International conference on Reproductive Health, Infertility and IVF November 15-16, 2019 Tokyo, Japan

Biography:

Marija Hadji Lega has earned her Medical degree from St. Cyril & Methodius University, Medical Faculty, FYRO Macedonia (1997). She has completed her Specialization in Obstetrics & Gynecology from the same university in 2005 and also sub-specialization in Perinatal Medicine (Maternal-Fetal Medicine) in 2014 also from the same university. She has obtained her PhD degree in Clinical Medicine (Prediction of Preterm Deliveries) from Medical Faculty, University of Nish, Serbia. She has more than 21 years of experience in obstetrics, gynecology and especially in fetal medicine (first trimester screening, anomaly scans, growth scan). She was the Chief of High Risk Pregnancy Unit at University Clinic for Gynecology and Obstetrics (Unique Tertiary level Clinic for Gynecology and Obstetrics), Skopje, FYRO Macedonia.

Abstract:

Preterm delivery is the leading cause of neonatal mortality and morbidity in the world. Its worldwide incidence ranges from around 5%-15%, depending on the population. The worldwide rates of preterm birth have increased in the past couple of decades in spite of the efforts to alleviate the problems associated with preterm delivery and the medical advances made. Preterm deliveries and associated complications account for over 75% of the neonatal mortality rates and for around half of the neurological sequalle in newborn children. Consequently, women presenting with threatened preterm labor are often treated with hospitalization and the administration of tocolytics to avoid preterm delivery. Randomized studies on the use of tocolytics in threatened preterm labor have demonstrated a significant prolongation of pregnancy by about 7 days but no significant reduction in the incidence of preterm delivery, perinatal morbidity or mortality.

In order to contribute to the efforts for prediction of preterm delivery, we conducted a prospective cohort study at the Clinic for Gynecology and Obstetrics, Skopje. Patients were eligible to join this prospective cohort study if they attended the University Clinic for Gynecology and Obstetrics, Skopje and were admitted to Department of High Risk Pregnancy Unit with symptoms of preterm labor (symptoms of uterine activity, three regular uterine contractions in 10 minutes).

The aim of this study was to determine the relationship between sonographic cervical length, fetal fibronectin (fFN), phIGFBP-1 (Actim partus test), cytokines (IL-6,IL-2R and TNF-alpha) and spontaneous preterm birth(SPTB) up to 14 days from sampling.

In this study was include symptomatic and asymptomatic patient at 24.0 to 36.6 gestation weeks. The studied biochemical markers in our study were only moderately successful in the prediction of preterm delivery. The best predictor model in our study was the combination of the fFN test, Actim partus test, concentration of IL-6 in the cervical fluid, the cervical length <21.5 mm, concentration of CRP and IL-6 in the serum.

Our study is only the beginning of this type of research in our population. Further research is required in terms of the evaluation of cost-benefit of using such test to prevent subsequent unnecessary interventions in the low-risk group, as well as achieve the benefits from such intervention in the high-risk groups of patients.

Biography:

George Lampos is Obstetrician & Gynecologist. He has a PhD in Gynecological Endocrinology from the University of Athens and a DU (Diplôme Universitaire) in ART in Paris- Saclay, Paris. He was a Clinical Associate in the University of Athens. He works as a Consultant in the Infertility Clinic of Genesis, Athens.

