Papers by Mahmoud Zakherah
Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked app... more Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy. Main body Given the potential dangers associated with uterine niche occurrence, numerous studies in recent years have delved into the concept of cesarean scar niche, exploring its risk factors, diagnostic approaches, and treatment options. Various diagnostic modalities, such as two-or three-dimensional transvaginal ultrasonography, twoand three-dimensional sono-hysterography, hysterosalpingography, hysteroscopy, or magnetic resonance imaging, can be employed to detect uterine niches. However, none of these diagnostic methods is universally accepted as the "gold standard, " and there remains a lack of unequivocal guidelines on certain aspects related to the diagnosis of cesarean scar niche. These niches, characterized by hypoechoic regions within the myometrium at the site of a previous CS scar, pose diagnostic complexities and provoke inquiries into their prevalence, factors influencing their development, clinical presentations, and appropriate therapeutic approaches. Conclusion As CS rates rise, this review aims to understand and address uterine niches and mitigate their impact on maternal health and reproductive outcomes.
Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked app... more Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy.
Middle East Fertility Society Journal/Middle East Fertility Society Journal, May 31, 2024
Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked app... more Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy. Main body Given the potential dangers associated with uterine niche occurrence, numerous studies in recent years have delved into the concept of cesarean scar niche, exploring its risk factors, diagnostic approaches, and treatment options. Various diagnostic modalities, such as two-or three-dimensional transvaginal ultrasonography, twoand three-dimensional sono-hysterography, hysterosalpingography, hysteroscopy, or magnetic resonance imaging, can be employed to detect uterine niches. However, none of these diagnostic methods is universally accepted as the "gold standard, " and there remains a lack of unequivocal guidelines on certain aspects related to the diagnosis of cesarean scar niche. These niches, characterized by hypoechoic regions within the myometrium at the site of a previous CS scar, pose diagnostic complexities and provoke inquiries into their prevalence, factors influencing their development, clinical presentations, and appropriate therapeutic approaches. Conclusion As CS rates rise, this review aims to understand and address uterine niches and mitigate their impact on maternal health and reproductive outcomes.
Contraception, 2011
This study compared the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) to... more This study compared the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) to low dose combined oral contraceptive pills (COC) in the management of idiopathic menorrhagia. A single-center, open, randomized clinical trial. One hundred twelve women complaining of excessive menstruation who desired contraception were randomized to receive LNG-IUS or COC. Treatment failure was defined as the need for medical or surgical treatment during the follow-up. Other outcomes included: menstrual blood loss (MBL) by alkaline hematin and by pictorial blood assessment chart (PBLAC), hemoglobin levels and assessment of lost days in which physical or mental health prevented participating women from performing usual activities. At baseline, LNG-IUS (n=56) and COC (n=56) groups were comparable in age (mean ± S.D.) (39.3 ± 6.7 vs. 38.7 ± 5.2 years, p=.637), parity (median and range) [3(1-6.4) vs.3(2-6), p=.802] and BMI (mean ± S.D.) (29.6 ± 5.9 vs. 31.1 ± 5.7 kg/m(2), p=.175). Time to treatment failure was longer in LNG compared to COC group with a total of 6 (11%) patients who had treatment failure in the LNG-IUS compared to 18 (32%) in COC group with a hazard ratio of 0.30 (95% CI, 0.15-0.73, p=.007). Using alkaline hematin, the reduction in MBL (mean ± S.D.) was significantly more in the LNG-IUS group (87.4 ± 11.3%) compared to the COC group (34.9 ± 76.9%) (p=.013). Utilizing PBLAC scores, the reduction in the LNG-IUS (86.6 ± 17.0%) group was significantly more compared to the COC group (2.5 ± 93.2%) (p<.001). In the LNG-IUS group, increase in the hemoglobin and ferritin levels (mean ± S.D.) were noted (from 10.2 ± 1.3 to 11.4 ± 1.0 g/dL; p<.001; with reduction of the number of lost days (from 6.8 ± 2.6 to 1.6 ± 2.4 days, p=.003). The LNG-IUS is a more effective therapy for idiopathic menorrhagia compared to COC.
