Masters Degrees (Obstetrics and Gynaecology)

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Browsing Masters Degrees (Obstetrics and Gynaecology) by Subject "Artificial insemination, Human"

Now showing 1 - 4 of 4
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    A controlled randomised study to compare the IUI biochemical pregnancy outcome between a routine swim-up and the Sep-D Kit semen preparation method
    (Stellenbosch : Stellenbosch University, 2013-03) Gentis, Roxanne; Windt De Beer, Marie-Lena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Male factor infertility is a general term that describes couples in which an inability to conceive is associated with a problem identified in the male partner. Intrauterine insemination (IUI) together with ovulation induction has been shown to be an effective treatment method for male factor infertility. Oocyte production by the ovaries is stimulated by the use of fertility drugs. A prepared sperm sample is then injected into the uterus through the vagina using an IUI catheter which brings the oocytes and spermatozoa into close proximity. Semen preparation is an integral part of an IUI cycle. In a developing country, a simple inexpensive semen preparation method for IUI procedures, not necessitating a lot of equipment, is essential. An example of such a method, the Sep-D Kit (Surelife Sep-D Kit, Surelife Media Technologies Pty Ltd, Singapore) has been proposed as a possible preparation method. In a pilot study performed by the principal investigator (Roxanne Gentis), comparing the Sep-D Kit and standard swim-up preparation methods, it was found that the Sep-D Kit compared very well with the swim-up method regarding most pre- and post-preparation semen parameters. The Sep-D Kit method, however, still needed further testing to see whether or not pregnancy rates resulting from the method are comparable with that resulting from the standard swim-up method, as this ultimately is the required result of an IUI. The primary aim of this study was to compare the Sep-D Kit method to the standard swim-up method with regards to biochemical pregnancy outcome, post-preparation sperm count, motility, total motile count (TMC), morphology, DNA compaction and fragmentation (CMA3 and TUNEL). The secondary aim was to evaluate which variables, male and female, affect biochemical pregnancy outcome. The study took place at Drs Aevitas Fertility Clinic, Vincent Pallotti Hospital, Pinelands. The study was a prospective analytical study and was conducted from December 2010 until October 2012. A total of 473 IUI cycles were evaluated. Results showed that the Sep-D Kit semen preparation method was non-inferior to the standard swim-up method with regards to biochemical pregnancy rates, post-preparation count and TMC. The swim-up method produced samples with a significantly higher post-preparation motility compared to the Sep-D Kit method, however both methods still managed to produce similar biochemical pregnancy rates (10.39% for the swim-up group versus 11.57% for Sep-D Kit group). For the total cohort of cycles analysed the only female parameter which significantly predicted biochemical pregnancy outcome in this study was age. Sperm motility (post-preparation) was the only male parameter that significantly affected biochemical pregnancy outcome. The Sep-D Kit method is more cost effective and also time saving compared to the swim-up method. There is also no need for expensive laboratory equipment or a trained embryologist using the Sep-D Kit preparation method. The Sep-D Kit may therefore be used with confidence as a standard semen preparation method, and may be implemented in developing countries for use in routine IUI procedures.
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    Predictive value of normal sperm morphology in intrauterine insemination (IUI) : a structured literature review
    (Stellenbosch : Stellenbosch University, 2001-12) Van Waart, J. (Johannes); Kruger, T. F.; Stellenbosch University. Faculty of Medicine & Health Sciences . Dept. of Obstetrics & Gynaecology.
    ENGLISH ABSTRACT: The aim of the study was to conduct a structured review of the literature published on the use of normal sperm morphology, as an indicator of male fertility potential in intrauterine insemination (M) programs. Published literature in which normal sperm morphology was used to predict pregnancy outcome in lUI during the period 1984 - 1998 was reviewed. Four hundred and twenty one articles were identified. Eighteen provided data that could be tabulated and analyzed. Eight of the analyzed studies provided sufficient data for statistical analysis. Six studies used the Tygerberg strict criteria and two the WHO guidelines (1987, 1992). A meta-analysis of the six studies in the strict morphology group yielded a risk difference (RD) between the pregnancy rates achieved in the patients below and above the 4% strict criteria threshold of -0.07 (95% CI: -0.11 to -0.03; p< 0.001). WHO criteria group (1987,1992) had insufficient data to be analysed. Meta-analysis showed a significant improvement in pregnancy rate above 4% threshold for strict criteria. Accurate evaluation of normal sperm morphology results should be an integral part of evaluating the male factor.
