Maternal age and intracytoplasmic sperm injection outcome in infertile couples at Khartoum, Sudan

Evaluating the Contribution of Oocyte, Sperm, and Uterus in Determining the Outcome of Intracytoplasmic Sperm Injection - A Retrospective Observational Comparative Study on Intracytoplasmic Sperm Injection using Own Oocytes and Donor Oocytes

Context

Several studies have assessed the contribution of oocyte, sperm, and endometrium on the outcome of intracytoplasmic sperm injection (ICSI) separately. This study assesses the relative contribution of oocyte, sperm, and uterus in achieving clinical pregnancy (CP) through ICSI by comparing own and third-party ICSI cycles.

Aim

The aim of the study is to evaluate and compare the strength of contribution of oocyte, sperm, and uterus in achieving CP through ICSI.

Settings and Design

This retrospective observational study of ICSI cycles for 20 months including 1000 embryo transfers (ETs).

Methodology

Subjects were divided into two groups, Group 1 - ICSI with own oocytes (550 ETs) and Group 2 - ICSI with donor oocytes (450 ETs). Both the groups had 3 subgroups - a (husband sperm, transferred to self), b (donor sperm, transferred to self), c (husband sperm, transferred to a gestational surrogate). CP rate (CPR) as a major outcome was studied in the groups and subgroups.

Statistical Analysis

CPR was compared between various subgroups using Z-test and Chi-square of significance of difference between proportions. A P < 0.05 was taken as the level of statistical significance.

Results

CPR in subgroup 1a < 35 years, 1a ≥35 years, and 2a was 42.98%, 26.21%, and 40.92%, respectively (P = 0.001). CPR was compared between 2a and 2c (40.92%, 56.5%, P = 0.044) and between 2a and 2b (40.92%, 42.11%, P = 0.866). Implantation rate was highest in Group 2c (34.88%) compared to other subgroups.

Conclusion

The higher CPR in women <35 years undergoing ICSI with own oocytes than older women and a comparable CPR as that of recipients of donor oocytes suggests that age thereby oocyte quality is the strongest determining factor in achieving clinical pregnancy. Among oocyte recipients, higher CPR in surrogate uterus than patient uterus suggests that uterus/endometrium plays a considerable role, and comparable CPR between ICSI using husband sperm and donor sperm indicates that sperm quality might not play a major role in achieving CP.

Prevalence of infertility in Sudan: A systematic review and meta-analysis

BACKGROUND/AIM

Infertility is defined as the inability of heterosexual couples to achieve a successful clinically recognizable pregnancy after 12 months or more of regular, unprotected sexual intercourse. Infertility estimations are very important to inform the healthcare policymakers and governments to implement appropriate social and economic policies. Thus, this study aimed to estimate the pooled prevalence of infertility (primary and secondary) and its etiologic factors in Sudan.

METHODS

This study included all published and unpublished studies written in Arabic or English. Electronic sources (namely, PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and nonelectronic sources (direct Google search, Google Scholar, OpenGrey, OATD, WorldCat log, and university websites) were used from their inception to May 16, 2021. A total of 1955 studies were reviewed, of which only 20 studies were eligible for the meta-analysis. Studies were eligible if they provided the prevalence of infertility in Sudan. The Joanna Briggs Institute Quality Assessment Tool was used to evaluate each study. Data synthesis and statistical analysis were conducted using Jeffrey's Amazing Statistics Program version 0.14.1.0.

RESULTS

The pooled prevalence of overall infertility, primary infertility, and secondary infertility in Sudan were 13% (I² = 96.45, p < 0.001), 65% (I² = 98.5, p < 0.001), and 35% (I² = 98.5, p < 0.001), respectively, and the prevalence of infertility factors were 41%, 27%, 16%, and 17% for female, male, combined factors, and unexplained factors, respectively. Women with infertility were mainly present because of ovulatory disorders (ovulatory factors, 36%; polycystic ovary syndrome, 38%). By contrast, spermatic disorders such as azoospermia (37%), oligozoospermia (30%), and asthenozoospermia (30%) were the main causes of male infertility.

CONCLUSION

In Sudan, the prevalence of primary infertility is higher than that of secondary infertility. Female factors were the most common causes of infertility in Sudan, and this study found a high prevalence of unexplained factors. Polycystic ovary syndrome and azoospermia were the most common causes of female and male infertility in Sudan, respectively. The interpretation of these findings should take into consideration the presence of substantial heterogeneity between the included studies.