Gynecologic and Obstetric Investigation, 2011
Background/Aims: The pictorial blood assessment chart (PBAC) is a method for evaluation of menstr... more Background/Aims: The pictorial blood assessment chart (PBAC) is a method for evaluation of menstrual blood loss (MBL). This study was conducted to evaluate the accuracy of the PBAC score in diagnosing MBL compared to alkaline hematin as a gold standard. Methods: Two cohorts were constructed: 30 women who reported ‘normal’ menses and 170 who reported ‘heavy’ menses. Evaluation of menstruation was performed using the PBAC score and by alkaline hematin. Results: Women who reported normal menses were younger (p = 0.071), had lower parity [median parity of 3 (range 1–6) vs. 4 (range 1–12), p < 0.001] and higher hemoglobin levels (11.1 ± 1.1 vs. 10.1 ± 1.6 g/dl, p < 0.001). PBAC scores and MBL by alkaline hematin were significantly correlated (Spearman r = 0.600, p < 0.001). The PBAC score of 150 had a ĸ of 0.593 (95% CI 0.480–0.687) and an area under the curve of 0.796 (95% CI 0.770–0.821). In a multivariable regression PBAC score >150, presence of blood clots and period duration >7 days were independent predicators of heavy menstrual bleeding with an overall area under the curve of 0.858 (95% CI 0.835–0.879). Conclusions: The PBAC score is a simple and accurate tool for semiobjective of MBL that can be used in clinical practice to aid the decision about treatment and follow-up.
Gynecologic and Obstetric Investigation, 2010
Aims: To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperiton... more Aims: To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications. Design: A randomized clinical trial. Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either DT entry (group A, n = 500) or VN (group B, n = 500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. Outcomes: The duration of the procedure, volume of gas consumption, ease of performance and frequency of complications were analyzed. Results: Patients in the 2 groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group A (2.2 ± 0.7 min, 95% CI 2.14–2.26) than in group B (8.2 ± 1.4 min, 95% CI 8.08–8.32; p < 0.0001). The mean gas consumption was significantly less in group A (2.6 ± 0.9 liters, 95% CI 2.52–2.68) than in group B (8.4 ± 2.6 liters, 95% CI 8.17–8.63; p < 0.0001). No major complications in both groups were encountered. Minor complications were significantly less in group A (0.4%, 95% CI 0.77–3.23) than in group B (14%, 95% CI 10.96–17.04; p < 0.0001). Conclusions: DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost and instrumentation and rapid creation of pneumoperitoneum.
International journal of gynaecology and obstetrics, Feb 26, 2009
OBJECTIVE: To assess the effectiveness of 800 microg of rectal misoprostol compared with an intra... more OBJECTIVE: To assess the effectiveness of 800 microg of rectal misoprostol compared with an intravenous infusion of 5 IU of oxytocin as prophylaxis against postpartum hemorrhage (PPH). METHODS: A total of 514 women in labor were randomized into two groups (257 women in each). Within 1 minute of delivery of the anterior shoulder participants in group 1 received 800 microg of rectal misoprostol and 1 ampoule of normal saline in 5 mL lactated Ringer solution intravenously; group 2 received a rectal placebo tablet and 5 IU of oxytocin in 5 mL lactated Ringer solution intravenously. RESULTS: Both groups were comparable regarding the need for uterotonics, blood transfusion, and hematocrit drop of 10% or greater, 24 hours post partum (P=0.54, P=0.25, and P=0.85, respectively). Fever was significantly higher among misoprostol patients (18.7% vs 0.8%, P
Fertility and Sterility, Feb 1, 2011
Objective: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in ca... more Objective: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in cases with blind vagina due to androgen insensitivity syndrome. Design: Case series with description of the technique.
International journal of gynaecology and obstetrics, Oct 15, 2008
Objective: The aim of the present prospective study was to compare the effects of postoperative p... more Objective: The aim of the present prospective study was to compare the effects of postoperative predominant traction and predominant distension on penetration and sexual satisfaction among women undergoing LAB-V and their partners. Methods: Eighteen women with vaginal aplasia were included in the study. Sexual satisfaction was measured using a visual analogue scale from zero to 100 and divided into 10 compartments, with 100 representing maximum satisfaction and 0 representing no satisfaction. The patients were randomly allocated to either the predominant distension group (PD) or the predominant traction group (PT) Results: The operative procedure was the same for both groups Postoperative care consisted of preventing infection and controlled traction and distension in each group but at different levels. In the PD group, the balloon was distended at 5 mL/day to a maximum of 40 mL reached on the seventh postoperative day. The catheter was then removed the following day. Traction was performed at a rate of 1 cm per day. In the PT group, traction was done daily using the catheter to the level of patient tolerance (maximum 3 cm) and controlled distension at a rate of 3 mL every other day. Counter traction was applied in both groups every 20-30 minutes during the first 6 hours after the daily increase in traction force. Upward massage of the upper thigh and inward massage of perineal skin were also done to relieve the pressure exerted by the distension and traction. The length and width of the vagina were measured by a specially designed measurement piece, graded in centimeters (0-20) with two ball ends, the smaller being 2 cm and the larger being 4 cm. Conclusion: increasing traction or distension is effective and safe, although increasing distension can lead to rupture of the Foley catheter balloon. Women in the PD group experienced less postoperative pain and less dyspareunia than women in the PT group.
