of pain (p<0.01), a significant improvement in every scale of the SF-36 (p<0.01), and also a significant reduction (p<0.01) in the median uterine volume as assessed by TVS. Conservative laparoscopic electrocoagulation adenomyolysis may be an effective and safer minimal invasive procedure for the management of symptomatic adenomyosis in premenopausal women.

Research paper thumbnail of 64 Multidetector CT with multiplanar reformation in evaluation of bilateral ovarian masses

The Egyptian Journal of Radiology and Nuclear Medicine, 2012

To evaluate the role of 64 multidetector CT (MDCT) with multiplanar reformation in evaluation of ... more To evaluate the role of 64 multidetector CT (MDCT) with multiplanar reformation in evaluation of bilateral ovarian masses and to correlate the findings with histopathological results and surgery. Material and methods: MDCT was performed to 23 patients with sonographically detected bilateral ovarian masses. All scans were performed on a 64 row CT scanner at the oncology center, Mansoura University. The axial and reformatted images were evaluated for lesion characterization and the relationship to adjacent structures. The radiological findings were correlated with operative and pathological findings. Results: There were 11 bilateral malignant lesions and 9 bilateral similar benign lesions. Three cases showed different benign lesions in both sides. All malignant lesions were read by MDCT as malignant, also all benign lesions were read by MDCT as benign except for one case with endometrioid cyst which was diagnosed as malignant tumor by CT. Conclusion: 64 Multidetector CT with MPR in different planes allows good visualization and characterization of bilateral ovarian masses with greater diagnostic accuracy and improves the detection of peritoneal metastases.

Research paper thumbnail of Transvaginal Bilateral Uterine Artery Occlusion for Treatment of Symptomatic Uterine Myomas: An Effective Modality in Low Resource Settings

International journal of Gynecology, Obstetrics and Neonatal Care, 2014

Research paper thumbnail of Uterine Artery Occlusion for Treatment of Symptomatic Uterine Myomas

JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2010

Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy ver... more Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy versus embolization as a treatment modality for symptomatic uterine fibroids. Methods: Ninety-six premenopausal women with symptomatic uterine leiomyomata were studied. None of them desired further pregnancy. They were randomized to treatment either by laparoscopic occlusion (group 1) or by radiologic embolization of uterine arteries (group 2). The primary outcome measure was patient satisfaction as regards menstrual blood loss compared with pretreatment loss. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: Ninety women were followed for 1, 3, 6, and 12 months after both procedures. The primary outcome was comparable between the 2 groups (86.7% after laparoscopic occlusion versus 88.8% after embolization, with no statistically significant difference). After 12 months of follow-up, more patients resumed heavy periods in the uterine artery occlusion group [4/45 patients, 8.8% in occlusion group compared with 3/45 (6.6%) in embolization group, Pϭ0.044]. Conclusion: Both laparoscopic occlusion and superselective embolization of uterine arteries improved clinical symptoms in the majority of patients. At 12-month followup, embolization might be more effective.

Research paper thumbnail of Erratum to: Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Journal of Assisted Reproduction and Genetics, 2014

Research paper thumbnail of Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Journal of Assisted Reproduction and Genetics, 2013

The aim of this study was to examine the effect of clomiphene citrate [CC] co-administration duri... more 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.

Research paper thumbnail of Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy

International Journal of Gynecology & Obstetrics, 2009

Objective: To compare the effectiveness of preliminary uterine artery ligation versus pericervica... more Objective: To compare the effectiveness of preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during myomectomy. Methods: A total of 103 patients undergoing myomectomy were randomly allocated to undergo preliminary uterine artery ligation (52 patients) or pericervical tourniquet (51 patients). The primary outcome measure was estimated blood loss. Secondary outcomes included duration of the operation, duration of hospital stay, postoperative hemoglobin, and the need for postoperative analgesia. Results: Operative blood loss was significantly less with uterine artery ligation compared with tourniquet (433.80 ± 285.21 vs 823.23 ± 237.33 mL, P b 0.001). The mean duration of the operation was lower in the uterine artery ligation group compared with the tourniquet group (50.5 ± 8.7 vs 76.3 ± 9.4 minutes, P b 0.001). Postoperative hospital stay was significantly shorter in the uterine artery ligation group compared with the tourniquet group (4.1 ± 0.1 vs 5.1 ± 0.2 days; P b 0.001). Postoperative hemoglobin concentrations and the need for postoperative analgesia were higher in the uterine artery ligation group (P = 0.012 and P b 0.001, respectively). Conclusion: Uterine artery ligation was more effective than pericervical tourniquet as a preliminary step in reducing blood loss during abdominal myomectomy.