Evaluation of Thyroid Hormones and AntiThyroglobulin Antibodies among Sudanese Polycystic Ovarian Syndrome Patients

Background: Polycystic ovarian syndrome (PCOS) and thyroid disorders are the most common endocrine disorders in women. Evidently, the involvement of polycystic ovarian syndrome (PCOS) and thyroid autoimmunity triggering thyroid disorders has not yet occurred. Objective: The aim was to assess serum free tri-iodothyronine (FT3), free thyroxin (FT4) and anti-thyroglobulin antibodies among polycystic ovary syndrome Sudanese patients. Materials and methods: Fifty Sudanese patients diagnosed with PCOS and 50 healthy age matched females were recruited in this cross-sectional controlled study. Serum FT3 and FT4 were measured by an immunoassay analyzer and serum anti-thyroglobulin antibodies were measured using ELISA. The data was then analyzed using the SPSS. Results: The results showed a signifi cant increase in serum FT3 and anti-thyroglobulin antibodies and there was no statistical difference in PCOS serum FT4 levels compared to the control group. The results revealed no correlation between levels of FT3, FT4 and anti-thyroglobulin antibodies with age; also there were no correlation between levels of FT3 and FT4 with BMI while there was a positive correlation between anti-thyroglobulin antibodies levels and BMI. Conclusion: Patients with PCOS had elevated FT3 and antithyroglobulin. Therefore, the assessment of thyroid autoantibody with thyroid hormones in patients with PCOS should be investigated.

Thyroid function/antibodies in sudanese women with polycystic ovarian disease

Objective

To evaluate thyroid function and hormonal profile in women with polycystic ovary syndrome (PCOS).

Methods

A case-control study was conducted at Saad Abualila Center, Khartoum, Sudan. The cases were women with confirmed PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history were gathered using a questionnaire. Thyroid hormones (thyroid-stimulating hormone, free tri-iodothyronine, and free thyroxine), anti-thyroid peroxidase, and anti-thyroglobulin antibodies were measured.

Results

While there were no significant differences in the age and haemoglobin levels of the two studied groups (55 women in each arm), body mass index was significantly higher in women with PCOS. There were no significant differences in the levels of thyroid-stimulating hormone, luteinizing hormone, follicle stimulating hormone, luteinizing hormone/follicle stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin antibodies, cholesterol, triglycerides and low-density lipoprotein cholesterol between the cases and the controls. The mean±standard deviation of free tri-iodothyronine (3.50±0.2 vs. 3.38±0.3 pg/mL, P=0.040) and median (interquartile) high-density lipoprotein cholesterol (37.0 [34.0 to 42.0] vs. 35.80 [29.0 to 41.0] mg/dL, P=0.015) were significantly higher in PCOS patients compared with the control group. In linear regression, PCOS (0.151 pg/mL, P=0.023) and anti-thyroid peroxidase levels (-0.078 pg/mL, P=0.031) were significantly associated with free tri-iodothyronine.

Conclusion

Free tri-iodothyronine was a significantly higher among PCOS patients compared with the control group.

Maternal age and intracytoplasmic sperm injection outcome in infertile couples at Khartoum, Sudan

Background

Intracytoplasmic sperm injection (ICSI) was considered as the mainstay of treatment for male infertility. Nowadays, the scope of ICSI has been widened to include other causes of infertility. There are few published data on ICSI in countries with low incomes.

Aims

A cross-sectional study was conducted at Saad AbuAlla and Banoun Centers, Khartoum, Sudan to investigate outcomes of ICSI and to determine the parameters that might predict pregnancy success rate following ICSI.

Methods

The study included 191 infertile couples who underwent 296 ICSI cycles between 1st April 2013 and 31 March 2014.

Results

One hundred and ninety one couples (comprising 296 cycles of ICSI) were enrolled to the study. The mean (SD) number of retrieved oocytes was 9.7 (7.5).  The mean (SD) number of transferred embryos was 2.9 (1.0). Out of these, 50 (26.2%) and 40 (20.9%) had chemical and clinical pregnancy, respectively. Thirty–six couples (18.8%) and five couples (2.6%) had miscarriage and had ectopic pregnancy, respectively. Under logistic regression, younger age (OR = 0.8, 95% CI= 0.81 ─ 0.96, P = 0.004) and endometrial thickness (OR = 1.3, 95% CI= 1.07─1.60, P = 0.009) were the significant predictors for the success of ICSI in inducing pregnancy.

Conclusion                

The rates of successful fertilisation and pregnancy-to-term rates in this setting depend mainly on the maternal age.