الفهرس 
LITERATURE REVIEW
Genetics of male infertilityOnly 14 pages are availabe for public view
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Abstract
Infertility is a major health problem which is considered a public health problem because it does not affect the couples’ life only, but it also affects the healthcare services and social environment. By definition it is inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. With the fast progression in reproductive medicine and the experiences gained through infertility management, a wider range of treatment options have become available for those who have difficulties to conceive a child. To increase chances of conception, a range of assisted reproduction techniques (ART) are available. One of these options is Intracytoplasmic sperm injection (ICSI). The present study was carried out in order to assess the outcome of intracytoplasmic sperm injection (ICSI) for treatment of infertile couples. The justification for this study was based on the importance and wide spread of ICSI procedure in management of infertile couples and its promising results. In addition, the results of the present study will be considered as a base line of data base for both national and international comparison. Post intervention follow up study was carried out to patients who carried out ICSI for the management of their infertility. The target population of the study included 265 infertile couples of both sexes, attending the two selected IVF centers in Alexandria / Damanhur governorates and subjected to ICSI procedure. Evaluation of the outcome of ICSI products concerning; mode of delivery, gestational age at delivery, fetal sex, multiplicity, presence or absence of congenital malformations and postnatal survival was followed. The following results were obtained.
• Male infertility was predominant followed by combined causes, female causes and unexplained causes.
• Primary infertility was predominant than secondary infertility.
• Most of the parental ages, were of young age group (92.8% and 98% for both maternal and paternal ages respectively), low consanguineous marriages, negative male and female medical history and female special habits.
• Induction of pregnancy through ICSI revealed that the success rate was estimated to be 63.4%.
• Among ICSI group, the incidence of abortion was found to be 19% most of them occurred of early onset.
• A high rate of prematurity associated with application of ICSI procedure was found as high as 41.9%. This could be explained on the basis that obstetricians involved in ICSI application try to deliver their patients early in order to guarantee the wellbeing of the fetus and avoid any possible complications.
• It was found that most of the deliveries resulted from ICSI were live births (95.6 %) while the remaining were either still births (0.7%) or combined live births or still births (3.7%).
• Although the rate of stillbirths of the present study was higher than that of the general population. The high rate of resulted stillbirths may be referred to either ICSI technique itself or due to the infertility problem / treatment.
• In the present study, the frequency of post delivery deaths among the first and second babies constituted 8.9% for each.
• It was found that 4.7% and 7.4% of the represented sample had congenital malformations among the first and second babies respectively, while no congenital malformations was found among the third baby. Half of the recorded malformations were major ones.
• It was found that most of the cases delivered by caesarean section (C.S) (89.7%). This high rate of C.S does not reflect the actual indicated mode of delivery resulted from feto-maternal causes but it was carried out for the safety of those precious babies.
Several risk factors have been found to affect the success rate of ICSI and ICSI outcomes. Fertility problem, maternal age, paternal age, parental consanguinity, number of embryo transferred and female medical history are important factors found to have effect on outcomes of ICSI.
A- Maternal age was found to have direct effect on infertility, success rate of ICSI and ICSI outcomes. A significant difference in the success rate of induction of pregnancy between young and advanced maternal age (P=0.008). In the mean time, no significant effect of maternal age on the occurrence of abortion (P=0.607), pregnancy outcomes (P=1), maturity (p=0.219), occurrence of congenital malformations (p=0.378), and post delivery deaths (p= 0.731).
B- Although there was a difference between consanguineous and non-consanguineous groups regarding; induction of pregnancy (P= 0.117), occurrence of abortion (P= 0.861), pregnancy outcomes (P= 0.656), maturity (p=0.456), congenital malformations (p= 0.318) and post delivery deaths (p= 0.253). Yet none of these differences were significant.
C- Studying of gravidity, female medical history, and type of infertility (primary and secondary infertility), revealed that although there were differences between those who had positive and negative findings yet the difference was not significant (p=0.618, 0.224, 0.876, 0.442, 0.884 and 0.898 for gravidity ), (p=0.379, 0.678, 0.718, 0.375, 0.815, 1.000 and 0.608 for positive maternal medical history) and (p= 0.245, 0.325, 0.673, 0.720, 0.684 and 0.530 for type of infertility ). Although there was a difference between different grades of gravidity .Yet the difference was not statistically significant. This might be due to the fact that most of the represented sample is of low gravidity (94.6%).
D- Studying couple’s infertility revealed a statistically significant difference recorded in the induction of pregnancy among different responsible partner (p=0.038) and occurrence of prematurity (p=0. 006). This might be due to the application of the present study on ICSI patients who are mainly suffer from male causes.
On the other hand, no significant difference associated with couple’s infertility and occurrence of abortion, pregnancy’s outcomes, congenital malformations and post delivery deaths (p= 0.333, 0.478, 0.808 and 0.148).
E- Referring to the number of embryo transfer the present study showed inconsistent finding. High induction of pregnancy rate was associated with four embryos transferred, while decreased abortion’s occurrence, decreased percentage of live births, increased percentage of congenital malformations, and increased post delivery deaths were associated with increased numbers of embryo transfer. There was no consistent finding regarding prematurity. None of these findings had a significant difference.
In conclusion, ICSI is safe and effective therapy for male factor infertility, but may carry some increased risks. The available data on the outcomes after ICSI are very encouraging, the procedure must still be considered as novel and the safety aspect to a great extent unexplored. The recorded disadvantages are not considered as real contraindications or real disadvantages if compared with ICSI advantages .The most important advantage of ICSI is it may give you and your partner a chance of conceiving your genetic child when other options are closed to you in addition to the other known advantages of ICSI.
Several recommendations are raised after conducting this study such as:
- ICSI must be recommended for specific cases of infertility especially those involve male partner.
- The optimum number of embryo transferred must be guided and control in order to avoid multiple pregnancies and the sub consequences of complications or birth defects.
- Selection of the day for embryo transfer is very important factor for the success rate of ICSI. Three to five days after which the resulting embryos are transferred to the uterus or frozen for future use are recommended.
- Preparation of the female partner before ICSI procedure is of much help for the success of ICSI.
- Proper maternal age of the female partner might add and help for a successful outcomes.
- Association of Pre-implantation Genetic diagnosis (PGD) together with ICSI application will have a significant effect on improving the outcomes of ICSI.
- Improvements of the ICSI technique will result in improvement of the outcomes.
- Further researches concerning ICSI outcomes are highly recommended for proper evaluation.
- Counseling the infertile couples, informing them all possible advantages and disadvantages which might be faced by ICSI application is highly recommended. Informed consent must be signed by the infertile couple then after.