Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycysti... more Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycystic ovarian syndrome. Anovulation problems could occur in some patients presenting with CC resistance. In PCOS patients, very high levels of AMH were observed. The role of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS) is investigated in this study. Objective: To assess the predictive value of Anti Mullerian hormone (AMH) in Clomiphene citrate response in patients with polycystic ovary syndrome. Methods: This cross-sectional study was conducted at Tanta University Hospitals, Egypt. The study included 120 anovulatory PCOS women who underwent ovarian stimulation with clomiphene citrate. Day 3 measurement of AMH concentrations was done. Results: Cycles with poor response had significantly (p<0.0001) higher basal serum AMH concentration compared to that of cycles with normal response. AMH area under receiver oper...
Objective: To study the effect of prophylactic cerclage in ICSI twin pregnancies with normal cerv... more Objective: To study the effect of prophylactic cerclage in ICSI twin pregnancies with normal cervical measurements on pregnancy outcome. Design: a randomized controlled prospective study. Setting: at Tanta university hospitals and outpatient clinics. Patients: 120 selected cases of ICSI twin pregnancy were recruited and classified into 2 groups randomly, cerclage group (n=80cases) and control group without cerclage (n=40). Interventions: Transvaginal ultrasound was done for number of fetuses, viability, cervical length and diameter and applying Mc Donald cerclage at 14-16weeks for cerclage group. Main Outcome Measures: Occurrence of abortion, Preterm labour, premature rupture of membranes, the time of stitch removal, gestational age at delivery, mode of delivery, neonatal complications. Results: The mean age (29.09 ± 3.26 years) and (28.36 ± 3.24 years) in cerclage group and control group respectively. Most patients were suffering primary infertility 68.75%. The mean gestational age...
Assisted reproductive techniques are nowadays widely used to help couples suffering from infertil... more Assisted reproductive techniques are nowadays widely used to help couples suffering from infertility to achieve successful pregnancy. By far IVF and ICSI are the most popular techniques used. Although these techniques are beneficial and have a reasonable success rates, they have some risks and catastrophic complications. Both gynaecologists and couples may opt to these procedures without clear indications. In this article complications of these techniques are discussed.
Objective: To determine the outcome of pregnancies occurring on top of missed intra-uterine devic... more Objective: To determine the outcome of pregnancies occurring on top of missed intra-uterine devices (IUDs) and the relation to IUD site at a tertiary care hospital. Methods: All files of patients admitted at Tanta University Hospitals were reviewed in the period of in the period from January 1, 2013, to December 31, 2015. The relation between pregnancy outcomes and presence of missed IUD were evaluated. Results: The age of enrolled patients was ranged from 19to 44 years, the mean duration since IUD insertion was 36.82 ± 19.65 months. The most common type of IUDs detected in this study was the Multiload® being detected in 73.58% of patients. Most full-term deliveries 13/53 (24.53%) and preterm deliveries 30/53 (56.60%) occurred in the displaced IUD group. On the other hand, abortions were higher in the in-situ IUD group 51/81 (62.96%) versus 30/81 (37.04%) especially late abortions. No differences were found in the incidence of ectopic pregnancies in both groups. Conclusion: Poor pre...
Purpose: To compare the effectiveness of the rectally administered misoprostol pre-operative vers... more Purpose: To compare the effectiveness of the rectally administered misoprostol pre-operative versus post-operative in minimizing intraoperative blood loss and prevention of postpartum hemorrhage in cesarean delivery. Material and Methods: This study included 180 pregnant women at term (37 40 weeks) undergoing Caesarean delivery under regional anesthesia. Group I (n = 84) received 400μg rectal misoprostol preoperatively, and Group II (n = 82) received 400μg rectal misoprostol postoperatively. Hematocrit level was measured and recorded at admission as a preoperative routine investigation and repeated 24 hours following cesarean delivery. The patients were evaluated in terms of operative time, operative blood loss and any side effects of administered drugs. Results: The demographic characteristics of participants as age, parity and gestational age were comparable between the two groups. As regard the estimated blood loss (M ± SD) during cesarean section in group I (preoperative misopro...
