Jibrel.net

By REBECCA TORR
Tuesday 23 October 2007
MANAMA

TWIN Bahraini boys are the first babies to be born through the Bahrain Specialist Hospital’s (BSH) In-Vitro Fertilisation (IVF) programme.

Faris and Saif Yacoob were born on October 15 at the hospital (BSH), Juffair.

Faris weighed in at 2,500 grammes and Saif at 2,200 grammes and were born at just over 37 weeks of pregnancy.

They were delivered by BSH IVF programme director Professor Dr Salam Jibrel. Their parents Dr Ebrahim Yacoob, 58, and Arlie, 37 decided to go for IVF after a vasectomy reversal failed twice.

Dr Yacoob had the vasectomy about 15 years ago after the birth of his second child with his first wife, but when she died at a young age he remarried and wanted to have more children to complete his family.

“We tried a vasectomy reversal, but it failed twice and then we tried Intracytoplasmic Sperm injection (ICSI) and thank God it worked,” Dr Yacoob told a Press conference at the BSH yesterday.

“We are extremely happy and delighted to be blessed with two boys.”

In IVF-ICSI a single live sperm is taken and injected by needle into the centre of a mature human egg.

The eggs are extracted from the female partner through the vagina following ovarian stimulation to ensure that several mature eggs develop and then one or more are injected with a single sperm.

Once fertilisation has taken place, which is usually within one to six days, the resulting embryo or embryos are placed in the woman’s uterus in a procedure called embryo transfer.

The BSH’s IVF-ICSI procedures are supported by a laser to help in assisted hatching of the formed embryos, which helps to increase pregnancy rates.

Seventy-two couples have had IVF trials since the programme was launched 10 months ago and other births are expected in the coming weeks and months.

A cycle of IVF costs an average of BD1,800 and the success rate is 35 to 40 per cent.

According to the World Health Organisation (WHO), almost 15pc of couples have infertility problems and almost half of them will have IVF treatment.

“IVF-ICSI is the most advanced technology in assisted reproduction and our pregnancy rates are as good as any in the region and world,” said Dr Jibrel, who is also obstetrics and gynaecology services head and consultant.

“The success rate at BSH is about 42pc.

“The best age for IVF is less than 38, but that doesn’t mean women at 40 or 42 aren’t able to benefit if we get eggs from them we can freeze and implant them later.”

The BSH IVF laboratory is the first in Bahrain and the region to offer fertility preservation procedures for female cancer patients that need to have chemotherapy or radiotherapy.

In female patients, ovarian tissue is removed by laproscopy to be transplanted later when she has completed her chemotherapy and radiotherapy.

“Our first patient was a woman in her early 30s who had breast cancer,” said Dr Jibrel.

“It’s a one-hour procedure that requires general anaesthesia.

“Tissue will be taken and frozen and later the ovarian tissue is thawed and re-implanted.

“Ovarian tissue cryopreservation has been performed in humans for less than a decade and the first ovarian transplant procedure was reported in 2000.”

Syndrome

BSH also offers pre-implantation genetic diagnosis (PGD) for patient suffering from hereditary diseases and to rule out Down Syndrome or other chromosomal syndromes.

This can be helpful for patients who have abnormal chromosomes that may have an affect on their children.

Such diseases can be inherited through sex chromosomes and by performing a PGD Fluorescent In-situ Hybridisation test you can determine the sex of the embryos.

“We do sex determination if there is an hereditary disease in the family,” explained Dr Jibrel. “If boys have the disease we exclude the XY chromosomes and implant female chromosomes - and vice-versa if the disease is in girls.”

Another treatment, In Vitro Maturation of eggs for patients suffering from polycystic ovarian syndrome, is also available at BSH.

This method of growing up eggs outside the ovaries of the female prevents dangerous ovarian hyperstimulation syndrome, which may occur after giving those patients hormonal stimulation during IVF trials.

BSH medical director and chief executive officer Dr Karim Ardati was also present at the Press conference.

by becky@gdn.com.bh

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New advances in medicine usually bring with them hope. However, they also bring new risks. The history of medicine has demonstrated that with almost every new treatment, whether medical or surgical, new complications arise.

The most common cancers diagnosed in women under the age of 40 years are breast cancer, melanoma, cervical cancer, non-Hodgkin’s lymphoma, and leukemia.

An estimated 1,372,910 people were diagnosed with cancer in 2005, of which 4% (approximately 55,000) are under the age of 35.

The effect of chemotherapy and radiotherapy on future fertility is of concern to patients and their families. A common concern of female patients and their families is the effect of chemotherapy and radiotherapy on future fertility. It should be stressed that some cancer treatments result in 99% ovarian failure. Whereas menopausal symptoms and signs can be treated medically, no solution is available to preserve female gametes.

The enormous advances in oncology, haematology and bone marrow transplantation (BMT) have resulted in a 90% remission rate in various diseases.

Both male and female fertility preservation is a new modality of treatment for patients at the reproductive age undergoing cancer treatment. For the male patient sperm from semen collection and biopsies tissue banking is commonly performed, but for the female eggs are not so amenable to cryopreservation (freezing them to be used in the future). Fertility preservation method of treatment in female patients is used for cases that are treated for cancer such as Breast cancer or Lymphomas and leukemia diseases at reproductive age

At the present time, we recommend urgent IVF in most patients requesting fertility preservation. Ovarian cryopreservation should be offered when emergency IVF is not possible.

Fertility preservation options in females depend on the patient’s:

            - Age.

            - Type of treatment.

