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Abstract Background Infertility is an important health problem, affecting couples worldwide. Non-obstructive azoospermia is the most severe form of azoospermia, which is mostly idiopathic or caused by different causes such as chemotherapy and genetic disorders. Testicular fine needle aspiration (or testicular sperm aspiration (TESA)) is simple, cost-effective and less invasive than testicular sperm extraction. Materials and methods Three hundred twenty Middle Eastern patients with NOA were recruited in this study. The patients underwent routine infertility assessment including medical, surgical, and reproductive history, physical examination, semen analysis, and hormonal profile including FSH, Testosterone, and inhibin B in addition to Genetic assessment including karyotype and Y-chromosome micro-deletion. Results Testicular sperm aspiration was positive in 70 patients (22.18%). Serum FSH levels were clearly elevated in the patients with negative sperm retrieval (mean = 21.39 U/L), while they were reduced in the patients with positive sperm retrieval (mean = 14.61 U/L). Testosterone value did not clearly correlate with the results of testicular sperm aspiration in the two groups of patients, and testicular volume was normal for most of the patients in the two groups. Patients with Y-chromosome micro-deletion were 11.22% of the total patients studied and they had negative TESA results, while 13.12% of patients had Klinefelter Syndrome and their TESA results were negative. Conclusion We confirmed that there are many factors that negatively affect Testicular sperm aspiration results: high FSH and low inhibin B levels, smoking, and genetic disorders. Despite the absence of sperm in the semen, some NOA patients have a chance to have children by using this technique.

Introduction: Insulin like growth factor-1 (IGF-1) has been found to stimulate follicular development, estrogen and progesterone production and oocyte maturation. This study aims to detect the changes in the follicular fluid IGF-1 levels in normo-ovulatory women undergoing in vitro fertilization (IVF) cycle and evaluate the possibility of IGF-1 to be a predictive marker for IVF outcome in normo-ovulatory women. Materials and methods: This prospective cross-sectional study was performed among 88 IVF normo-ovulatory women who were categorized according to IVF pregnancy outcome (clinical pregnancy) into two groups: 55 pregnant women and 33 non-pregnant women. Follicular fluid IGF-1 levels have been measured at the time of oocyte retrieval by utilizing enzyme linked immune-sorbent assay (IGF-1 ELISA kit, Diametra, Inc, Italy). The relationship between follicular fluid IGF-1 (FF IGF-1) levels and the number of oocytes retrieved, number of mature oocytes, number of embryos, fertilization and clinical pregnancy rate were assessed. The demographic data were similar between two groups as regards age and BMI. Results: FF IGF-1 levels were significantly higher in pregnant women than in non-pregnant women (90.11 ± 44.31 ng/ml, 69.07 ± 30.55 ng/ml) respectively (p

Introduction: Inhibin-B is glycoproteins of the transforming growth factor-β superfamily, is produced almost exclusively by the Sertoli cells and has been proposed as direct markers of their function and indirect markers of spermatogenesis. Our objective was to evaluate the predictive value of serum Inhibin-B levels as an indicator of the presence of testicular spermatozoa in non-obstructive azoospermia (NOA), compared with other markers such as FSH and testicular volume. Material and methods: A total of 228 patients with idiopathic non-obstructive azoospermia (NOA) were recruited in this prospective study. Inhibin-B in serum has been evaluated before sperm retrieval by Enzyme-Linked Immuno-Sorbent Assay (Elisa), in addition to FSH and testosterone. Testicular volume was measured by sonography. Testicular Fine Needle Aspiration (FNA) and Testicular Sperm Extraction (TESE) were performed for sperm retrieval. The patients were classified according to the presence or absence of Testicular spermatozoa into two groups (I and II respectively). Results: Spermatozoa were retrieved in 87 patients (38.16%), classified as group I and were absent in 141 patients (61.84%) classified as group II. Mean serum Inhibin-B ± SD was significantly higher in group I than in group II, 71.77 versus 27.49 respectively (P

