Debates

3. ELDEEB. M.W , MANSY A., YOUSSEF H,
ELGENDY E, FOUDA E

7.  In patients with at least 2 failed cycles
of ART, diagnostic hysteroscopy and, if
necessary, operative hysteroscopy is
mandatory to improve reproductive
outcome.
Jan Bosteels et al. Gynecol Surg. Aug 2013; 10(3): 165–
167.

8. In infertile patient with Intra
cavitary myoma (1.5 X 1.5 cm.)
To be done.
Neglect it .
To be done after ICSI .
Medical treatment(long agonist for 3 months).

9. In Infertile patient with 4 cm. type II
To be done.
Neglect it .
To be done after ICSI.
Medical treatment (long agonist for 3 months) .

10. In infertile patient with
Subserous myoma 4 cm.
To be done.
Neglect it .
To be done after ICSI.
Medical treatment (long agonist for 3
months) .

11. In the same patient if surgical
interference …..
To be done by
Laparoscopy.
To be done by
Laparatomy.

12. (The Cochrane Library 2012, Issue 11)
Metwally M, Cheong YC, Horne AW

13.  There is currently insufficient
evidence from RCTs to
evaluate the role of
myomectomy to improve
fertility

14.  Regarding surgical approach to
myomectomy, current evidence
from 2 RCTs suggests there is no
significant difference between
the laparoscopic and open
approach regarding fertility
performance.

15. (The Cochrane Library 2013, Issue 1)
Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol
BWJ, D’Hooghe TM

16.  In women with unexplained sub
fertility and sub mucous fibroids, there
is no evidence of benefit with
hysteroscopy myomectomy compared to
regular fertility-oriented intercourse
during 12 months for clinical pregnancy
(odds ratio (OR) 2.4, 95% confidence interval (CI) 0.97 to 6.2, P =
0.06, 94 women) and miscarriage (OR 1.5, 95% CI 0.47
to 5.0, P = 0.47, 94 women).

17.  Hysteroscopic removal of polyps prior to IUI
increases the odds of clinical pregnancy (63%)
compared to diagnostic hysteroscopy and
polyp biopsy only (28%) (OR 4.4, 95% CI 2.5
to 8.0, P < 0.00001).

18.  Hysteroscopic myomectomy might increase the
odds of clinical pregnancy in women with
unexplained sub fertility and sub mucous
fibroids, but the evidence is at present not
conclusive.
 Hysteroscopic removal of endometrial polyps
suspected on ultrasound in women prior to IUI
might increase the clinical pregnancy rate.

19.  More randomized studies are needed to
substantiate the effectiveness of hysteroscopic
removal of suspected endometrial polyps, sub
mucous fibroids, uterine septum or intrauterine
adhesions in women with unexplained sub
fertility or prior to IUI, IVF or ICSI

22. IMSI in oligo-astheno-
teratozoospermia (OAT) patients
Beneficial .
Commercial .
Increase fertilization & pregnancy
rate .
It is only a sort of magnification in
sperm selection .

24.  Compared to conventional ICSI,
this study found that IMSI
increased the IVF-ET success
rates in patients with OAT.
Kim HJ et al. Mar 2014

25. (The Cochrane Library 2013, Issue 17)
Teixeira DM, Barbosa MAP, Ferriani RA, Navarro PA,
Raine-Fenning N, Nastri CO, Martins WP

26.  Results from RCTs do not support the clinical use
of IMSI. There is no evidence of effect on live birth
or miscarriage and the evidence that IMSI
improves clinical pregnancy is of very low
quality.
 Further trials are necessary to improve the
evidence quality before recommending IMSI in
clinical practice.

29. Microscopic TESE in Non obstructive
Azospermic patients
Has no relation to sperm retrieval .
Improve sperm retrieval.
Increase fertilization & pregnancy rate.
It is only a sort of magnification in sperm
selection .

