الفهرس 
* Introductory Remarks on ICSIOnly 14 pages are availabe for public view
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Abstract
Since the birth of Louise Brown, the first test tube baby, in 1978, in vitro fertilization (IVF) has become a well established treatment procedure for certain types of infertility including long standing infertility due to tubal disease, endometriosis, unexplained infertility, or infertility involving a male factor. Since 1992 the first human pregnancies and births after replacement of embryos generated by intracytoplasmic sperm injection (ICSI) procedure for assisted fertilization. Since then, the number of worldwide centers offering ICSI has increased tremendously, as has the number of treatment cycles per year. Conventional assisted reproduction treatment (ART) involves the induction of a multifollicular response to gonadotropins in an attempt to maximize the number of oocytes retrieved and therefore the number of embryos available for transfer allowing a degree of selection. Follicular maturation and timing of oocyte retrieval must be appropriate to maximize the mature oocyte yield and thereby increase the likelihood of achieving and sustaining a pregnancy. Some indices that have been evaluated as potential indicators for timing of hCG administration include two dimensional (2D) ultrasound measurements of lead follicles, endometrial thickness, estradiol (E2) level, and cervical mucus production. But the recent use of three dimensional (3D) ultrasonography and quantitative 3D power Doppler angiography (3D-PDA) as a diagnostic modality has an important role in improving the predictive accuracy of ultrasound assessment of IVF\ICSI outcome. Aim of the work:- The aim of this work was to evaluate the efficacy of 3D transvaginal ultrasound and power Doppler angiography in prediction of outcome of ICSI. Patients and methods:- After approval was first received by the faculty research ethics board, fifty consenting patients underwent controlled ovarian stimulation before ICSI were selected from those attending outpatient clinic in Menoufia University Hospital care and a private centre. Patients with normal basal fsh level and no previous history of OHSS, no previous history of ovarian surgery included in the study. Al l patients subjected to :- • Complete history taking • Complete physical examination. • Laboratory investigations: CASA, hormonal profile and preparatory investigations. • Downregulation strated moidluteal with decapeptyl 0.1 mg syrige sc daily then on third day of next cycle 3D ultrasound was done for counting antral follicles, measuring ovarian volume , stromal area and power Doppler was used to measure ovarian stromal flow index, vascularization index and vascularization flow index. • Induction of ovulation started with 150-300 IU FSH till reaching mature follicles then on day of HCG administration evaluation of endometrial thickness and vascular grading was done followed by administration of 10,000IU OF HCG • Ultrasound guided oocytes retrival was done. • ICSI procedures were done followed by embryo transfer on third day and luteal support was given. Results:- This study was conducted on fifty infertile women underwent controlled ovarian stimulation among couples scheduled to undergo intracytoplasmic sperm injection (ICSI) for any indication. Patients were examined by 3D ultrasound and power doppler angiography to detect antral follicle count, ovarian stromal area, ovarian stromal flow index, stromal vascularization index, ovarian vascularization flow index and endometrial vascular grading. Demographics and cycle characteristics of the women included in the study showed in patients of average age (28.6 3.6 years), BMI (26.8 2.4 kg/m2) and AFC (12.34 1.11), the yield of mature oocyte (9.65 1.66) at retrieval was clinically satisfactory and helped in achieving accepted clinical pregnancy rate 23 patients (35%) in the study population. This could also be due to indication of ICSI. Thirty six percent of study group were due to male factor, (12%) due to unexplained infertility, (38%) due to tubal disease, and (14%) due to mixed causes, with no cases of ovulatory dysfunction although it was not an exclusion criteria. Our study determined predictive values of total antral follicle number, total ovarian volume, total ovarian stromal area, ovarian stromal FI, ovarian stromal vascularization index and ovarian stromal vascularization flow index in relation to the number of oocytes and pregnancy rates obtained in 50 consecutive women undergoing ICSI treatment. All of the patients had normal basal serum FSH concentrations and received the same standard protocol for pituitary down-regulation and gonadotropin induction for the first time. The results of our study suggest that there is an association between total antral follicle number, mean ovarian stromal FI, total ovarian stromal area and total ovarian volume after pituitary suppression, and the number of mature oocytes retrieved and pregnancy rates. We found that in patients with normal basal serum FSH concentrations, total antral follicle number was the most important predictor of ovarian response in ICSI outcome followed by ovarian stromal FI. Our data also demonstrated that isolated evaluation of endometrial vascularization with power doppler is not an important factor for the prediction of pregnancy in an ICSI program.