Research paper thumbnail of Effect of childhood kidney transplantation on puberty

Fertility and Sterility, 2010

Objective: To evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyc... more Objective: To evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyclosporine A, low-dose prednisolone and azathioprine. Study Design: Prospective case-control study. Setting: University-affiliated urology and nephrology center, obstetric and gynecology departments. Patient(s): Eighteen girls and 21 boys with successful KTX before the age of 16 years. Controls were healthy and age matched (200 girls and 171 boys). Intervention(s): Assessment of sexual maturation by Tanner staging and linear growth by height standard deviation score (HSDS) and height increment (HI). Main Outcome Measure(s): Pubertal age in KTX vs. control, ratios of KTX with normal and retarded sexual maturation and linear growth. Result(s): Puberty in KTX children was significantly delayed compared with controls. Delayed sexual maturation was found in 22.2% of girls and 19.1% of boys, and poor HSDS was found in 38.9% of girls and 33.3% of boys. Improvement in HSDS was significantly lower in girls compared with boys. Improvement in HSDS did not significantly differ in prepubertal vs. pubertal children. Prepubertal HI was significantly higher than pubertal HI in boys, but not in girls. Significant negative correlation was found between HI, duration of immunosuppression, and serum creatinine level. Conclusion(s): KTX children receiving cyclosporine A, low-dose prednisolone, and azathioprine showed acceptable sexual and physical maturation in a majority of cases. Impaired sexual and linear growth after receiving KTX is related to poor graft function, post-KTX interval, and gender.

Research paper thumbnail of Effect of stimulation protocol on the risk of luteinized unruptured follicle (LUF) in polycystic ovarian syndrome (PCOS):does LUF affect luteal phase profile?

Fertility and Sterility, 2009

sequence was screened for novel and known bi-allelic SNPs. Polymorphisms were tested under linkag... more sequence was screened for novel and known bi-allelic SNPs. Polymorphisms were tested under linkage disequilibrium analysis to define markers representing total sequence variation and haplotype blocks in this population. Newly identified tagging SNPs were then evaluated by TaqMan genotyping in 96 age matched normal responders (>6 antral follicles, 6-13 oocytes retrieved). RESULTS: Sequence analysis identified 5 tagging SNPs captured all AMHR2 haplotypes effectively (dbSNP IDs; rs2002555, rs2272002, rs2071558, rs3741664, rs11170555). Subsequent haplotyping of a case/control population identified a diverse haplotype distribution in both populations. Unique haplotypes were only identified in the poor responder group at a small percentage (3.2%), suggesting that a larger population is needed to fully validate their significance. CONCLUSIONS: Evaluation of genetic heterogeneity of AMHR2 requires characterization of at least 5 tagging SNPs. Initial evaluation suggests a specific haplotype may increase the probability of poor ovarian responsiveness. Larger studies evaluating this relationship with ovarian responsiveness and reserve are ongoing.

