الفهرس 
ART, IVF & ICSIOnly 14 pages are availabe for public view
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Abstract
In vitro fertilization or fertilization (IVF) is a process by which an egg is fertilized by sperm outside the body: in vitro (”in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilize them in a liquid in a laboratory. The fertilized egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.
The first successful birth of a ”test tube baby”, Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. With egg donation and IVF, women who are past their reproductive years or menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. After the IVF treatment many couples are able to get pregnant without any fertility treatments.
Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. Defective sperm function remains the single most important cause of human infertility. Although certain severe forms of male infertility have a genetic origin, others may be the result of environmental factors. During the past decade, ICSI has been applied increasingly around the world to alleviate problems of severe male infertility in human patients who either could not be assisted by conventional IVF procedures or could not be accepted for IVF because too few motile and morphologically normal sperm were present in the ejaculate of the male partner.
In a clinical point of view, practitioners need to have some objective measurements to determine the probability for a healthy pregnancy in both aspects of embryo and endometrium, in a given human cycle. Assisted reproductive technology (ART) cycles allow us to understand human biology in detail and to develop some objective clinical parameters to measure and in turn to determine successful implantation. Currently, although the classical embryo grading system seems to be a subjective measurement to determine for choosing the best embryo, best embryo selection has being improved by ’embryo-metabolomics’ that the initial results are very promising.
As endometrial biopsy is invasive and hormonal milieu assessment inaccurate, the need to evaluate endometrial development encouraged the use of high-resolution ultrasonography as an alternative non-invasive method of assessment for uterine receptivity. Endometrial biopsy for determination of various kinds of gene products is not a feasible and reasonable method. However, in the clinical point of view, the assessment of endometrial thickness using gray-scale ultrasound seems to be an easy and reliable method.
Indeed, an adequate thickness of endometrium is indispensable for a successful pregnancy in ART cycles. However, criteria for adequacy of endometrium for a successful pregnancy are still controversial.
The aim of our study was to evaluate the Endometrial thickness and pattern as predictors of the ICSI success rate after Embyo Transfer. The current study is a prospective cohort study, which included infertile women attending the Assisted Reproductive Unit, Ain Shams University. The study was conducted during a period of six months, starting from January 1st, 2015 till June 31st, 2015, and included 180 infertile women. In particular, we aimed to assess the correlation between endometrial thickness and pattern (individually and together) and IVF outcome.
Pattern A (with endometrial thickness between 7 – 14 mm) showed a statistically significant difference (p < 0.001) in relation to the incidence of both biochemical and clinical pregnancy.
The only parameters that showed a statistically significant difference in relation to both positive biochemical and clinical pregnancy test is the endometrial pattern A.
A pattern A endometrium had a fair predictive value for either biochemical or clinical pregnancy as evidenced by an area under the ROC curve (AUC) of 0.621 (p-value, <0.0001) or 0.622 (p-value, <0.0001) for biochemical or clinical pregnancy, respectively.