الفهرس 
The Art Of IvfOnly 14 pages are availabe for public view
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Abstract
E
mbryo implantation represents a critical step of the reproductive process and consists of a unique biological phenomenon. The blastocyst comes into intimate contact with the endometrium and forms the placenta that will provide an interface between the growing fetus and the maternal circulation (Guzeloglu-Kayisli et al., 2009). Successful implantation requires a receptive endometrium, a functional embryo and a synchronized dialog between maternal and embryonic tissues (Simon et al., 2000).
The human endometrium undergoes a complex series of organized proliferative and secretory changes in each menstrual cycle, and exhibits only a short period of receptivity, known as the ’window of implantation’ (Strowitzki et al., 2006).
Each month, the human endometrium undergoes a series of distinct cyclical changes in preparation to receive the developing blastocyst. Such changes necessitate well-controlled, dynamic remodelling of the endometrial microvasculature through the processes of angiogenesis and arteriogenesis (Smith, 2000; Rogers and Abberton, 2003).
The standard method of endometrial dating is the histological evaluation of an endometrial biopsy. Obviously, such an invasive method is not acceptable in order not to damage the endometrium. Therefore, endometrial receptivity should be ideally assessed before embryo transfer using a non-invasive method (Alcázar, 2006).
Transvaginal ultrasonography may represent theoretically such an ideal non-invasive technique. Several sonographic parameters have been used to assess uterine receptivity, including endometrial thickness, endometrial pattern and endometrial subendometrial and uterine blood flow. However, many studies performed in the last 15 years clearly show that all of these sonographic parameters have a low predictive value for determining endometrial or uterine receptivity (Chien et al., 2004).
Therefore, the method to predict endometrial receptivity has yet to be established. However with the advent of three-dimensional ultrasound it became possible to perform a reliable and reproducible sonographic endometrial volume calculations as well as an assessment of endometrial and subendometrial vascularization. Therefore, some researchers have evaluated the role of endometrial volume as well as subendometrial and endometrial vascularization for predicting uterine receptivity (Alcázar, 2006).
The current study was conducted in the Assisted Reproductive Technology Unit of Ain Shams University Maternity Hospital during the period from September 2012 to July 2011. It was conducted on 120 patients undergoing intracytoplasmic sperm injection (ICSI). Those patients were not older than 40 years old, with normal uterine cavity and with no previous uterine scars. The ovarian stimulation protocol, used in this study for all patients, was the long protocol, before ovarian stimulation therapy, patients instructed to use oral contraceptive pills from day 2 starting the preceding cycle, then a standard regimen of GnRH triptorelin (Decapeptyl,0.1 mg, Fering, Kiel, Germany) was administrated subcutaneously in a daily dose 0.1 mg beginning in the midluteal phase of the preceding cycle, this dose was continued till the day of hCG administration. This drug was used to prevent the pituitary gland from interfering with the function of the ovaries during ovarian stimulation. This is called ”pituitary down regulation”. Subsequently, controlled hyperstimulation with human menopausal gonadotrophin (HMG, 75 IU FSH and 75 LH; Menogon, Ferring, Kiel, Germany) was given by intramuscular injection starting in the second day of the stimulated cycle and continued till more than three follicles attain the diameter of 18-22mm. The dose was adjusted according to the age, built, or previous history of induction. The dose was increased or decreased depending on the response to the drug detected by folliculometry.
On the day of hCG administration, 2D transvaginal ultrasound measurements were performed by the same observer after the patients had emptied their bladders. Measurements included: endometrial volume and 3 D Power Doppler parameters, endometrial vascularization index (VI), flow index (FI), vascularization flow index (VFI). Overall pregnancy rate was 43-3%.
The results show that E2 was significantly higher in cases with non pregnant group than those with pregnant. No significant difference between non pregnant and pregnant cases as regards LH and Prolactine was significantly higher in non pregnant cases.
The present study show that the endometrial thickness > 10mm and endometrial volume > 6.9 in prediction of Endometrial Receptivity in 1CSI Patients had good sensitivity and good specificity in a group application, in an individual application it had good Predictive negative value, and good predictive positive value. So it could be used as a good test to exclude success.
The results show that endometial volume, flow Index, vascularization index and vascularization flow index were significantly lower in the non pregnant group than those of pregnant group.
The area under curve in the receiver operating characteristic (ROC) for Three-dimensional ultrasound and power Doppler angiography parameters was statistically significant. Their values, FI (≤ 22.**) with accuracy (0.725). VI (≤ 0.72) with accuracy (0.567) with accuracy (0.532), and there was suggestive conclusion in prediction of endometrial receptivity in ICSI patients.