Research paper thumbnail of The effect of luteal phase support protocol on cycle outcome and luteal phase hormone profile in long agonist protocol intracytoplasmic sperm injection cycles: a randomized clinical trial

Fertility and Sterility, 2009

Objective: To study the effect of luteal phase support protocol on cycle outcome and luteal phase... more Objective: To study the effect of luteal phase support protocol on cycle outcome and luteal phase hormone profile, in long agonist protocol intracytoplasmic sperm injection (ICSI) cycles. Design: Prospective randomized trial. Setting: Private infertility center. Patient(s): Two hundred seventy-four women undergoing first ICSI cycles were randomized after ovum pickup into three groups of luteal support. Intervention(s): Group I received IM P (P 4) only, group II received P 4 þ oral E 2 valerate, group III received P 4 þ hCG. Main Outcome Measure(s): Pregnancy rate (PR), implantation rate, rates of multiple pregnancy and miscarriage, and midluteal serum E 2 and P 4 , and midluteal E 2 :P 4 ratio. Result(s): The PR and implantation rates were significantly higher in group II compared to group I and the miscarriage rate was significantly lower in group II compared with group I. Midluteal E 2 was significantly higher in group II compared with group I. The decline in E 2 after ovum pickup was lowest in group II, highest in group I. The midluteal E 2 :P 4 ratio was significantly higher in group II compared with groups I and III. Conclusion(s): The E 2 luteal phase supplementation in long GnRH-agonist (GnRH-a) protocol ICSI cycles resulted in better cycle outcome and better luteal phase hormone profile. (Fertil Steril Ò 2009;92:486-93. Ó2009 by American Society for Reproductive Medicine.

Research paper thumbnail of SCIENTIFIC PAPER Uterine Artery Occlusion for Treatment of

Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy ver... more Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy versus embolization as a treatment modality for symptomatic uterine fibroids. Methods: Ninety-six premenopausal women with symptomatic uterine leiomyomata were studied. None of them desired further pregnancy. They were randomized to treatment either by laparoscopic occlusion (group 1) or by radiologic embolization of uterine arteries (group 2). The primary outcome measure was patient satisfaction as regards menstrual blood loss compared with pretreatment loss. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: Ninety women were followed for 1, 3, 6, and 12 months after both procedures. The primary outcome was comparable between the 2 groups (86.7 % after laparoscopic occlusion versus 88.8 % after embolization, with no statistically significant difference). After 12 months of follow-up, more patients resumed heavy periods in...

Research paper thumbnail of Permanent Occlusion of Uterine Arteries in Management of Abnormal Uterine Bleeding

International journal of Gynecology, Obstetrics and Neonatal Care, 2016

Objectives: To assess the effectiveness of permanent bilateral occlusion of uterine arteries as a... more Objectives: To assess the effectiveness of permanent bilateral occlusion of uterine arteries as a treatment modality of abnormal uterine bleeding. Design: prospective single arm study. Setting: Done in Mansoura university hospital, department of Obstetrics and gynecology and private center (Mansoura Integrated Fertility Center-MIFC) Mansoura-Egypt from October 2011to October 2015 including the study and follow up period. Patients: The study includes One hundred eighteen (118) premenopausal patients followed up for thirty six months. All of them completed their families and needing to preserve their uteri. 68.6 % of them experienced failed medical treatment. Intervention: permanent bilateral uterine arteries occlusion in management of abnormal uterine bleeding. Measurements: The primary outcome measures were patient satisfaction, Quality of life and improvements of pain and bleeding compared with pretreatment one. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: One hundred and nine patients completed follow up for three years 109/118 (92.4%) reported their satisfaction as indicated by reduction in days of menstrual flow per cycle (3.7 ± 2.8 vs. 8.8 ± 6.2 days, p < 0.0001) also, significant improvement in quality of life scores (9 ± 1.2 vs. 2.6 ± 1.8 p < 0.0001). with a variable failure rate varies from 5.6% at 6 months to 3.9% at 36 months follow up. Conclusion: permanent bilateral uterine arteries occlusion may be a good alternative to radical surgery in management of abnormal uterine bleeding.

