This is a story of a very nice lady, Mrs. R.K., that first seen complaining of depression as she was losing hope of being a mother. Although she is young, being 27 years old, she spent all her life since is marriage (9 years), visiting doctors. The reason behind this that she never had a period and her husband is of poor quality to achieve spontaneous pregnancy.
She was always treated as polycystic ovarian disease (PCO), and prescribed Metformin for a long time, as her ovaries are filled with many small cysts. Her husband had varicocelectomy in an attempt to improve semen quality, but the operation added nothing to any of the parameters of the semen. Also, she had a trial of intra uterine insemination (IUI), but again with no success. She had many attempts of ovulation induction with clomid, but again with no luck, as no follicles grow. Accordingly she was diagnosed as ovulation induction resistant PCO patient.
Mrs. R K initial consultation took 1 hour 38 minutes, during which a full story was obtained with every detail of her medical history, together with transvaginal ultrasound. Full endocrine profile was undertaken at GFC. All has confirmed that Mrs. RK is not a PCO patient but a case of hypogonadotophic hypogonadism, a case that the pituitary gland which is responsible for producing the stimulating hormones of the ovaries do not secrete or secrete minimal levels of these hormones, and hence no ovulation process is never complete.
The couple were advised that their best option would be ICSI after preparations. Indeed, three months later they have started their attempt, and was successful. Two weeks later, vaginal ultrasound has proved the presence of twin gestational sacs. Her pregnancy has passed uneventful, till 35 weeks when she had preterm labour that ended with Cesarean section and two lovely girls came to life.

The story of Mrs. D. N. is by any mean a typical case of the best spirit that combines hope, faith, fight and struggle. It is easy to combine these spiritual characters in words, but how to build them into human being, is very difficult. Although every person would like to have these characters, but the repeated failure would break down any strength one would have except for D.N.!!
Her case was the ever easy to diagnose condition POF. In simple terms; menopause would come early denoting a poor ovarian reserve. Her mother has had POF at the age of 34 and so was her Aunts and grand mother. Mrs. D.N., currently 31 years was trying since she was 25 years to achieve pregnancy even with using the most successful mode to start pregnancy ICSI. She has received 5 previous attempts with no success, sometimes no eggs, or very few numbers of oocytes. Her condition has become worse as she started to feel post menopausal symptoms as hot flushes and night sweats.
Dr. Zaki was not convinced at all times that this is a case of pure POF, as ovarian reserve has shown to be very low well before the age all her relatives had their early menopause. The belief was that their must be another factor possibly immunological or other medical conditions that would decrease the blood supply to her ovaries. Some of the investigations requested have confirmed this likelihood of other contributing factors.
Mrs. D.N. was prescribed relevant medications, and after 2 months an ICSI attempt was started, produced two eggs. Unfortunately the attempt was not successful. Another attempt was carried but again was not successful. The third attempt was carried out using different ovulation induction protocol and this time pregnancy test was positive 12 days after embryo transfer. Two weeks later a vaginal ultrasound has proved a pregnancy sac inside the uterus with a fetal heart well seen beating, and so it was till delivery of a healthy nice looking baby girl. Simply it is a gift from nobody except God.

Mrs. E.S.M. aged 32 years old has been trying for 11 years to achieve her dream of having a family of 3 kids. Three months after her marriage she has lost her first pregnancy at 7 weeks of pregnancy. The story was repeated twice later during the first eight weeks of pregnancy, within a period of 15 months. She was diagnosed at that stage of having polycystic ovarian disease (PCO) that she has done laparoscopic ovarian diathermy for. For five years after no pregnancy has occurred. She was then advised to have intra uterine insemination (IUI) that two trials were done with no success. At that stage the couple was advised to have ICSI. Four attempts at three different centers with three different ovarian stimulation protocols were carried out; two of these were cancelled as there were no oocytes at aspiration.
The couple was frustrated as they have felt that their condition has deteriorated from difficulty to maintain pregnancy to difficulty in achieving pregnancy, to difficulty in obtaining the necessary eggs!Meanwhile, Mrs. E.S.M has developed diabetes.The couple was treated at the center; their condition was fully investigated with a careful diagnostic workup, followed by well designed therapeutic plan that was ended with an attempt of ICSI.
She has produced 18 oocytes (eggs). Embryo transfer was carried out on Day 6 after aspiration, and 3 blastocysts were returned back to the uterus. 10 days later pregnancy test was positive. Two weeks later two pregnancy sacs were found inside the uterus. However, one has shown no fetal heart. The other continued till the second week of the last nine months of pregnancy when delivery was done with Cesarean section, and a long waited healthy boy was delivered. Another gift from God.