Clinical and experimental reproductive medicine, 2018
The purpose of this paper is to review the current clinical uses of platelet-rich plasma (PRP) in... more The purpose of this paper is to review the current clinical uses of platelet-rich plasma (PRP) in the field of gynecology. All relevant articles published from January 2000 to December 2017 were reviewed and analyzed. The articles on PRP in the field of gynecology were mainly case series, pilot studies, or case reports. PRP is currently considered a new therapeutic modality for some disorders that are refractory to conventional drugs.
Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocr... more Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocrine/metabolic disorder, including hyperinsulinemia and hyperandrogenism. Two phenotypes are present, either lean or obese, with different biochemical, hormonal, and metabolic profiles. Evidence suggests many treatment modalities that can be applied. However, many of these modalities were found to be not suitable for the lean phenotype of PCOS. Much contradictory research was found regarding lean patients with PCOS. The aim of this narrative review is to shed light on the debate prevailing regarding characteristics, as well as metabolic, hematological, and potential management modalities. Literature review was performed from January 1, 2000 to March 31, 2017 with specific word search such as lean PCOS, hormonal abnormalities in lean PCOS, and the management of lean PCOS. All retrieved articles were carefully assessed, and data were obtained. We could conclude that the debate is still prev...
Clinical and experimental reproductive medicine, 2017
To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any ... more To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group). The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating horm...
Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycysti... more Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycystic ovarian syndrome. Anovulation problems could occur in some patients presenting with CC resistance. In PCOS patients, very high levels of AMH were observed. The role of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS) is investigated in this study. Objective: To assess the predictive value of Anti Mullerian hormone (AMH) in Clomiphene citrate response in patients with polycystic ovary syndrome. Methods: This cross-sectional study was conducted at Tanta University Hospitals, Egypt. The study included 120 anovulatory PCOS women who underwent ovarian stimulation with clomiphene citrate. Day 3 measurement of AMH concentrations was done. Results: Cycles with poor response had significantly (p<0.0001) higher basal serum AMH concentration compared to that of cycles with normal response. AMH area under receiver oper...
Objective: To study the effect of prophylactic cerclage in ICSI twin pregnancies with normal cerv... more Objective: To study the effect of prophylactic cerclage in ICSI twin pregnancies with normal cervical measurements on pregnancy outcome. Design: a randomized controlled prospective study. Setting: at Tanta university hospitals and outpatient clinics. Patients: 120 selected cases of ICSI twin pregnancy were recruited and classified into 2 groups randomly, cerclage group (n=80cases) and control group without cerclage (n=40). Interventions: Transvaginal ultrasound was done for number of fetuses, viability, cervical length and diameter and applying Mc Donald cerclage at 14-16weeks for cerclage group. Main Outcome Measures: Occurrence of abortion, Preterm labour, premature rupture of membranes, the time of stitch removal, gestational age at delivery, mode of delivery, neonatal complications. Results: The mean age (29.09 ± 3.26 years) and (28.36 ± 3.24 years) in cerclage group and control group respectively. Most patients were suffering primary infertility 68.75%. The mean gestational age...
Assisted reproductive techniques are nowadays widely used to help couples suffering from infertil... more Assisted reproductive techniques are nowadays widely used to help couples suffering from infertility to achieve successful pregnancy. By far IVF and ICSI are the most popular techniques used. Although these techniques are beneficial and have a reasonable success rates, they have some risks and catastrophic complications. Both gynaecologists and couples may opt to these procedures without clear indications. In this article complications of these techniques are discussed.
Objective: To determine the outcome of pregnancies occurring on top of missed intra-uterine devic... more Objective: To determine the outcome of pregnancies occurring on top of missed intra-uterine devices (IUDs) and the relation to IUD site at a tertiary care hospital. Methods: All files of patients admitted at Tanta University Hospitals were reviewed in the period of in the period from January 1, 2013, to December 31, 2015. The relation between pregnancy outcomes and presence of missed IUD were evaluated. Results: The age of enrolled patients was ranged from 19to 44 years, the mean duration since IUD insertion was 36.82 ± 19.65 months. The most common type of IUDs detected in this study was the Multiload® being detected in 73.58% of patients. Most full-term deliveries 13/53 (24.53%) and preterm deliveries 30/53 (56.60%) occurred in the displaced IUD group. On the other hand, abortions were higher in the in-situ IUD group 51/81 (62.96%) versus 30/81 (37.04%) especially late abortions. No differences were found in the incidence of ectopic pregnancies in both groups. Conclusion: Poor pre...