Research paper thumbnail of Uterine Arteries Occlusion for Treatment of Symptomatic Uterine Myomas

Journal of Minimally Invasive Gynecology, 2010

Research paper thumbnail of Extended culture of cleavage embryo to blastocyst embryo is among the good predictors of successful outcome in vitrified-thawed ICSI cycles

Middle East Fertility Society Journal

Background Previous studies showed that top-quality embryo transfer (ET), number of transferred e... more Background Previous studies showed that top-quality embryo transfer (ET), number of transferred embryos, endometrial preparation with natural cycles or mild stimulation, and female BMI independently affected the outcome in frozen-thawed ET. However, the effect of culturing thawed cleavage embryos to blastocyst stage on the outcome was not sufficiently elucidated. Our objective is to evaluate the role of this extended culturing as predictor of cycle outcome in vitrified-thawed ICSI cycles. Materials and methods One thousand forty-two consecutive cycles of vitrified-thawed ET done in a single IVF unit [Mansoura Integrated Fertility Centre (MIFC)] were reviewed during a period from 2014 to 2017. Endometrial preparation methods were natural, stimulation by antiestrogen and/or gonadotropins, or replacement using sequential estradiol (E2) and progesterone (P4). The primary outcome was the clinical pregnancy rate while the secondary outcome was the chemical and ongoing pregnancy rate. Resu...

Research paper thumbnail of Rising Rates of Caesarean Delivery at Mansoura University Hospital: A Reason for Concern

Gynecology & Obstetrics, 2013

Research paper thumbnail of Paraumbilical Hernia Repair During Caesarean Section; Maternal and Neonatal Outcomes

Design & Objectives : A prospective study to evaluate the outcome of combined caesarean section a... more Design & Objectives : A prospective study to evaluate the outcome of combined caesarean section and paraumbilicalhernia repair in tertiary referral university hospital.Patients and methods: 48 patients undergoing caesarean section combined with paraumbilical hernia repair versus 100patients undergoing caesarean section alone.Main Outcome Measures: Operation time, Apgar Score, blood loss, uterine atony, breast feeding initiation, painsensation, peripartum complications, prolonged lochia (more than 42 days), deep venous thrombosis, hospital stay,hernia recurrence, and patient choice.Results: The combined procedure consumed significantly longer time than caesarean section alone in the meshhernioplasty subgroup. There were no major complications. Apgar Score, uterine atony, initiation of breastfeeding,prolonged lochia, wound infection and hospital stay did not differ significantly from those of controls. Pain at herniasite repair in two patients, one hernia recurred in the primary repai...

Research paper thumbnail of Is adding estradiole (E2) to progesterone (P) luteal support in high responder long GNRH agonist ICSI cycles detrimental to outcome? : randomized controlled trial (RCT)

Fertility and Sterility, 2015

To determine whether antim€ ullerian hormone (AMH) predicts good quality supernumerary blastocyst... more To determine whether antim€ ullerian hormone (AMH) predicts good quality supernumerary blastocyst cryopreservation. DESIGN: Retrospective study. MATERIALS AND METHODS: First, fresh IVF cycles (n¼247) from two fertility ceneters, grouped as follows: women < 35 years with AMH < 1 ng/mL (n¼40) or AMH R 1 ng/mL (n¼77); women R 35 years with AMH < 1 ng/mL (n¼62) or AMH R 1 ng/mL (n¼68). AMH level was measured prior to IVF. Ovarian stimulation protocols based on patient age and AMH level included short Gonadotropin Releasing Hormone (GnRH) agonist, GnRH antagonist, or GnRH agonist microdose flare. Supernumerary good quality blastocysts were cryopreserved on days 5 or 6 post-retrieval. Primary outcomes measure was supernumerary good quality blastocyst cryopreservation in relation to AMH levels. Logistic regression was used for statistical analyses. RESULTS: Among women < 35 years of age, there was a significant difference in supernumerary good quality blastocyst cryopreservation between groups of AMH < 1 ng/mL and AMH R 1 ng/mL (30.0 % vs 58.4 %) when adjusted for age. Among women R 35 years of age, there was a significant difference in supernumerary good quality blastocyst cryopreservation between groups of AMH < 1 ng/mL and AMH R 1 ng/mL (16.1 % vs 42.6 %), when adjusted for age. CONCLUSIONS: Low AMH levels are associated with a significantly lower likelihood of blastocyst cryopreservation as compared to higher AMH levels. This effect was seen among women < 35 years of age and those R 35 years of age. Patient counseling should include realistic expectations for the probability of good quality supernumerary blastocyst cryopreservation.