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    A retrospective study of the effect of endometriosis on reproductive outcomes in assisted reproductive treatment
    (Stellenbosch : Stellenbosch University, 2023-03) Pfeiffer, Nadine; Erasmus, Evelyn; Burger, Riana; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY: Background: One of the leading causes of female infertility is a chronic condition known as endometriosis. There are four stages of endometriosis, and 25 to 50% of affected women experience endometriosis-related infertility. Endometriosis is suggested to impair the pelvic environment, ovaries (oocyte quality and quantity), and the uterus. Endometriosis is a frequent indicator for Assisted Reproductive Treatment (ART). However, there is a lack of consensus regarding the impact of this disease and its subsequent stages on outcomes achieved in ART. With the optimisation of ART, it is necessary to further evaluate the effect endometriosis may have on reproductive and embryological outcomes. Objectives: Primary objective: To retrospectively evaluate the reproductive outcomes (post-embryo transfer) of endometriosis patients (EE group) compared to the success of tubal factor infertility patients (TF group) by calculating implantation rate (IR), clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Secondary objective: To retrospectively evaluate the pre-embryo transfer outcomes of the EE group and TF group by calculating fertilisation rate (FR), number of oocytes retrieved, percentage of good quality day 3 embryos (GQE), and blastulation rate (BR). Tertiary objective: To retrospectively evaluate whether the stage of endometriosis affects BR, IR, CPR, LBR, and MR. Materials and Methods: This retrospective study (2017 to 2020) used anonymised data from the Tygerberg and Aevitas Fertility Clinics. It included a study group, the EE group (N = 101) and a control group, the TF group (N = 110). The EE group were subdivided, if the stage of endometriosis (ES) was known, as stage I and II (ES1-2 group [n=13]) and stage III and IV (ES3-4 group [n=65]). The data was submitted for statistical analysis, with statistical significance defined as P < 0.05. Results: Compared to the TF group, the EE group had a higher, but non-significant (p>0.05) number of metaphase II (MII) oocytes retrieved (6.02 MII oocytes vs 5.6 MII oocytes), IR (23.27% vs 19.6%), CPR (32.67% vs 32.11%), MR (28.13% vs 25.00%), and LBR (78.13% vs 75.00%). However, the EE group had a significantly reduced FR compared to the TF group (82.19% vs 87.46%, P = 0.04). Nonetheless, the GQE (77.66% vs 75.73%) and the BR (58.7% vs 63.79%) of the two groups were similar. No statistically significant differences (p>0.05) were found between the ES1-2 group and the ES3-4 group regarding BR (62.11% vs 57.63%), IR (26.92% vs 20.77%), CPR (38.46% vs 29.23%), and LBR (100% vs 66.67%). The MR of the ES3-4 group was significantly higher than the ES1-2 group (38.89% vs 0%, P = 0.04), however, the small sample size queries the validity. Conclusions: The current study found that endometriosis does not have a negative impact on post-embryo transfer reproductive outcomes, during ART. Similarly, the disease does not have a negative effect on the number of MII oocytes retrieved, GQE, and BR. However, a significantly reduced FR in the EE group was indicated, which may be a result of oocyte abnormalities in endometriosis patients. Furthermore, the study found that the reproductive outcomes and BR were lower in ES3-4 group, although it was not significant.
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    A retrospective study of the effect of testicular biopsy extracted spermatozoa in intracytoplasmic sperm injection (ICSI) on reproductive outcomes in assisted reproductive treatment (ART)
    (Stellenbosch : Stellenbosch University, 2023-03) Oosthuizen, Micke; Burger, Riana; Erasmus, Evelyn; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY: Background: Azoospermia, a possible cause of male infertility, is responsible for 10–15 percent of infertility cases. Azoospermia is characterized by the absence of spermatozoa following microscopic analysis and centrifugation of the complete sperm specimen. Azoospermia patients can be divided into two categories, obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). The effects of testicular spermatozoa compared to ejaculated spermatozoa on ART outcomes still remain controversial. Spermatozoa from different sources or diagnostic groups result in significantly different treatment outcomes in some studies but not in others. There are differences in the quality of sperm from patients diagnosed with OA and NOA. Due to ongoing controversy, this study was therefore conducted to establish ICSI outcomes with ejaculated spermatozoa and testicular retrieved spermatozoa under specific laboratory conditions. Aims: The primary aim was to retrospectively investigate the effect of testicular biopsy spermatozoa (TB group) compared to the effect of ejaculated spermatozoa (ES group) on ART outcomes. The secondary aim was to retrospectively evaluate whether the reason for azoospermia (NOA or OA) affects the IR, CPR, LBR, and MR. Materials and Methods: This study was retrospectively conducted on the data obtained from medical and laboratory records between 2017 and 2020 at Drs. Aevitas Fertility Clinic, Pinelands, South Africa and Tygerberg Fertility Clinic for the period of 2015 – 2020. Data was categorized and filtered based on predetermined inclusion and exclusion criteria. Data was submitted for statistical analysis (statistical significance: P < 0.05). Results: The FR (84.66% vs 82.47%), Cleavage Rate (97.15% vs 98.76%), Blastulation Rate (54.73% vs 53.82%), CPR (44.86% vs 35.94%) and MR (29.17% vs 36.28%) were not significantly different between the TB group and the ES group respectively (p>0.05). The IR (30.69% vs 23.06%) and the LBR (33.64% vs 23.96%) was significantly different between the TB group and the ES group respectively (p<0.05). The FR (86.30% vs 79.29%), Cleavage Rate (96.79% vs 98.39%), Blastulation Rate (57.19% vs 45.43%), IR (29.27% vs 35.33%), CPR (43.90% vs 48%), MR (36.11% vs 8.33%) and LBR (29.27% vs 44%) were not significantly different between the OA group and the NOA group respectively (p>0.05). Conclusion: The present study primarily compared the results of ICSI with testicular spermatozoa with those of ICSI with ejaculated spermatozoa. Sub analysis were done on the two different azoospermic groups (NOA and OA). This retrospective study indicated similar FR, Cleavage Rates, Blastulation Rates, PR and MR for the ES group and the TB group. The current study found a significant difference in the IR and LBR between these two groups. By comparing the OA and the NOA group no significant difference in the FR, Cleavage Rates, Blastulation Rates, IR, CPR, MR and LBR was found. The present study, as well as available literature, confirms that the use of testicular spermatozoa does not have a negative effect on ICSI treatment outcomes. This study can therefore provide valuable information during consultation for ICSI treatment in these patients and provide them with assurance that it is possible to achieve normal FR as well as good quality embryos, IR, CPR and lower MR with ICSI.