Abstract:

Recurrent Pregnancy Loss (RPL) is an important reproductive health issue affecting 2-5% of couples. The relationship of maternal age to miscarriage correlates with the frequency of aneuploidy in oocytes. Cytogenetic evaluation of sporadic spontaneous abortions has shown that 50-70% are chromosomally abnormal. Because most cases are de novo errors, the risk of an embryo aneuploidy occurring in a subsequent pregnancy is low and the higher the number of miscarriages, the less likely they are to be related to chromosomal abnormalities. The incidence of embryo chromosomal abnormalities is thus lower in women with RPL than in those with sporadic miscarriages. Other possible etiologies have been proposed in case of RPL, either well established such as uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders and high sperm DNA fragmentation levels or even controversial, such as chronic endometritis, inherited thrombophilia and luteal phase deficiency. However, about 50% of the pregnancy loss remains unexplained. Unexplained RPL (URPL) is considered the diagnosis if a complete genetic, anatomic, endocrine and immune evaluation was performed and returned as normal. The chances for a future successful pregnancy in couples with URPL could be as high as 50-70% and depend mostly on maternal age and the number of previous losses. Nevertheless, multiple pregnancy losses can have a significant psychological toll on affected couples and many efforts are being made to improve treatments and decrease the time needed to achieve a successful pregnancy. This study reviews the predisposing factors and the recommended therapeutic strategies with a focus on the role of preimplantation genetic testing in the management of recurrent pregnancy loss.

Biography:

Najib Dagher has obtained his MD degree from Odessa State Medical University where he also completed his Residency in Obstetrics and Gynecology. He has obtained in July 2018 a University Diploma in Infertility, Assisted Reproduction Technology (ART) and Endocrinology of the Reproduction at Foch Hospital IVF Center by the University of “Versailles Saint Quentin en Yvelines” in Paris, France. He is currently a Member of "Clinica Tambre" in Madrid, Spain, as well as “IVF Lebanon” in Beirut.

Abstract:

Introduction & Aim: Incubators with a time-lapse system are gaining ground on traditional incubators, especially in cycles of blastocysts culture. The objective of this study is to analyze if the number of blastocysts of good quality is higher in egg donation cycles using the Geri incubator compared to the traditional incubators.

Material & Methods: We analyzed 389 consecutive egg donation cycles with blastocyst culture from June 2016 to December 2017. In 156 cycles Geri time lapse incubator was used and in 233 a traditional incubator (MINC benchtop). Cycles with partner and donor semen were included, excluding testicular biopsy and PGD. The use or non-use of Geri time lapse incubator was valued as the main independent variable. As confusion variables: Age of the patient, REM, semen of the couple or the donor, number of cycles and number of embryos. As dependent variables, we analyzed the good quality blastocyst formation rate (number of blastocysts to transfer or vitrify per embryos on day 3 by T Student's and with a multivariate linear regression model.

Results: Cycles with Geri showed a higher rate of useful blastocysts since 48.27% of the embryos reached a useful blastocyst for the transfer or vitrification, which was only reached in 39.68% of the embryos developed without Geri. (Student T F:2.307, p<0.001). Appreciated in a multivariate regression model, the Geri culture was the only variable that showed an influence on the rate of useful blastocyst formation independent of the rest of the variables analyzed.

Conclusion: The use of Geri in egg donation cycles with blastocyst culture has a higher rate of good quality blastocysts available.

Biography:

Carol Coughlan is highly experienced Consultant Obstetrician Gynecologist specializing in Reproductive Medicine & Surgery at IVI Middle East Fertility Clinic, Dubai. She carries with her years of experience and associations with numerous hospitals and institutions worldwide. She has graduated with honors from University College Cork, Ireland in 1997. She acquired her Membership of the Royal College of Obstetricians & Gynecologists in 2003. In 2008, she joined the team at the Assisted Conception Unit at the Jessop Wing in Sheffield as a Clinical Research Fellow to pursue her interest in reproductive medicine. She was awarded Doctor of Medicine (MD) in July 2013 from the University of Sheffield. Her MD thesis focused on recurrent implantation failure and recurrent miscarriage and her research findings have been presented both nationally and internationally. She has an interest in fertility preservation particularly for oncology reasons and prior to moving to the UAE held the position of Clinical Director, Rotunda/IVF, the National Oncofertility Centre at Rotunda Hospital, Dublin.

