American Journal of Clinical Medicine Research

Purpose: To evaluate the effectiveness of temporally splitting in-vitro maturation and embryo transfer by elective cryopreserving of all 2PN oocytes after in–vitro maturation (IVM). Methods: This one armed clinical cohort study was prospectively performed. Twenty eight patients fulfilled the inclusion criteria after AFC assessment by transvaginal sonography. Patients were retrospectively divided into (primed) group which received a low dose of gonadotropin stimulation, and (non-primed) group which received no medication. IVM in combination with cryopreservation by vitrification of all 2PN oocytes was investigated for all included patients. Results: Mean number of cumulus-oocyte complex (COC) was found to be 9 ± 8.4 and the average number of matured oocytes was 4.1 ± 4.8. After vitrification and thawing, the overall survival rate was 92.9%. The overall clinical pregnancy rate per WHAT was 17.9%. The cumulative clinical and ongoing pregnancy rate per patient with at least one embryo transfer (ET) performed was 23.8% and 12.1-41.6% for 95% confidence interval (CI). No differences was found for in outcome between primed and non-primed patients in positive hCG results. Conclusions: The addition of electively cryopreservation by vitrification of all 2PN stage embryos to IVM technique applied for high AFC in patients undergoing IVF treatment in both primed and natural cycles results in an acceptable chance of ongoing pregnancy.

American Journal of Clinical Medicine Research. 2015, 3(1), 14-17. DOI: 10.12691/ajcmr-3-1-3
Pub. Date: March 23, 2015

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Review of the Clinical Presentation of Uterine Fibroid and the Effect of Therapeutic Intervention on Fertility

by Atombosoba. A. Ekine, Lucky O. Lawani, Chukwuemeka A. Iyoke, Israel Jeremiah and Isa. A. Ibrahim

Original Research

Uterine fibroid is a common gynecological problem among women of reproductive age. The objective of this study was to review the common clinical presentation of uterine fibroid and assess the effect of therapeutic intervention on fertility. A retrospective descriptive study of 368 women, who were managed for uterine fibroid over a 5 years period (January 1^st, 2008 to December 31^1st, 2012) was conducted at a University Teaching Hospital. The main outcome measures were common presentations, effect of treatment on fertility. Data were analyzed with Epi Info™ statistical software version 7.0. The incidence of uterine fibroids was 29.3%. Fibroids mainly affected those in the reproductive age group (31-40 years). The common clinical presentations- were abdominopelvic mass (100%), menorrhagia (95.7%), infertility (41.9%), anemia (32.9%), dysmenorrhoea (12.5%), abdominopelvic pain (15.8%), and urinary pressure symptoms (6.8%). Abdominal myomectomy (97.3%) was the main stay of treatment. The Odd Ratio of achieving pregnancy within two year of therapeutic intervention was 1.33 (0.27-6.60), p-value=0.0007, while the risk ratio of recurrent pregnancy loss was about three times less in those who had therapeutic interventions [3.56 (0.52-24.21)], p-value=0.11. Uterine fibroid presents with abnormal uterine bleeding and impaired fertility in women of reproductive age, and removal conferred fertility benefits in some cases.

American Journal of Clinical Medicine Research. 2015, 3(1), 9-13. DOI: 10.12691/ajcmr-3-1-2
Pub. Date: March 17, 2015

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Ovarian Cancer Screening: the Role and Drawbacks of Ultrasonography and Feasibility in Low Resource Settings

by Chukwuemeka Anthony Iyoke, Osaheni LuckyLawani, George Onyemaechi Ugwu, Euzebus Chinonye Ezugwu, Leonard Ogbonna Ajah and Robinson Chukwudi Onoh

Review Article

Context: Although there have been reports of increasing incidence of ovarian cancer in developing countries, no developing country has been involved in current trials of ovarian cancer screening. Aim: To review the evolution of the role and drawbacks of ultrasonography in ovarian cancer screening and the feasibility of implementing current potential screening strategies inlow resource settings. Methods: An electronic literature search for all articles written in English language on ovarian cancer screening from 1960-2013. Information from appropriate articles were collated and analysed for content. Results: Ultrasound was used as the first-line or second-line test in the most popular multicentre multimodal trials of ovarian cancer screening. It has a high sensitivity but a low specificity. The low specificity of ultrasound screening necessitates the use of further measures to aid the triaging of ultrasound positive cases, which add to the overall cost of screening. There is yet scant evidence of the cost effectiveness of multimodal screening for ovarian cancer. Current potential strategies for ultrasound-based screening for ovarian cancer demand the training and employment of large numbers of highly skilled personnel as well as the acquisition of high resolution scanners and technology for biochemical assay of tumour markers. Conclusion: Transvaginal ultrasonographyhas evolved into a potentialtool for ovarian cancer screening and ovarian cancer screening strategies based on CA125 assays and ultrasonography would demand substantial resources. If and when reduction in mortality and cost-effectiveness of this approach to screening are proven, itmay not be feasible in developing countries.

American Journal of Clinical Medicine Research. 2015, 3(1), 1-8. DOI: 10.12691/ajcmr-3-1-1
Pub. Date: February 02, 2015

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