International journal of reproduction, contraception, obstetrics and gynecology, Mar 26, 2019
The total number of cesarean section done was 180 cases and the number of CS on demand was 64 (35... more The total number of cesarean section done was 180 cases and the number of CS on demand was 64 (35.6%). The demographic data were collected by one of the study investigators. Women were asked about the causes of requesting CS before surgery. Results: The study group was 64 women with age ranging from 18-40 years old, 40 primipara and 24 multipara. Of those 24 women, 21 of them previously delivered vaginally and only 3 women delivered by emergency CS. Twentysix women had a history of previous abortion. Fear of pain was the main cause for CS on demand in the whole study participants (57.8%). In primipara, the main cause for requesting CS is fear of pain in 62.5% of participants followed by fear on the baby in 45 % of women. On the other hand, in multipara, the main cause for CS on demand was bad history of previous experience (60%) followed by fear of pain in 50% of cases. There was statistical significant difference between both groups in only two causes; fear of pelvic floor injuries (50% in multipara vs. 20% in primipara, p=0.02) and bad history of previous experience (60% in multipara vs. 0% in primipara, p=0.001). Other causes were not statistically different. Conclusions: The incidence of cesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but also due to social, cultural, and psychological factors.
Obstetrical & Gynecological Survey, May 1, 2010
To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum du... more To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications. A randomized clinical trial. One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either DT entry (group A, n = 500) or VN (group B, n = 500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. The duration of the procedure, volume of gas consumption, ease of performance and frequency of complications were analyzed. Patients in the 2 groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group A (2.2 +/- 0.7 min, 95% CI 2.14-2.26) than in group B (8.2 +/- 1.4 min, 95% CI 8.08-8.32; p < 0.0001). The mean gas consumption was significantly less in group A (2.6 +/- 0.9 liters, 95% CI 2.52-2.68) than in group B (8.4 +/- 2.6 liters, 95% CI 8.17-8.63; p < 0.0001). No major complications in both groups were encountered. Minor complications were significantly less in group A (0.4%, 95% CI 0.77-3.23) than in group B (14%, 95% CI 10.96-17.04; p < 0.0001). DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost and instrumentation and rapid creation of pneumoperitoneum.
Fertility and Sterility, Sep 1, 2011
measured by real-time PCR. A cell cytotoxicity assay was performed with the CytoTox-Fluor Cytotox... more measured by real-time PCR. A cell cytotoxicity assay was performed with the CytoTox-Fluor Cytotoxicity Assay. Comparisons between different groups were made using the one-way analysis of variance (ANOVA) following Scheff e's method. Statistical significance was defined as a P-value of <0.05. RESULTS: The cytotoxicity assay demonstrated that there was no significant difference among the control, 12mmHg and 8mmHg groups. Hyaluronan protein levels were significantly lower in the 12mmHg group than that of the 8 mmHg group throughout the time course of the study. CONCLUSION: The present findings suggest that the synthesis of hyaluronan might be lower after CO2 pneumoperitoneum at a high IPP (12mmHg).
Assiut Scientific Nursing Journal (Print), Dec 1, 2014
Background: Persons with disabilities represent a significant portion of the world's population a... more Background: Persons with disabilities represent a significant portion of the world's population and they are part of every community. They find that information on reproductive health (RH) is often inaccessible to them. Aim: evaluate the impact of an educational program about RH for blind and deaf adolescent girls. Methods: it was Quasi-experimental research design which conducted in Al Noor and Al Amal Schools in Assiut Governorate. The total sample was 80 girls. Tools: it included three tools:-a structured interview sheet, to assess disabled girls' knowledge and attitudes towards RH and an observational checklist (using doll) to assess practice related perineal care. Results: All the studied sample (100%) has poor knowledge regarding to RH in pre test while their knowledge improved in post test to 58.8%. Regarding to perineal care, all of the studied sample (100%) carried out all steps of perineal care except three steps which include the correct direction for cleaning the perineum, while their practice improved in post and follow up test. Conclusion: All the studied girls have poor knowledge in pre test while after implementation the education programe their knowledge were improved (P= ≤ 0.001). Recommendation: Continues health education programs should be implemented for increasing awareness of them about reproductive health.