Abstract:

Infertility is acknowledged as a global health problem with a prevalence which is estimated to be one in every seven couples in the Western world and one in every four couples in developing countries. Geographical, sociocultural/religious and ethnical dissimilarities contribute to these global variations in infertility prevalence. This study critically appraises’ the existing evidence regarding the association between female fertility and relevant sociocultural factors in Middle East countries focusing on aspects such as obesity, vitamin D deficiency and parental consanguinity which has been shown to be associated with female infertility and prematurely reduced ovarian reserve. In addition to the current standard evaluation of infertile couples, region-specific counselling is required and treatment modalities such as Pre-implantation Genetic Screening (PGS) and Pre-implantation Genetic Diagnosis (PGD) may be of benefit. This study reviews the advances in PGS and PGD and the role played by these treatments in the management of the infertile couple. Considering the facts presented in this presentation, it is important to develop educational public health strategies for couples with the aim to increase public awareness about the impact of consanguinity, obesity and vitamin D deficiency. Future diagnosis, counseling and treatment of infertility should take region-specific risk factors into account.

Biography:

Muzibunnisa Begam is a Consultant Ob-Gyn and a Maternal Fetal Medicine Specialist with more than 20 years of experience in the field of Ob-Gyn. She is a Fellow of Royal College of Obstetricians and Gynecologists (FRCOG) and further sub-specialized in Maternal Fetal Medicine from the United Kingdom. She has published in several internationally renowned journals and her research interests are future complications of cesarean section and prenatal manifestation of autosomal recessive diseases prevailing in United Arab Emirates.

Abstract:

Routine ultrasound examination is an established part of antenatal care if resources are available and access possible. It is offered increasingly during the first trimester (from embryonic cardiac activity up to 13±6 weeks of gestation), particularly in high-resource settings. To achieve optimal results, it is important that they are performed by individuals who fulfill the established criteria utilizing the high-resolution ultrasound and findings documented clearly. The use of B-mode and M-mode prenatal ultrasonography, due to its limited acoustic output, appears to be safe for all stages of pregnancy. Doppler ultrasound is, however, associated with greater energy output with more potential bioeffects and hence, should only be used in the first trimester, if clinically indicated. First trimester scan is best performed when gestational age is between 11 and 13±6 weeks’ gestation, as this provides an opportunity to achieve the goals simultaneously, i.e. confirm viability, establish gestational age accurately, determine the number of viable fetuses, chorionicity and evaluate fetal gross anatomy and risk of aneuploidy. It is acknowledged, however, that many gross malformations may develop later in pregnancy or may not be detected. In this workshop, we aim to describe the techniques to achieve the individual goals of the first trimester scan.

Biography:

Ali M Zeyad has completed his PhD in Assisted Reproductive Medicine and Postdoctoral Researcher in Assisted Reproductive Medicine, Saarland University, Homburg/Saar, Germany. He is a Senior Embryologist working as IVF Lab Manager at HMG, Riyadh, KSA.

Abstract:

Introduction: Infertility is a clinical and social problem. About 15% of couples cannot conceive. The male factor is associated with up to 40% of this problem, where they suffered abnormal sperm parameters according to WHO criteria (WHO, 2010). Bacteriospermia had associated with about 35% of male infertility.

Aim: The purpose of this study was to detect the effects of bacterial infection on human sperm nuclear protamines, DNA fragmentation and ICSI outcome.

Material & Methods: In this study 120 semen samples were collected from unselected male partners of couples consulting in infertility and obstetrics clinic. All the samples were screened bacteriologically according to World Health Organization guidelines as well as sperm parameters and DNA fragmentation was evaluated. The protamines P1 and P2 concentrations were quantified using acid urea acrylamide gel electrophoresis. 84 couples underwent for ICSI treatment.