Research paper thumbnail of Difficult embryo transfer (ET) components and cycle outcome in ICSI/IVF-cycles: which is more harmful?

Fertility and Sterility, 2015

in blastocyst development, aneuploidy, pregnancy or implantation rate between patients with Low o... more in blastocyst development, aneuploidy, pregnancy or implantation rate between patients with Low or High BMI. CONCLUSIONS: The impact of maternal BMI on the kinetics of embryo development, determined by time-lapse image analysis, is dependent on maternal age. Maternal BMI does not influence the success of ART in patients 35 years or older, possibly due to the overriding negative impact of maternal age on oocyte quality.

Research paper thumbnail of Does the time of starting progesterone (P4) luteal support (LS) affect the ease of embryo transfer (ET) in long agonist protocol down-regulated IVF cycles? A randomized controlled trial

Fertility and Sterility, 2017

Research paper thumbnail of Difficult embryo transfer (ET) components and cycle outcome. Which is more harmful?

Middle East Fertility Society Journal, 2016

The perfect electromagnetic conductor (PEMC) is a paradigmatic medium in electromagnetics. It was... more The perfect electromagnetic conductor (PEMC) is a paradigmatic medium in electromagnetics. It was introduced, using differential forms, as a truly isotropic medium. In this paper we will show, using spacetime algebra, that the PEMC is just an extreme case of a more general class of Tellegen media that are truly isotropicthat of Minkowskian isotropic media (MIM). A PEMC is shown to be a MIM that corresponds to an ideal electromagnetic conductor.

Research paper thumbnail of Conservative laparoscopic electrocoagulation adenomyolysis for the management of symptomatic adenomyosis

Gynecological Surgery, 2015

The objective of the study was to assess the safety and efficacy of conservative laparoscopic ele... more The objective of the study was to assess the safety and efficacy of conservative laparoscopic electrocoagulation adenomyolysis (CLEA) in the management of women with symptomatic adenomyosis. The study design is prospective observational study. The setting was Department of Obstetrics and Gynecology, Mansoura University Hospital. Thirty-nine premenopausal women, complaining of chronic pelvic pain and/or menorrhagia, were diagnosed to have adenomyosis by transvaginal ultrasonography (TVS) and/or magnetic resonance imaging (MRI), between June 2008 and June 2011. They were subjected to laparoscopic multiple uterine unipolar electrocoagulation diathermy punctures aiming at adenomyolysis. Women were evaluated before and at 3, 6, and 12 months after the procedure. Main outcome is the magnitude of pain by using the visual analog scale (VAS) and the overall patient self satisfaction as assessed by short form 36 (SF-36) questionnaires; secondary outcome is the uterine volume as measured by TVS. At 3-, 6-, and 12-month follow-up visits, there was a gradual, yet a significant, reduction in the median VAS scoring system of pain (p<0.01), a significant improvement in every scale of the SF-36 (p<0.01), and also a significant reduction (p<0.01) in the median uterine volume as assessed by TVS. Conservative laparoscopic electrocoagulation adenomyolysis may be an effective and safer minimal invasive procedure for the management of symptomatic adenomyosis in premenopausal women.

Research paper thumbnail of 64 Multidetector CT with multiplanar reformation in evaluation of bilateral ovarian masses

The Egyptian Journal of Radiology and Nuclear Medicine, 2012

To evaluate the role of 64 multidetector CT (MDCT) with multiplanar reformation in evaluation of ... more To evaluate the role of 64 multidetector CT (MDCT) with multiplanar reformation in evaluation of bilateral ovarian masses and to correlate the findings with histopathological results and surgery. Material and methods: MDCT was performed to 23 patients with sonographically detected bilateral ovarian masses. All scans were performed on a 64 row CT scanner at the oncology center, Mansoura University. The axial and reformatted images were evaluated for lesion characterization and the relationship to adjacent structures. The radiological findings were correlated with operative and pathological findings. Results: There were 11 bilateral malignant lesions and 9 bilateral similar benign lesions. Three cases showed different benign lesions in both sides. All malignant lesions were read by MDCT as malignant, also all benign lesions were read by MDCT as benign except for one case with endometrioid cyst which was diagnosed as malignant tumor by CT. Conclusion: 64 Multidetector CT with MPR in different planes allows good visualization and characterization of bilateral ovarian masses with greater diagnostic accuracy and improves the detection of peritoneal metastases.