International journal of reproduction, contraception, obstetrics and gynecology, Jan 23, 2018
Background: Polycystic ovary disease (PCOD) is the most common endocrine disorder in women of rep... more Background: Polycystic ovary disease (PCOD) is the most common endocrine disorder in women of reproductive age, with a prevalence of approximately 5-10%. This study aims to assess the rate of spontaneous ovulation and pregnancy in patients. The present study was a cross sectional study conducted at Woman'
American Journal of Obstetrics and Gynecology, Nov 1, 2009
International journal of gynaecology and obstetrics, Nov 19, 2010
Objective: To compare the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) wi... more Objective: To compare the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) with that of a low-dose combined oral contraceptive (COC) in reducing fibroid-related menorrhagia. Methods: In this singlecenter, open, randomized clinical trial, 58 women with menorrhagia who desired contraception were randomized to receive a LNG-IUS or COC. The outcomes included treatment failure, defined as the need for another treatment; menstrual blood loss (MBL) by the alkaline hematin method and a pictorial assessment chart (PBAC); hemoglobin levels; and "lost days." Results: Treatment failed in 6 women (23.1%) in the LNG-IUS group and 11 (37.9%) in the COC group, for a hazard ratio of 0.46 (95% CI, 0.17-1.17, P = 0.101). Using the alkaline hematin test, the reduction of MBL was significantly greater in the LNG-IUS group (90.9% ± 12.8% vs 13.4% ± 11.1%; P b 0.001). Using PBAC scores, the reduction was also significantly greater in the LNG-IUS group (88.0% ± 16.5% vs 53.5% ± 51.2%; P = 0.02). Moreover, hemoglobin levels increased from 9.7 ±1.9 g/dL to 11.7± 1.2 g/dL (P b 0.001) and lost days decreased from 8.2 ± 3.3 days to 1.3 ± 1.5 days (P = 0.003) in the LNG-IUS group. Conclusion: Although the rate of treatment failure was similar in both groups, the LNG-IUS was more effective in reducing MBL than the COC in women with fibroid-related menorrhagia.
International journal of reproduction, contraception, obstetrics and gynecology, Jul 26, 2018
Placenta previa (PP) is an obstetric complication that occurs in the second and third trimesters ... more Placenta previa (PP) is an obstetric complication that occurs in the second and third trimesters of pregnancy. It may cause serious morbidity and mortality to both the fetus and the mother. It is one of the leading causes of vaginal bleeding in the second and third trimesters. 1 Placenta previa complicates approximately 0.4 % pregnant women and has a mortality rate of 0.0 3%. 2,3 Placenta previa may be associated with placenta accreta (PA) or one of its more advanced forms as (placenta increta and percreta). Clinically, PA becomes problematic during delivery when the placenta does not completely separate from the uterus and is followed by massive obstetric hemorrhage, leading to disseminated intravascular coagulopathy; the need for hysterectomy; surgical injury to the ureters, bladder, bowel, or neurovascular structures; adult respiratory distress syndrome; acute transfusion reaction; electrolyte imbalance; and renal failure. 4 In the period of 1982-2002, researchers have reported the incidence of PA as 1 in 533 deliveries. 5 The marked increase in the incidence has been attributed to the ABSTRACT Background: The aim of the current study was to estimate the incidence of placenta previa (PP) and accreta (PA) in the period from January 2015 to December 2016 at Women's Health Hospital, Assiut University, Egypt and to evaluate the maternal and neonatal outcomes. Methods: The study included all cases of PP with or without suspicion of accreta who were diagnosed preoperatively by ultrasound at Women's Health Hospital, Assiut University. Maternal and neonatal outcomes were evaluated. All intraoperative and postoperative data were reported. The obtained data was analyzed by means of SPSS software (version 22.0) and p<0.05 was taken as the significant level. Results: Total number of deliveries was 29027 cases. The number of cases of PP was 494 cases making an incidence of 1.7%, among them 95 cases were confirmed during surgery to be accreta (0.33%). Uterine artery ligation was carried out 300 cases (60.7%) of cases while cesarean hysterectomy was performed in 56 cases (11.3%). Bladder injury occurred in 58 cases (11.7%), ureteric injury occurred in 6 cases (1.2%), colon injury occurred in 1case (0.2%) and vascular injury occurred in 2 cases (0.4%). Maternal mortality was 4 cases (0.8%). The mean gestational age was 34.73 ± 2.8 weeks. Also, over the two years there were 148 neonatal cases (29.9%) needed assisted ventilation in the form of ambu bag or endotracheal intubation gestation. NICU admission needed in 109 neonatal cases (22.06%) and neonatal mortality reported in 18 neonates (3.6%). Conclusions: The incidence of both PP and PA is very high in our locality due to increase CS rate.
