Papers by Mohamed Mitwally
Although clomiphene citrate and FSH remain the mainstay of therapy for ovarian stimulation among ... more Although clomiphene citrate and FSH remain the mainstay of therapy for ovarian stimulation among women with unexplained infertility, both drugs have their shortcomings. Two experts present the evidence supporting the value of AIs in this patient population.
Human chorionic gonadotropin administration is associated with high pregnancy rates during ovaria... more Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse or intrauterine insemination
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Human chorionic gonadotropin administration is associated with high pregnancy rates during ovaria... more Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse or intrauterine insemination
Contemporary Ob Gyn, 2003
With new research showing that aromatase inhibitors can dramatically cut the risk of recurring br... more With new research showing that aromatase inhibitors can dramatically cut the risk of recurring breast cancer, patients will probably have many questions about drugs like anastrozole and letrozole. Two experts review the scientific evidence on these valuable agents.
Reproductive biology and endocrinology : RB&E, Jan 4, 2005
Clinical utilization of ovulation stimulation to facilitate the ability of a couple to conceive h... more Clinical utilization of ovulation stimulation to facilitate the ability of a couple to conceive has not only provided a valuable therapeutic approach, but has also yielded extensive information on the physiology of ovarian follicular recruitment, endometrial receptivity and early embryo competency. One of the consequences of the use of fertility enhancing agents for ovarian stimulation has been the creation of a hyperestrogenic state, which may influence each of these parameters. Use of aromatase inhibitors reduces hyperestrogenism inevitably attained during ovarian stimulation. In addition, the adjunct use of aromatase inhibitors during ovarian stimulation reduces amount of gonadotropins required for optimum stimulation. The unique approach of reducing hyperestrogenism, as well as lowering amount of gonadotropins without affecting the number of mature ovarian follicles is an exciting strategy that could result in improvement in the treatment outcome by ameliorating the deleterious ...
Journal of Gynecologic Surgery, 2013
Background: This article describes a case of heterotopic pregnancy that included a normal twin in... more Background: This article describes a case of heterotopic pregnancy that included a normal twin intrauterine pregnancy and one cesarean section (CS) scar pregnancy diagnosed at 6 weeks of gestation. Ultrasound-guided aspiration of the ectopic gestational sac was performed, and the concurrent twin intrauterine pregnancy (IUP) was preserved successfully. The patient was a 50-year-old woman with secondary infertility. Case: The patient underwent in vitro fertilization and embryo transfer using a donor-egg program to achieve pregnancy with her current partner. At 6-weeks' gestation, she underwent a transvaginal ultrasound scan (US) examination showing a viable twin IUP with a third gestational sac with viable embryo located low within the anterior wall of the uterus. The appearance was consistent with a cesarean scar ectopic pregnancy. This was confirmed on a subsequent US 1 week later. She desired to continue the intrauterine pregnancy. US-guided aspiration of the cesarean scar ectopic pregnancy was attempted. The treatment was successful. Results: The twin pregnancy progressed without further complications. Conclusions: Heterotopic CS ectopic pregnancy can be successfully treated with transvaginal US-guided aspiration.
Ultrasonography in Reproductive Medicine and Infertility, 2009
Journal of Minimally Invasive Gynecology, 2006
To explore the effectiveness (success, safety, and complications) of a novel technique of gestati... more To explore the effectiveness (success, safety, and complications) of a novel technique of gestational sac aspiration in the management of early pregnancy failure as an alternative to dilation and evacuation (D&E) and conservative management. Prospective historical cohort study comparing effectiveness of gestational sac aspiration (study group) to conservative management (control group) with follow-up until negative quantitative beta human chorionic gonadotropin testing is achieved (Canadian Task Force classification II-1). An infertility treatment center. Among 60 women with failed early pregnancies that were achieved by in vitro fertilization or intrauterine insemination, 20 underwent gestational sac aspiration, whereas 40 chose conservative management. Gestational sac aspiration was done by transvaginal ultrasound-guided needle aspiration under conscious sedation. Aspirated tissue was sent for karyotyping. Both study and control (conservative management) groups received close follow-up with ultrasound and serial beta human chorionic gonadotropin measurements. There was no significant difference in age, infertility factor, or treatment between study and control groups. Mean gestational age was 8 versus 6 weeks in study and control groups, respectively (p < .05). One and 11 patients required D&E in the study and control groups, respectively (p < .05). Karyotyping was successful in all except one patient in the study group. Chromosomal abnormalities were found in 36% of products of conception. No significant complications occurred Gestational sac aspiration is a simple and safe outpatient technique that is more effective than conservative management of early pregnancy failure and less invasive than D&E. Moreover, the technique provides a high probability of obtaining a noncontaminated adequate gestation tissue sample for chromosomal study.
