Knowledge, Attitudes and Practice about Obstetric Ultrasonography among Women Attending a University Hospital: A Cross-Sectional Study

Background: Obstetric sonography is one of the prenatal tests offered to most pregnant women and an essential tool that helps health care providers to establish fetal condition and growth. The Objective: to assess the knowledge, attitudes, and practice about obstetric sonography among women at KAUH in Jeddah, Saudi Arabia. Method: A cross-sectional study was conducted during 2018-2019 among 367 women. It included all women that attend the OB/GYN outpatient clinic at KAUH in Jeddah. The data was collected through interviewing questionnaire. The questionnaire consisted of 5 items to assess their knowledge, attitude, practice, and sociodemographic characteristics. Data were entered into a Microsoft Excel 2014 sheet, and statistical analysis was performed using IBM SPSS Statistics. Result: The mean knowledge score about obstetric sonography was 13.9 ± 1.7, where 343 (93.0%) had good knowledge, and only 26 (7.0%) had poor knowledge. The result revealed that the third-fourths of the women 291 (78.9%) believed that obstetric sonography is safe, and 309 (83.8%) believed that obstetric sonography doesn’t lead to a congenital anomaly. There was a difference in the knowledge score regarding education level, occupation, monthly income, and those with higher education, those who worked, and those with higher monthly payment had a higher knowledge score. Also, there was a positive correlation between knowledge score and both gravidity and parity. Conclusion: Women’s knowledge, attitude, and practice about the purpose of the obstetric sonography were good. So, the primary health care providers should be advised to focusing more on providing health education on obstetric sonography to all pregnant women during their ANC visits.

Does Leukocytospermia Considered as an Indicator of Infection?

Background: The acceptable count of Leukocytospermia in semen sample has been defined by the World Health Organization (WHO) as ≤1 × 106 WBC/ml. The presence of more than one million peroxidase positive white blood cells (WBC) per ml is considered abnormal and is labeled as “leukocytospermia” [1]. But, is there any deterioration in the semen parameters in cases where the number of leukocytes is higher than “normal”, or is it an indication for infection? Objective: To test the significance of the presence of leukocytes in the semen sample. Design: A retrospective randomised study. Materials and Methods: 6481 semen samples were divided into two groups according to the availability of the leukocytes. Group I includes samples with ≤1 × 106 leukocyte/ml (n = 3948) and group II includes samples with >1 × 106 leukocyte/ml (n = 2533). Semen samples were from partners of couples undergoing infertility evaluation. Specimens were collected by masturbation, and subjected to routine semen analysis including count, motility, sperm morphology (assessments were performed according to the Tygerberg strict criteria), number of leukocytes present (identification of Leukocytes was done using peroxidase staining) and Mixed Antiglobin Reaction (MAR) test was done for detection of sperm surface antibodies. All semen samples from group II were sent for culture. Results: A comparison in the mean ± standard deviation (mean ± SD) between the two groups showed statistical significant differences in the mean ± SD motility (55.9 ± 27.8 vs 53.4 ± 27.3, P Conclusion: From the results obtained, we support the studies showing that the presence of leukocytes may not be linked to infection. Future studies are needed to verify the effect of lipoperoxidation process as a result of leukocytes’ presence and to determine the cut off number of leukocytes in semen to be considered of importance since the semen parameters were affected significantly.

Obesity in Relation to Ovarian Response in IVF Treatment

Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the over-weight terminology and BMI cutoffs [1]. Objective: To verify the relationship between BMI and ovarian response in IVF treatment cycle. Design: Retrospective study. Materials & Methods: The study includes 2625 IVF treatment cycles performed in our IVF center in the period of 4 years. Patients were divided into five groups using the WHO criteria according to their BMI [2]. Cancellation rate, mean last E2 before hCG administration, mean endometrial thickness, mean duration of stimulation, number of eggs retrieved, fertilization rate, pregnancy and abortion rates were analyzed. The unpaired t-test was used in statistical analysis. Results: There was statistically significant less mean oestradiol level prior to hCG, less endometrial thickness and less number of simulation days as BMI gets higher. In contrast, there was a positive relationship between cancellation rate and higher BMI except with BMI >39 which was not, possibly due to lower number of patients available. But if we look at the cause of cancellation, it was 100% due to insufficient number of follicles obtained for this group (BMI >39). Also, days of stimulation are significantly lower for the same group of patients in comparison with the other groups. Retrieval, fertilization and pregnancy rates were not significant between all groups. Abortion rate gets significantly higher as BMI increased. Conclusion: Overweight affects ovulation, if we consider the cause of cancellation being insufficient number of follicles reflects the poor response. The fertilization and pregnancy rate were not affected once oocytes retrieved. The reduction of weight is an important part of infertility treatment in obese women with regards to the ovarian response and abortion rate in IVF cycle.

Pregnancy Rate after Embryo Transfer on Day 5 and Day 6 in IVF. A Systematic Review and Meta-Analysis

Study Question: The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular in assisted reproductive technology (ART) centers today. Very few articles concentrate on comparing Day 5 and Day 6 embryo transfer with conflict results. Objective, Study Design: Systematic review and meta-analysis of published controlled studies. Searches conducted from 2001-2020 on PubMed. Medline, EMBASE, and ISI Web of Science Electronic database is used to collect data, using the following search terms: blastocyst, Day 5, Day 6, embryo transfer (E.T.) and pregnancy rate. Materials, Setting, Methods: A total of 6 full-text articles preselected from 211 references, based on title and abstract. Two independent reviewers performed data selection and extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). This systematic review was conducted according to (PICO) standard. Random-effect meta-analysis performed on all data (overall analysis). Results and the Role of Chance: Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 - 0.82) p value < 0.000. Sensitivity analysis led to similar results and conclusions. Limitations, Reasons for Caution: The validity of meta-analysis results depends mainly on the quality and the number of published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Wider Implications of the Findings: In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts. Further RCTs are needed to address the question of whether D6 embryos should be transported.