Research paper thumbnail of Transvaginal Bilateral Uterine Artery Occlusion for Treatment of Symptomatic Uterine Myomas: An Effective Modality in Low Resource Settings

International journal of Gynecology, Obstetrics and Neonatal Care, 2014

Research paper thumbnail of Uterine Artery Occlusion for Treatment of Symptomatic Uterine Myomas

JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2010

Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy ver... more Objective: To compare the effectiveness and safety of uterine artery occlusion by laparoscopy versus embolization as a treatment modality for symptomatic uterine fibroids. Methods: Ninety-six premenopausal women with symptomatic uterine leiomyomata were studied. None of them desired further pregnancy. They were randomized to treatment either by laparoscopic occlusion (group 1) or by radiologic embolization of uterine arteries (group 2). The primary outcome measure was patient satisfaction as regards menstrual blood loss compared with pretreatment loss. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: Ninety women were followed for 1, 3, 6, and 12 months after both procedures. The primary outcome was comparable between the 2 groups (86.7% after laparoscopic occlusion versus 88.8% after embolization, with no statistically significant difference). After 12 months of follow-up, more patients resumed heavy periods in the uterine artery occlusion group [4/45 patients, 8.8% in occlusion group compared with 3/45 (6.6%) in embolization group, Pϭ0.044]. Conclusion: Both laparoscopic occlusion and superselective embolization of uterine arteries improved clinical symptoms in the majority of patients. At 12-month followup, embolization might be more effective.

Research paper thumbnail of Erratum to: Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Journal of Assisted Reproduction and Genetics, 2014

Research paper thumbnail of Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Journal of Assisted Reproduction and Genetics, 2013

The aim of this study was to examine the effect of clomiphene citrate [CC] co-administration duri... more 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.

Research paper thumbnail of Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy

International Journal of Gynecology & Obstetrics, 2009

Objective: To compare the effectiveness of preliminary uterine artery ligation versus pericervica... more Objective: To compare the effectiveness of preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during myomectomy. Methods: A total of 103 patients undergoing myomectomy were randomly allocated to undergo preliminary uterine artery ligation (52 patients) or pericervical tourniquet (51 patients). The primary outcome measure was estimated blood loss. Secondary outcomes included duration of the operation, duration of hospital stay, postoperative hemoglobin, and the need for postoperative analgesia. Results: Operative blood loss was significantly less with uterine artery ligation compared with tourniquet (433.80 ± 285.21 vs 823.23 ± 237.33 mL, P b 0.001). The mean duration of the operation was lower in the uterine artery ligation group compared with the tourniquet group (50.5 ± 8.7 vs 76.3 ± 9.4 minutes, P b 0.001). Postoperative hospital stay was significantly shorter in the uterine artery ligation group compared with the tourniquet group (4.1 ± 0.1 vs 5.1 ± 0.2 days; P b 0.001). Postoperative hemoglobin concentrations and the need for postoperative analgesia were higher in the uterine artery ligation group (P = 0.012 and P b 0.001, respectively). Conclusion: Uterine artery ligation was more effective than pericervical tourniquet as a preliminary step in reducing blood loss during abdominal myomectomy.