Fertility and Sterility, 2008
In this retrospective cohort study of 102 ovarian stimulation cycles for IVF/intracytoplasmic spe... more In this retrospective cohort study of 102 ovarian stimulation cycles for IVF/intracytoplasmic sperm injection using GnRH antagonist and gonadotropins, we sought to assess the effect of high E 2 levels on endometrial stripe thickness and its association with pregnancy outcomes and serum E 2 levels. We found no significant correlation between serum E 2 levels (both peak and area under the curve E 2 concentration) and the endometrial thickness. However, there was a statistically significant inverse relationship with early pregnancy loss (31%) if the endometrial thickness was <9.8 mm (sensitivity 71%; specificity 76%).
Fertility and Sterility, 2007
Fertility and Sterility, 2004
Fertility and Sterility, 2005
To study the effect of unilateral versus bilateral adnexal involvement on the pregnancy rate afte... more To study the effect of unilateral versus bilateral adnexal involvement on the pregnancy rate after operative laparoscopy. Historic cohort study. A total of 143 patients with advanced stages of endometriosis (stage III and IV) who underwent operative laparoscopy for infertility treatment were categorized into those with unilateral versus bilateral adnexal disease. Forty-three patients had primarily unilateral (group 1) and 100 had bilateral disease (group 2). Follow-up was up to 2 years. There was no significant difference between group 1 and group 2 with respect to pregnancy rates (28% vs 31%), delivery rates (21% vs 23%), miscarriage rates (25% vs 13%), and ectopic rates (0% vs 13%). Cumulative conception rates after up to 24 cycles of natural intercourse and up to three IUI cycles were 59% and 49% for group 1 and group 2, respectively. Operative laparoscopy for advanced stages of endometriosis appears to be an effective treatment modality for establishing a pregnancy in infertile patients. Pregnancy and delivery rates are not different in patients with unilateral or bilateral adnexal involvement.
Ovarian stimulation aims at the development of one or more of the ovarian follicles to reach the ... more Ovarian stimulation aims at the development of one or more of the ovarian follicles to reach the stage of maturity culminating in the release of one or more mature oocytes ready for fertilization. Ovarian follicular development is under the control of local factors inside the ovaries (most of it is poorly understood), as well as hormones produced from extraovarian sources, mainly pituitary gonadotropins. Other hormones may play a role in ovarian follicular development; the extent and details of such a role are not fully understood. There are two mechanisms for ovarian stimulation: the first involves applying pharmacological agents that mimic endogenous gonadotropins (injectable gonadotropins) that directly stimulate ovarian follicular development through gonadotropin receptors. The second involves pharmacological agents that manipulate and moderate endogenous gonadotropin production. Those agents are oral ovulation induction agents that are believed to stimulate ovulation through mo...
Journal of Minimally Invasive Gynecology
To determine the incidence of postoperative ascending infection without antibiotics with the use ... more To determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology. Design: Retrospective case series (Canadian Task Force classification III). Setting: University-affiliated outpatient medical center. Patients: Patients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015. Interventions: In all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation. Measurements and Main Results: A total of 1010 patients who underwent operative hysteroscopy for uterine septum (n = 479), arcuate uterine anomaly (n = 483), or multiple submucosal myomas (n = 48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery. Conclusion: In 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed.
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Papers by Mohamed Mitwally