            - Diagnosis.

            - Whether she is married.

            - The time available and.

            - The potential that cancer has metastasized to her ovaries.

In the USA alone, >650 000 women will be af¯icted by cancer in 2003, and 8% of these cases will be aged <40 years. Due to improvements in cancer therapy, cure rates of both adult and childhood cancers increased significantly over the past three decades. However, long-term consequences of cancer therapy and impact on quality of life are now being recognized. One of the major sequelae of cytotoxic chemotherapy is gonadal failure. Cytotoxic chemotherapy and/or radiotherapy are not only used to treat malignant diseases, but also non-malignant systemic conditions.

Upon reviewing the extent and mechanism of gonadal damage due to chemo-/radiotherapy, this article discusses indications and the wide range of methods of fertility preservation in a comprehensive manner. All current, emerging, experimental as well as controversial approaches are reviewed. A comprehensive algorithm to manage fertility preservation through an individualized approach is presented.

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تولد التطورات الحديثة في الطب الأمل دوما بالشفاء، ولكنها تحمل في طياتها أيضا المخاطر الجديدة للعلاج الحديث. وقد اثبت تاريخ الطب بأنه مع كل أسلوب علاج جديد (سواء كان بالعقاقير أو بالجراحة) فانه يحمل في طياته ظهور مضاعفات جديدة .

ولعل أكثر أنواع أمراض السرطان عند النساء تشخيصا في اللواتي تقل أعمارهن عن40 عاما: سرطان الثدي، سرطان الجلد، سرطان عنق الرحم، الليمفوما ، وسرطان الدم .

وقد قدر عدد اللذين أصيبوا بالسرطان في الولايات المتحدة الأمريكية وتم تشخيصهم في عام 2005 بحوالي 1372910، 4% منهم ( أي ما يعادل 55000) كانوا تحت سن 35 سنه. وينتهي الحال بهؤلاء المرضى إلى أخذ العلاجات الكيماوية أو العلاج بالأشعة. , اثر العلاج الكيماوي والعلاج بالأشعة على الخصوبة المستقبلية للمريض من الأمور المهمة للمريض وعائلته وخصوصا إذا كان المريض المرأه.

ويجب التأكيد هنا على أن العلاجات التي تعطى في بعض حالات السرطان يمكن أن تؤدي إلى الفشل الوظيفي الكامل للمبيض في 99% من الحالات وهذا يؤدي إلى العقم الدائم وظهور أعراض سن اليأس مبكرا عند هذه الفئة من المريضات. وفي حين يمكن معالجة أعراض سن اليأس عند النساء بالعلاج إلا انه لم يكن هناك علاج لحفظ النطف ( البويضات) للمرأة.

وقد أدت التطورات الحديثة في علاج الأورام وأمراض الدم وزراعة النخاع العظمي إلى شفاء ما يقارب من 90% من هؤلاء المصابين. والمحافظة على الخصوبة عند الرجل والمرأة ( إذا كانوا سيخضعوا لعلاج الأورام وهم في سن الإنجاب)، أصبح من الطرق الحديثة التي نحافظ بواسطتها على قدرتهم على إنجاب أبناء لهم بعد علاجهم من السرطان.

اما في حالة الزوج فالاحتفاظ بعينات السائل المنوي أو بعينات من نسيج الخصية والتي تؤخذ من الزوج على شكل خزعات ويتم الاحتفاظ بها بتجميدها في مراكز الاخصاب. أما بالنسبة للمرأة فان تجميد البويضات اصبح ممكنا (حتى يتم استعمالها في المستقبل).

وطرق المحافظة على الخصوبة عند المرأة يمكن  اجراؤها في حالات الاصابة بسرطان الثدي ، أو الليمفوما وأمراض سرطان الدم في عمر الاخصاب عند\ة المرأة.

والخيارات في طرق المحافظة على الخصوبة عند المرأة متعددة ومنها :

-          تجميد الاجنة وتجميد البويضات (مع أو بدون التحريض على الاباضة).

-          تجميد أنسجة المبيض.

-          التقليل من نشاط المبيض.

-          نقل المبيض.

-          العلاج الكيماوي أو الشعاعي بشكل محدود (في بعض أنواع السرطان).

ومن البدائل العملية للأحتفاظ بنسيج المبيض وتجميده، وتأجيل علاج السرطان (اذا أمكن)، حتى نستطيع تجميع البويضات من المريضة بعد اخضاعها لبرنامج تحريض على الاباضة، ومن ثم سحب هذه البويضات وتخصيبها  بحيوانات منوية من الزوج. بعدها يتم تجميد هذه الاجنة لاعادة استعمالها بعد الانتهاء من علاج السرطان وخصوصا اذا نتج عن علاج السرطان فشل المبيض الوظيفي الكامل.

وتعتمد خيارات علاج المحافظة على الخصوبة عند النساء وأهمها:

-          عمر المريضة.

-          نوع العلاج.

-          التشخيص .

-          كون المريضة متزوجة أو عزباء.

-          الوقت المتاح لاجراء هذه التداخلات للمحافظة على الخصوبة.

-          اذا كان السرطان قد انتشر ووصل الى المبيضين.

والنصيحة الاخيرة لهؤلاء المريضا ت المتزوجات ان يقومن باجراء عملية أطفال الانابيب اذا كن يرغبن بالمحافظة على خصوبتهن. بحيث يبقى تجميد المبيض وأنسجته كبديل اذا لم تتوفر امكانية عمل اطفال الانابيب بشكل مستعجل,

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