Research paper thumbnail of Effect of childhood kidney transplantation on puberty

Fertility and Sterility, 2010

Objective: To evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyc... more Objective: To evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyclosporine A, low-dose prednisolone and azathioprine. Study Design: Prospective case-control study. Setting: University-affiliated urology and nephrology center, obstetric and gynecology departments. Patient(s): Eighteen girls and 21 boys with successful KTX before the age of 16 years. Controls were healthy and age matched (200 girls and 171 boys). Intervention(s): Assessment of sexual maturation by Tanner staging and linear growth by height standard deviation score (HSDS) and height increment (HI). Main Outcome Measure(s): Pubertal age in KTX vs. control, ratios of KTX with normal and retarded sexual maturation and linear growth. Result(s): Puberty in KTX children was significantly delayed compared with controls. Delayed sexual maturation was found in 22.2% of girls and 19.1% of boys, and poor HSDS was found in 38.9% of girls and 33.3% of boys. Improvement in HSDS was significantly lower in girls compared with boys. Improvement in HSDS did not significantly differ in prepubertal vs. pubertal children. Prepubertal HI was significantly higher than pubertal HI in boys, but not in girls. Significant negative correlation was found between HI, duration of immunosuppression, and serum creatinine level. Conclusion(s): KTX children receiving cyclosporine A, low-dose prednisolone, and azathioprine showed acceptable sexual and physical maturation in a majority of cases. Impaired sexual and linear growth after receiving KTX is related to poor graft function, post-KTX interval, and gender.

Research paper thumbnail of Effect of stimulation protocol on the risk of luteinized unruptured follicle (LUF) in polycystic ovarian syndrome (PCOS):does LUF affect luteal phase profile?

Fertility and Sterility, 2009

sequence was screened for novel and known bi-allelic SNPs. Polymorphisms were tested under linkag... more sequence was screened for novel and known bi-allelic SNPs. Polymorphisms were tested under linkage disequilibrium analysis to define markers representing total sequence variation and haplotype blocks in this population. Newly identified tagging SNPs were then evaluated by TaqMan genotyping in 96 age matched normal responders (>6 antral follicles, 6-13 oocytes retrieved). RESULTS: Sequence analysis identified 5 tagging SNPs captured all AMHR2 haplotypes effectively (dbSNP IDs; rs2002555, rs2272002, rs2071558, rs3741664, rs11170555). Subsequent haplotyping of a case/control population identified a diverse haplotype distribution in both populations. Unique haplotypes were only identified in the poor responder group at a small percentage (3.2%), suggesting that a larger population is needed to fully validate their significance. CONCLUSIONS: Evaluation of genetic heterogeneity of AMHR2 requires characterization of at least 5 tagging SNPs. Initial evaluation suggests a specific haplotype may increase the probability of poor ovarian responsiveness. Larger studies evaluating this relationship with ovarian responsiveness and reserve are ongoing.

Research paper thumbnail of The effect of luteal phase support protocol on cycle outcome and luteal phase hormone profile in long agonist protocol intracytoplasmic sperm injection cycles: a randomized clinical trial

Fertility and Sterility, 2009

Objective: To study the effect of luteal phase support protocol on cycle outcome and luteal phase... more Objective: To study the effect of luteal phase support protocol on cycle outcome and luteal phase hormone profile, in long agonist protocol intracytoplasmic sperm injection (ICSI) cycles. Design: Prospective randomized trial. Setting: Private infertility center. Patient(s): Two hundred seventy-four women undergoing first ICSI cycles were randomized after ovum pickup into three groups of luteal support. Intervention(s): Group I received IM P (P 4) only, group II received P 4 þ oral E 2 valerate, group III received P 4 þ hCG. Main Outcome Measure(s): Pregnancy rate (PR), implantation rate, rates of multiple pregnancy and miscarriage, and midluteal serum E 2 and P 4 , and midluteal E 2 :P 4 ratio. Result(s): The PR and implantation rates were significantly higher in group II compared to group I and the miscarriage rate was significantly lower in group II compared with group I. Midluteal E 2 was significantly higher in group II compared with group I. The decline in E 2 after ovum pickup was lowest in group II, highest in group I. The midluteal E 2 :P 4 ratio was significantly higher in group II compared with groups I and III. Conclusion(s): The E 2 luteal phase supplementation in long GnRH-agonist (GnRH-a) protocol ICSI cycles resulted in better cycle outcome and better luteal phase hormone profile. (Fertil Steril Ò 2009;92:486-93. Ó2009 by American Society for Reproductive Medicine.