Effect of Adding a Delayed Blastocyst to a Good Quality One during Embryo Transfer on ICSI Cycle Outcomes

Objectives: Study the effect of adding a delayed blastocyst to a transferred good quality one on ICSI cycle outcomes. Study design: Prospective cohort study. Participants/materials, setting, methods: 90 infertile patients aged from 20 - 35 years due to mild male factor, unexplained infertility or tubal factor. Patients with PCOS, endometriosis, RIF, poor responder and azoospermia were excluded. Setting: Duration 6 months from October 2019 to April 2020 in a private IVF center in Egypt. 30 cases were subjected to elective single embryo transfer and the other 60 with two embryo transfers, one good quality and another poor quality blastocyst. Results: (clinical pregnancy rate) was comparable between the two groups, being 47.7% and 36.7% in SET and DET groups respectively (p = 0.361). Miscarriage and ectopic pregnancy rate were observed in 10% of the cases pregnant after SET (group I) and in only 6.7% of the cases pregnant after DET (group II) denoting no significant statistical difference between the two groups. The highest incidence was missed miscarriages in the two groups and ectopic pregnancy was observed only in one case in group II (DET). Twin pregnancy occurred in 22% of pregnant females in the second group. Late pregnancy complications in the form of preterm labour, premature rupture of membrane and preeclampsia occurred mainly in pregnant females in the second group 18%. Conclusion: Neither adding a delayed blastocyst negatively affected the good one nor affected the live birth rate but increased multiple pregnancy rates.

Celiac disease as potential obstacle to childbearing

AIM: The authors have aimed at confirming or excluding gluten sensitivity in infertile couples. PATIENTS AND METHODS: Between 2004 and 2010, at our outpatient clinics of immunology, both partners of 223 couples, who had striven for having a child unsuccessfully, underwent history taking, physical examination, laboratory and immuno-serologic tests including anti-tissue-transglutaminase antibody (antitTG), as well as deep duodenal biopsy in antibody-carrying patients. RESULTS: Antibodies against tissue transglutaminase were positive in 6/223 female patients of whom the diagnosis of celiac disease was histologically confirmed in 3/223 cases (1.34%). Of the male patients 2/223 (0.9%) have proven to be carriers of the antibody;histology was pathognomonic in both of them. Curiously, one of the male patients with celiac disease has been the partner of a woman who also had celiac disease diagnosed by the authors. In the followup period, a female patient and the female member of the couple with celiac disease gave birth to healthy newborns after spontaneous conception, as the result of a strictly kept gluten-free diet, as well as occasional treatments of acetylsalicylate for antiphos-pholipid syndrome or levothyroxine for latent hypothyroidism due to autoimmune thyroiditis. CONCLUSION: The results underline that it is worth performing a screening for celiac disease in both partners of couples assessed due to the lack of success in having a child, as infertility can be ceased by an appropriate diet.