Results: Out of a total number of 120 sample, 36 (30%) of them were infected with bacteria. Nine species of bacteria belonging to five genera, Staphylococcus, Escherichia, Streptococcus, Enterococcus and Klebsiella, were identified. The comparison between infected (36) and non-infected (84) samples appeared the negative impact of bacterial infection on sperm parameters and P1/P2 ratios. The percentages of P1/P2 ratio abnormality were significantly higher in infected patients. Sperm concentration, motility, progression and chromatin condensation were significantly lower in infected patients (P<0.010). Moreover, high DNA fragmentation with low P1 and P2 concentrations were noticed in the infected patients in comparing to the non-infected patient put no significant. Also the fertilization rate decreased significantly (p<0.05) with infected patients.

Conclusion: Sperm bacterial infections affects significantly sperm quality and fertilization rate in patients undergoing ICSI treatment.

Biography:

Dr. Desislava Markova graduated from the Higher Medical University Bulgaria qualifying as a Consultant in Obstetrics and Gynecology. She was a Senior Assistant Professor in Obstetrics and Gynecology at Higher Medical University Bulgaria as well. Dr. Desi successfully completed a three-year training and practicing of Fetal Medicine at Kings’ College Hospital-London under the direction of Professor Kypros Nicolaides and was awarded the Fetal Medicine Foundation Diploma. She also completed the Advanced Training Skills Module in Fetal Medicine at King’s College Hospital-London and a master’s degree in prenatal genetics and fetal medicine in University College London, UK.She has extensive experience in ultrasound scanning during the first, second and third trimesters of pregnancy and intrauterine procedures.

She is skilled in diagnosing an early fetal anomaly or any chromosomal abnormality and suggests an appropriate medical plan to solve the problem out as early as possible.

Abstract:

More than five million babies are born after Assisted Reproductive Technologies (ARTs). Nowadays ARTs are applied not only for infertile couples but also for couples with monogenic diseases and chromosomal abnormalities. Prenatal genetic testing although still not accepted as a standard procedure for couples requiring IVF has been widely used to end the transmission of genetic diseases. PGT can be applied as Prenatal Genetic Testing for Monogenic diseases (PGT-M), Prenatal Genetic Testing for Aneuploidies (PGT-A) and Prenatal Genetic Testing for Structural Rearrangements (PGT-SR). The accuracy of the PGT is still not 100% and hence couples needs to be counselled about the necessity of performing further non-invasive or invasive testing in pregnancy. Both PGT and NIPT (Non Invasive Prenatal Testing) are associated with false positive and false negative results due to trophoblast-derived mosaicism. First trimester combined screening test has been the gold standard for calculation of the risk for Trisomy 21, 13 and 18 with a detection rate of 95% when nuchal translucency, nasal bone, ductus venosus and tricuspid valve blood flow are assessed. It involves also early assessment of fetal anatomy and detection of major fetal defects in the first trimester. The management plan for IVF patient with PGT should be first trimester screening test, followed by comprehensive counselling and reassurance or recommendation for NIPT or invasive testing depending on the findings. The role of the IVF specialist is to recommend the correct test for the correct patient. Fetal medicine specialist should perform the necessary screening tests and advice additional testing if required or further reassurance.

Biography:

Zahraa Al - Tamimi has completed her Masters degree in community medicine at the age of 27 from Baghdad University, PhD degree in obstetrics and Gynecology at the age of 37 from the Arab board of obstetricians and gynecologgists. She had a special interest in uro gynecology. She is a lecturer at the Medicall College/ Al Iraqia University in Baghdad giving lectures in her field to the undergraduate and postgraduate students. She also runs the obstetrics and gyne ward in a leading hospital in Baghdad. She attends her patients at her private clinic and operates on them in private hospial. She has published many papers in reputed journals and is supervising specialty exams in her field.

Abstract:

Stress urinary Incontinence is defined as the involuntary leak of urine during efforts or exertion (I) It is reported to be affecting (4-35%) of women with successive increase in prevalence over age(2) In our society the prevalence is probably higher considering the trend for multiparty from one side and the social conflict of declaring the problem on the other side, all on the background of the diminished availability of the specialized centers to deal with it. 