Purpose: To compare the effectiveness of the rectally administered misoprostol pre-operative vers... more Purpose: To compare the effectiveness of the rectally administered misoprostol pre-operative versus post-operative in minimizing intraoperative blood loss and prevention of postpartum hemorrhage in cesarean delivery. Material and Methods: This study included 180 pregnant women at term (37 40 weeks) undergoing Caesarean delivery under regional anesthesia. Group I (n = 84) received 400μg rectal misoprostol preoperatively, and Group II (n = 82) received 400μg rectal misoprostol postoperatively. Hematocrit level was measured and recorded at admission as a preoperative routine investigation and repeated 24 hours following cesarean delivery. The patients were evaluated in terms of operative time, operative blood loss and any side effects of administered drugs. Results: The demographic characteristics of participants as age, parity and gestational age were comparable between the two groups. As regard the estimated blood loss (M ± SD) during cesarean section in group I (preoperative misopro...
Clinical and experimental reproductive medicine, 2018
The purpose of this paper is to review the current clinical uses of platelet-rich plasma (PRP) in... more The purpose of this paper is to review the current clinical uses of platelet-rich plasma (PRP) in the field of gynecology. All relevant articles published from January 2000 to December 2017 were reviewed and analyzed. The articles on PRP in the field of gynecology were mainly case series, pilot studies, or case reports. PRP is currently considered a new therapeutic modality for some disorders that are refractory to conventional drugs.
Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocr... more Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocrine/metabolic disorder, including hyperinsulinemia and hyperandrogenism. Two phenotypes are present, either lean or obese, with different biochemical, hormonal, and metabolic profiles. Evidence suggests many treatment modalities that can be applied. However, many of these modalities were found to be not suitable for the lean phenotype of PCOS. Much contradictory research was found regarding lean patients with PCOS. The aim of this narrative review is to shed light on the debate prevailing regarding characteristics, as well as metabolic, hematological, and potential management modalities. Literature review was performed from January 1, 2000 to March 31, 2017 with specific word search such as lean PCOS, hormonal abnormalities in lean PCOS, and the management of lean PCOS. All retrieved articles were carefully assessed, and data were obtained. We could conclude that the debate is still prev...
Clinical and experimental reproductive medicine, 2017
To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any ... more To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group). The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating horm...
Journal of Obstetrics, Gynecology and Cancer Research, 2022
Background & Objective: Multifetal reduction not only lowers the number of fetuses but also impro... more Background & Objective: Multifetal reduction not only lowers the number of fetuses but also improves pregnancy outcomes. A great conflict emerges when obstetrician faces triplet or higher order multifetal pregnancies. Decision-making is so difficult whether to continue pregnancy as such with its risks or reduce the number of fetuses to improve outcomes. This study aimed to assess the obstetrical outcomes of Embryo Reduction to Twins (ERTT) procedures in IVF/ICSI centers in Egypt. Materials & Methods: This retrospective cross-sectional study was conducted from June 2017 to December 2020. Data of the patients in five IVF/ICSI centers were accessed using the computer-stored patients' files. Patients who got pregnant spontaneously or after IVF/ICSI procedures with 3 or more embryos were recruited in the study. The patients were counseled for ERTT and those who accepted the procedure were included. The measured obstetrical outcomes were abortion rate, preterm labor, and preeclampsia, premature rupture of membranes, and neonatal morbidity and mortality. Results: One hundred and twenty four cases were included in this study from 5 IVF/ ICSI centers. Most cases (83.87%) of multifetal pregnancies were due to IVF/ICSI procedures. The mean age was 28.3 ± 2.5 years and the mean gestational age at reduction was 8.4 ± 0.6 weeks. The great majority of cases (72.58%) were operated by aspiration. The abortion rate was 29.84%. The mean gestation age at delivery was 34.51 ± 1.82 weeks. The incubator admission rate was 41.93% and the overall postoperative complication was 9.68%. Conclusion: Embryo Reduction to Twins in triplets or higher order pregnancies was considered feasible, safe and linked to minimal complications. The ERTT procedure improved obstetrical and neonatal outcomes.
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Papers by Ayman S Dawood