Masters Degrees (Obstetrics and Gynaecology)
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Browsing Masters Degrees (Obstetrics and Gynaecology) by browse.metadata.advisor "Erasmus, Evelyn"
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- ItemA retrospective study of the effect of endometriosis on reproductive outcomes in assisted reproductive treatment(Stellenbosch : Stellenbosch University, 2023-03) Pfeiffer, Nadine; Erasmus, Evelyn; Burger, Riana; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.ENGLISH SUMMARY: Background: One of the leading causes of female infertility is a chronic condition known as endometriosis. There are four stages of endometriosis, and 25 to 50% of affected women experience endometriosis-related infertility. Endometriosis is suggested to impair the pelvic environment, ovaries (oocyte quality and quantity), and the uterus. Endometriosis is a frequent indicator for Assisted Reproductive Treatment (ART). However, there is a lack of consensus regarding the impact of this disease and its subsequent stages on outcomes achieved in ART. With the optimisation of ART, it is necessary to further evaluate the effect endometriosis may have on reproductive and embryological outcomes. Objectives: Primary objective: To retrospectively evaluate the reproductive outcomes (post-embryo transfer) of endometriosis patients (EE group) compared to the success of tubal factor infertility patients (TF group) by calculating implantation rate (IR), clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Secondary objective: To retrospectively evaluate the pre-embryo transfer outcomes of the EE group and TF group by calculating fertilisation rate (FR), number of oocytes retrieved, percentage of good quality day 3 embryos (GQE), and blastulation rate (BR). Tertiary objective: To retrospectively evaluate whether the stage of endometriosis affects BR, IR, CPR, LBR, and MR. Materials and Methods: This retrospective study (2017 to 2020) used anonymised data from the Tygerberg and Aevitas Fertility Clinics. It included a study group, the EE group (N = 101) and a control group, the TF group (N = 110). The EE group were subdivided, if the stage of endometriosis (ES) was known, as stage I and II (ES1-2 group [n=13]) and stage III and IV (ES3-4 group [n=65]). The data was submitted for statistical analysis, with statistical significance defined as P < 0.05. Results: Compared to the TF group, the EE group had a higher, but non-significant (p>0.05) number of metaphase II (MII) oocytes retrieved (6.02 MII oocytes vs 5.6 MII oocytes), IR (23.27% vs 19.6%), CPR (32.67% vs 32.11%), MR (28.13% vs 25.00%), and LBR (78.13% vs 75.00%). However, the EE group had a significantly reduced FR compared to the TF group (82.19% vs 87.46%, P = 0.04). Nonetheless, the GQE (77.66% vs 75.73%) and the BR (58.7% vs 63.79%) of the two groups were similar. No statistically significant differences (p>0.05) were found between the ES1-2 group and the ES3-4 group regarding BR (62.11% vs 57.63%), IR (26.92% vs 20.77%), CPR (38.46% vs 29.23%), and LBR (100% vs 66.67%). The MR of the ES3-4 group was significantly higher than the ES1-2 group (38.89% vs 0%, P = 0.04), however, the small sample size queries the validity. Conclusions: The current study found that endometriosis does not have a negative impact on post-embryo transfer reproductive outcomes, during ART. Similarly, the disease does not have a negative effect on the number of MII oocytes retrieved, GQE, and BR. However, a significantly reduced FR in the EE group was indicated, which may be a result of oocyte abnormalities in endometriosis patients. Furthermore, the study found that the reproductive outcomes and BR were lower in ES3-4 group, although it was not significant.
- ItemA retrospective study of the effect of testicular biopsy extracted spermatozoa in intracytoplasmic sperm injection (ICSI) on reproductive outcomes in assisted reproductive treatment (ART)(Stellenbosch : Stellenbosch University, 2023-03) Oosthuizen, Micke; Burger, Riana; Erasmus, Evelyn; Matsaseng, T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.ENGLISH SUMMARY: Background: Azoospermia, a possible cause of male infertility, is responsible for 10–15 percent of infertility cases. Azoospermia is characterized by the absence of spermatozoa following microscopic analysis and centrifugation of the complete sperm specimen. Azoospermia patients can be divided into two categories, obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). The effects of testicular spermatozoa compared to ejaculated spermatozoa on ART outcomes still remain controversial. Spermatozoa from different sources or diagnostic groups result in significantly different treatment outcomes in some studies but not in others. There are differences in the quality of sperm from patients diagnosed with OA and NOA. Due to ongoing controversy, this study was therefore conducted to establish ICSI outcomes with ejaculated spermatozoa and testicular retrieved spermatozoa under specific laboratory conditions. Aims: The primary aim was to retrospectively investigate the effect of testicular biopsy spermatozoa (TB group) compared to the effect of ejaculated spermatozoa (ES group) on ART outcomes. The secondary aim was to retrospectively evaluate whether the reason for azoospermia (NOA or OA) affects the IR, CPR, LBR, and MR. Materials and Methods: This study was retrospectively conducted on the data obtained from medical and laboratory records between 2017 and 2020 at Drs. Aevitas Fertility Clinic, Pinelands, South Africa and Tygerberg Fertility Clinic for the period of 2015 – 2020. Data was categorized and filtered based on predetermined inclusion and exclusion criteria. Data was submitted for statistical analysis (statistical significance: P < 0.05). Results: The FR (84.66% vs 82.47%), Cleavage Rate (97.15% vs 98.76%), Blastulation Rate (54.73% vs 53.82%), CPR (44.86% vs 35.94%) and MR (29.17% vs 36.28%) were not significantly different between the TB group and the ES group respectively (p>0.05). The IR (30.69% vs 23.06%) and the LBR (33.64% vs 23.96%) was significantly different between the TB group and the ES group respectively (p<0.05). The FR (86.30% vs 79.29%), Cleavage Rate (96.79% vs 98.39%), Blastulation Rate (57.19% vs 45.43%), IR (29.27% vs 35.33%), CPR (43.90% vs 48%), MR (36.11% vs 8.33%) and LBR (29.27% vs 44%) were not significantly different between the OA group and the NOA group respectively (p>0.05). Conclusion: The present study primarily compared the results of ICSI with testicular spermatozoa with those of ICSI with ejaculated spermatozoa. Sub analysis were done on the two different azoospermic groups (NOA and OA). This retrospective study indicated similar FR, Cleavage Rates, Blastulation Rates, PR and MR for the ES group and the TB group. The current study found a significant difference in the IR and LBR between these two groups. By comparing the OA and the NOA group no significant difference in the FR, Cleavage Rates, Blastulation Rates, IR, CPR, MR and LBR was found. The present study, as well as available literature, confirms that the use of testicular spermatozoa does not have a negative effect on ICSI treatment outcomes. This study can therefore provide valuable information during consultation for ICSI treatment in these patients and provide them with assurance that it is possible to achieve normal FR as well as good quality embryos, IR, CPR and lower MR with ICSI.