Proceedings in obstetrics and gynecology, Oct 22, 2016
Objectives: to evaluate the effect of oral ginkgo biloba extract (GB)) on asymmetrical intrauteri... more Objectives: to evaluate the effect of oral ginkgo biloba extract (GB)) on asymmetrical intrauterine growth restriction (IUGR). Study Design: A randomized trial conducted at Assiut Women Health on 226 pregnant women with asymmetrical IUGR. The patients randomly received GB extract or placebo for 6 weeks. The main outcome measures were improvement in fetal weight and feto-maternal blood flow. The data were analyzed by Student's t-test and chisquared tests. Result: There was a significant increase in the estimated fetal weight in the GB group (3047+ 127 gm) when compared to the placebo group (2734+ 127 gm) (p=<0.001). Moreover; there were significant increases in feto-maternal blood flow in GB group compared to the placebo group. Conclusions: GB extract improves placental functions, Doppler indices and fetal weight in pregnancies complicated with IUGR fetuses.
Gynecological Surgery, Jul 21, 2010
This study aims to evaluate the feasibility of a minimally invasive access-integrated protocol fo... more This study aims to evaluate the feasibility of a minimally invasive access-integrated protocol for aspiration or drainage of symptomatic uterine cysts. The design of the study is a prospective cohort study. The study setting is a tertiary care referral facility and university hospital. Twenty seven women with objective evidence of uterine cysts diagnosed by ultrasonography. The patients underwent transvaginal sonographic diagnosis of uterine cysts at different sites. Cyst aspiration was performed using interventional 2D ultrasonography, hysteroscopy and/or laparoscopy. Follow-up was performed for a maximum of 1 year to assess relief of symptoms and the recurrence rate. The main outcome measures of the study are success of aspiration tool, relief of symptoms, and persistence or recurrence rates. Cervical and corporeal uterine cysts were diagnosed in 19 and eight cases respectively. The mean size of the cervical cyst was 2.9±1.21 (1.8-3.7) cm, while that of the uterine cysts was 4.8±1.89 (3.4-6.1) cm. Improved health-related quality of life in the form of relief of deep dyspareunia and excessive vaginal discharge were reported in eight of 12 (66.6%) and 11/14 (78.5%) cases, respectively. Aspiration of symptomatic uterine cysts is technically feasible and achieves acceptable results. Uterine cysts may not be ignored as a potential cause of gynecologic symptoms, however, their precise pathogenesis and related co morbidities including impact on fertility should be substantiated by an adequately powered prospective randomized controlled study.
Fertility and Sterility, Mar 1, 2011
To compare reproductive outcome of adjusted thermal dose on the basis of ovarian volume versus fi... more To compare reproductive outcome of adjusted thermal dose on the basis of ovarian volume versus fixed-puncture dosage in laparoscopic ovarian drilling. Randomized controlled trial. University Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Center. One hundred twenty patients with polycystic ovary syndrome and clomiphene citrate resistance. Patients were assigned randomly to two groups of 60 women each. Group A received an adjusted thermal dose based on ovarian volume with use of a new model for dose calculation (60 J/cm(3) of ovarian tissue), and group B received 600 J per ovary through four ovarian holes regardless of size. One month afterward, the hormonal profile was reevaluated, and second-look laparoscopy was performed in patients who had not conceived by 6 months to evaluate adnexal adhesions. Ovulation, conception, and early abortion rates, cycle rhythm, and adnexal adhesions. More patients resumed regular cycles in group A than in group B (87.9% vs. 75.4%). The ovulation and pregnancy rates were significantly higher in group A than in group B (81.8% vs. 62.2% and 51.7% vs. 36.8%, respectively). There was no significant difference between groups in early miscarriage rate or postdrilling adhesions. Adjusted diathermy dose based on ovarian volume for laparoscopic ovarian drilling of polycystic ovary syndrome has a better reproductive outcome compared with fixed thermal dosage.
Uploads
Papers by Mahmoud Zakherah