No body is lucky to live in this decade like the men who do not have sperms in their semen! Intra Cytoplasmic Sperm Injection (ICSI) only came out in 1992, before that year even those with low number of sperms in their semen could not be helped even with test tube baby method (IVF). But now these people are lucky as ICSI can help them to have the joy of having children of their own.
Mr. A.M. & his wife Mrs. S.M presented to the center asking if their any way for having children of their own. He has had a diagnostic testicular biopsy elsewhere and they could not found any sperms in the biopsy but few cells. He has lost hope in himself but he still trust that science can help him! Mrs. S.M. was found to have polycystic ovarian disease (PCO). They were counseled and advised to have ICSI and testicular biopsy. The husband was very reluctant for his wife’s ovaries to be stimulated while he was not sure if he still has sperms in his testis especially after the first testicular biopsy being negative. He understood later on that the testis has many section, and the absence of sperms in the section sampled does not imply the absence in the other sections. Also, in the scenario of finding sperms they will better of if we inject them at the same session inside his wife eggs. If we will not find sperms his wife’s eggs will not be brought out.
Indeed, Mrs. S.M. was prepared properly in view of her PCO ovaries and then stimulated. At the time expected that her eggs were mature the husband had a testicular biopsy that was proven positive for sperms. His wife was 30 minutes later in theatre and 16 eggs were aspirated. 14 eggs were found to be mature and injected with her husband sperms. Four embryos were returned back to the uterus. Two weeks later pregnancy test was positive.
Mrs. S.M. had a transvaginal ultrasonography and found to have triplet. They were counseled in view of the risks bound to multiple pregnancy to do fetal reduction, but the couple has decided to keep the three. The pregnancy has passed uneventfully till 34 weeks of pregnancy when symptoms of preterm labour developed. She had a Cesarean section and delivered two girls and one boy, all are healthy babies.

No more frustration than you wait for pregnancy to happen, then you find that it is destined to end with no baby, especially if this happen more than twice.
This is what Mrs. S.Z. has told Dr. Zaki the first time, not only so but she also said; “that is happing when you are running out of time being 40”. Her first consultation took 1 hour and 15 minutes; as every detail of her story has to be carefully examined. Her period was delayed for 1 week, but she was afraid to do pregnancy test because if positive she will be waiting for the miscarriage to happen again, with all the depression bound to it. Yes, she was pregnant as a tiny pregnancy sac was seen inside the uterus. She was fully investigated for the different causes of repeated pregnancy loss. There was no time to wait for the results as miscarriage usually happens to her 10-12 days after the date of missed period. She prescribed treatment but unfortunately she started loosing. By the time she knew that events would be happing, events were occurring, a week later miscarriage were completed.
Her next consultation was a month later when all the diagnostic work up were completed, and the management plan was ready to be applied. A month later, the targeted cycle was started with the medication, ovulation induction was monitored and at the proper time sexual intercourse was advised. Pregnancy test was positive 16 days later. For very few occasions in life, human behavior is different than the expected usual, as the norm is when the test is positive the atmosphere is full of happiness, but not with Mrs. S.Z.. She was not sure what her feeling was supposed to be, not sure that she should be happy!!
Day ten after her missed period date has passed uneventful. Although she requested to spend that day in the hospital, but she was advised that hospital stay would not add any benefit. As life is always full of hope, her pregnancy continued uneventfully till week 35 of her pregnancy, when preterm labour pains started with a rapidly developing pregnancy induced hypertension. A healthy boy of 2.9 kg was delivered, and her pregnancy induced hypertension settled. No words can describe the look of her eyes to her baby. I must admit that I am fortunate to work in this field to see that look of hers’ and many others