Our study sample included patients with the stress urinary incontinence (SUI); and mixed unnary incontinence ( MUI) that have been admitted for TOT operation in our hospitals in the above period whose case files turned to be having accessible and full data pre and up to one year post ooperatively, and those were randomly selected till the ceiling of SO was reached, of those 38 cases had pure stress, while 12 had mixed stress with the first being predominant by urodynamic study. Patient records were retrospectively investigated for the success rate ( determined by subjective admittance of no more complaint of urine leaking upon exertion) both immediate and at one year follow up visit; for the postoperative complaints ( immediate and at one year); as well as for variables that might affect the success, including :[  ] Patient demographic variables ( age,  parity, menopausal status, BMI) at time of surgery.       [ ] Patient related clinical variables ( concomitant systemic disease as Asthma, OM or being a smoker; or concomitant surgery at time of TOT) Data were statistically analyzed using the SPSS, statistical significance was assessed using the quoi square and P value, where a value of < 0 05 was considered to be statistically significant. Persistent incontinence postoperatively was assigned as a TOT failure Assessment of the study sample demography revealed: a median age of 49 ( 33-65); median BMI of 28.3; 65% of them being postmenopausal, 93% being multiparious.  In the past obstetrical history: 85 % with vaginal delivery with the rest having either cesarean or both vaginal and cesarean. All those being reported in literature as risk factors for stress incontinence .Only few had coexisting medical conditions as OM or asthma, being less frequently encountered than concomitant surgeries at operation time where 35% had anterior +/- posterior repair done at TOT time

The success rate was calculated to be 81%, at 2 week postoperatively with no short  term  complications or complaints like pain, difficult urination or  worsening  urge  At one year follow  up visit: success  rate was calculated to be 84%, and  with complaints not  exceeding  15%.  Results  were  typically  in accordance with those in literature As for the procedure  complication,  short  term  ones  mostly reported in literature might include pain, bleeding, worsening urge, neither of which  have  been encountered in our cases; whereas the one year follow up visit, worsening urgency in 8%; cystocele in 12%; and finally  pain  in 10% seem to  be  consistent    with  the incidence rate  in previous  similar  studies ( 8) We also found a lower median age, BMI in successful  cases  than  in  failing  ones  again  in accordance with similar previous studies (9), multiparity was not found to be different between successful and faling cases There were higher incidences of postmenopausal status as well as vaginal deliveries among successful cases, again consistent with results of previous similar studies( 10). Among successful TOT cases, medical conditions were not higher, while pelvic organ prolapse correction surgery was found to be of a higher frequency compared to the other group, the possibly underlying structural defect contributing to both prolapse and urethral hyperrnobilty would make a reasonable explanation as documented in literature (II).

Biography:

Archana Siva Subarmanian has completed her Master’s in Clinical Embryology from JSS Uinversity Mysore and worked as an Embryologist in Gunasheela Maternity Hospital and IVF Centre Bangalore and ARC International Fertility Centre. She is the Research Person at Sri Ramachandra University, India and was awarded with Young Scientist award of the year 2017.

Abstract:

Exogenous elevation of serum estradiol shortly after the time of ovulation is known to reduce the endometrial receptivity in natural cycle. High serum estradiol may affect the synthesis and secretion of glycogen by endometrial epithelial cells. Studies on endometrial morphology, biochemistry and endometrial genomic pattern at the time of implantation showed that high estradiol may negatively affect the endometrial receptivity during infertility treatment. High estradiol is one of the contributing factors for OHSS. Controlled Ovarian Hyperstimulation (COH) creates a supraphysiologic environment which affects endometrial receptivity. Frozen embryo transfer avoids supraphysiological environment which alters the endometrial receptivity. Endometrial development can be controlled precisely in frozen embryo transfer cycle than in COH with gonadotropins.