Objective: The aim of this study was to evaluate the serum and follicular fluid levels of Vascular Endothelial Growth Factor (VEGF) as possible predictive markers for IVF outcome in PCOS patients. Design: Prospective cross-sectional study. Materials and Methods: Forty patients with PCOS and 40 age and weight matched control women were included in this study. All of them were enrolled in the IVF program. Blood and follicular fluid (FF) samples were collected from all subjects on the day of oocyte retrieval. VEGF levels were measured in serum and follicular fluid (FF) using enzyme linked immunosorbent assay (ELISA). The correlation between VEGF levels and number of retrieved oocyte, number of mature oocyte, number of fertilized oocyte, number of embryos, percent of mature oocytes, fertilization rate and pregnancy was assessed. Results: PCOS patients showed higher serum VEGF levels than controls (297.46 ± 159.45 pg/ml vs. 134.08 ± 113.06 pg/ml, p value = 0.0001) and higher FF VEGF levels compared to controls (1358.92 ± 820.86 pg/ml vs. 987.58 ± 236.62 pg/ml, p value = 0.007). Serum VEGF levels were not significantly correlated with the number of retrieved oocyte in both PCOS (r = 0.37, p value = 0.19) and control women (r = −0.03, p value = 0.83), and FF VEGF levels were not significantly correlated with the number of retrieved oocyte in both PCOS (r = −0.06, p value = 0.7) and control women (r = −0.13, p value = 0.43). Both serum and FF VEGF levels were not significantly correlated with the number of mature oocyte, number of fertilized oocyte, number of embryos, percent of mature oocytes or fertilization rate. Serum VEGF levels were not significantly different between pregnant and non-pregnant women in both PCOS (256.69 ± 139.11 pg/ml vs. 300.20 ± 114.60 pg/ml, p value = 0.416) and control women (107.98 ± 115.51 pg/ml vs. 154.39 ± 111.09 pg/ml, p value = 0.271), whereas FF VEGF levels were significantly lower in FFs from the group of pregnancy than those from the group of no-pregnancy in both PCOS (812.04 ± 308.16 pg/ml vs. 1936.78 ± 771.79 pg/ml, p value = 0.0001) and control women (822.45 ± 199.45 pg/ml vs. 1171.98 ± 139.60 pg/ml, p value = 0.0001). FF VEGF levels had a significant predictive value of pregnancy in both PCOS (p value = 0.0001) and control women (p value = 0.0001). Conclusion: FF VEGF levels may serve as a reliable predictive marker for pregnancy in both normal women and women with polycystic ovary syndrome undergoing IVF.

Introduction: AMH, is a member of the transforming growth factor (TGF-β) produced by granulosa cells with the highest expression being in small antral follicles. Our objective is to evaluate the predictive value of follicular AMH levels as an indicator of IVF outcomes in PCOS patients. Material and methods: A total of 63 patients undergoing the IVF trail were recruited for this prospective case-control study. The patients were classified into three groups: Group I: 43 patients with Polycystic ovary syndrome (PCOS). Group II: 20 normo-ovulatory patients were recruited for the IVF trail because of the male infertility factor (control group). Group III: consists of 33 patients from group I recruited to determine the effect of controlled ovarian hyperstimulation (COH) on serum AMH levels. Serum AMH levels were performed on day 3 of the menstrual cycle whereas the follicular fluid AMH level has been evaluated at the time of oocyte retrieval by enzyme linked immune-sorbent assay (AMH Gen II ELISA kit, Beckman Coulter, Inc. USA). AMH concentrations were adjusted to its protein content, to avoid possible bias due to FF volume variability. The relationship between follicular fluid AMH (FF AMH) levels and the number of oocytes retrieved, number of mature oocytes, number of embryos, fertilization and clinical pregnancy rate were assessed. The demographic data were similar between two groups as regards age and BMI. Results: Both serum AMH levels and FF AMH levels were significantly higher in PCOS patients than in the controls, the values for serum levels were (5.07 ± 3.39 ng/ml, 3.07 ± 2.09 ng/ml) respectively and for follicular fluid levels were (67 ± 50.7 ng/g∗, 38.5 ± 44.4 ng/g) respectively. Serum AMH levels showed a positive correlation with oocytes retrieved and mature oocyte number, but there was no significant correlation with good quality embryo number, fertilization rate or clinical pregnancy rate in PCOS patients. On the other hand FF AMH levels do not show correlation with any of the IVF outcomes mentioned above in PCOS patients. Interestingly, the interval change in serum AMH levels between baseline AMH levels and levels after COH had a significant predictive value of pregnancy. Conclusions: Serum AMH levels can predict the number of the retrieved oocytes and mature oocytes, whereas FF AMH may not be a valuable predictor for IVF outcomes in PCOS patients.

Abstract Background Consanguineous marriage is widely practised across the world. Its effect on acute lymphoblastic leukaemia (ALL) is controversial as both parents share some of the genes which might increase the incidence of sharing recessive genes. However, other theories suggest that consanguinity might have a protective factor as it does for other types of cancers. This study aims to study childhood ALL and consanguinity. Methods This is a case-control study, conducted in the major paediatric hospital in Damascus, Syria, using medical records. Case group included children with ALL, while control group included other patients and were matched by gender and age. Results This study comprised 386 patients, 193 of which were cases. Overall, 136 were of consanguineous marriages (36.8%), and there was no difference in consanguinity overall between cases and controls. However, when only comparing non-consanguineous parents and fourth-degree consanguinity, fourth degree was significantly higher among case group, suggesting a negative correlation OR = 0.387 (0.187–0.801) in contrast to third-degree consanguinity which was no significantly different when comparing the two groups (p > 0.05). We found no significant association between ALL and having a family history of cancer (p > 0.05) or between parents’ educational level and case-control groups (p > 0.05). Conclusion Our research suggests a negative association between fourth-degree consanguinity and childhood leukaemia. This was not observed with a third-degree consanguinity. Previous studies had contradicting data on consanguinity and ALL which demonstrates the need for further research.