30. Micro-dissection testicular sperm extraction
as an alternative for sperm acquisition in
the most difficult cases of Azoospermia:
Technique and preliminary results in
India.
 The success of micro-TESE was 50.0% with no
major complications .
 Their initial experience with micro-TESE
applied to the most difficult cases of
azoospermia is reassuring.
Ashraf MC, Singh S, Raj D, Ramakrishnan S, EstevesSC. J Hum Reprod Sci. 2013

32. Medical treatment .
Laparoscopic management .
Conservative treatment with repeated titer.

33. Disturbed ectopic pregnancy
with stable general condition
Laparatomy .
Laparoscopic salpingostomy .
Laparoscopic salpingectomy .

34. (The Cochrane Library 2007, Issue 1)
Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum
WM, Van der Veen F

35.  Laparoscopic salpingostomy is significantly less
successful than open surgical approach in
elimination of tubal ectopic pregnancy (2 RCTs, n = 165,
OR 0.28, 95% confidence interval (CI) 0.09 to 0.86) due to significant
higher persistent trophoblast rate in laparoscopic
surgery (OR 3.5, 95% CI 1.1 to 11).
 However, laparoscopic approach is significantly
less costly than open surgery (P = 0.03).

36.  Long term follow up (n = 127) shows no
evidence of difference in intra uterine
pregnancy rate (OR 1.2, 95% CI 0.59 to 2.5) .

37.  Medical treatment
 Systemic methotrexate in a fixed multiple dose
intramuscular regimen has non significant
tendency to increase treatment success than
laparoscopic salpingostomy (1 RCT, n = 100, OR 1.8, 95% CI
0.73 to 4.6).
 No significant differences are found in long term
follow up (n=74): intra uterine pregnancy (OR 0.82,
95% CI 0.32 to 2.1) and recurrent ectopic pregnancy (OR
0.87, 95% CI 0.19 to 4.1).

39. Continue medication.
Stop medication.
Continue medication if pressure symptoms.
Follow up by prolactine level & MRI .

40. Continue medication.
Stop medication.
Continue medication if pressure symptoms.
Follow up by prolactine level & MRI.

42. Local treatment .
Systemic treatment .
Local & systemic.
Wait for second trimester and start
treatment.

44. No increase .
Maximum dose 300 IU .
Maximum dose 450 IU .
Maximum dose 600 IU .

45.  There is no need to use doses
above 300 IU to increase the
pregnancy rate.
Berkkanoglu et al., Fertil Steril_2010; Kyrou et al.,2009 a
systematic review & meta-analysis. Fertil Steril _2009

47. Lower PR than conventional protocol with
higher incidence of OHSS .
Higher PR than conventional protocol with
comparable OHSS .
Good PR with complete prevention of OHSS .
Good PR with significant reduction of OHSS .

48. Good PR with significant
reduction of OHSS .
Iliodromiti et al, 2013, Human Reproduction, Vol.28, No.9 pp.2529-
2536.

49. (The Cochrane Library 2012, Issue 2)
Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ

50.  A statistically significant reduction in OHSS was
observed in the cabergoline treated group (OR 0.40,
95% CI 0.20 to 0.77; 2 RCTs, 230 women).
 There was a statistically significant difference in
the incidence of moderate OHSS, favouring
cabergoline (OR 0.38, 95% CI 0.19 to 0.78; 2 RCTs, 230 women)
but not in severe OHSS (OR 0.77, 95% CI 0.24 to 2.45; 2
RCTs, 230 women).

51.  There was no significant difference in the clinical
pregnancy rate (OR 0.94, 95% CI 0.56 to 1.59; 2 RCTs, 230 women),
miscarriage rate (OR 0.31, 95% CI 0.03 to 3.07; 1 RCT, 163 women)
or any other adverse effects of the treatment (OR
2.07, 95% CI 0.56 to 7.70; 1 RCT, 67 women).
 However, no data on multiple pregnancy rate or
live birth rate were reported.

53. FSH is the best
AFC
AMH
AFC & AMH

54.  The best available evidence
and the latest IMPORTANT
study concluded that AFC and
AMH are the best predictors
of ovarian response .

55. Premature HCG .
Low dose HMG/day .
HMG patch to patch variation .
Kind of protocol .

57. Dr. Walaa ElDeeb