الفهرس 
Anatomical BasicsOnly 14 pages are availabe for public view
 |  | from | 207 |  |  |
| | | from | 207 | | |
Abstract
Most IVF cycles are performed with use of stimulation protocols with GnRH agonist for cycle control followed by controlled ovarian hyperstimulation .these protocols increase the numbers of oocytes and embryos available and achieve the highest pregnancy rates. The pool of primordial follicles in the ovary of ovarian reserve is a major factor in the human fertility potential. The ageing ovary is characterized by reduction of the number of primordial follicles and this loss accelerates in the late 30’s and precedes the menopause by 10 – 12 years.
Woman’s age alone or with a combination of biochemical markers, dynamic tests and ultrasound measurements fail to predict this loss accurately.
Because of the time, high drug costs, and emotional expenditure incurred by patients under going in vitro fertilization, identifying predictive factors for fertilization in IVF therapy is extremely important. The outcome of IVF treatment is highly dependent on ovarian response of hormonal stimulation. There for the concept of diminished ovarian reserve has gained general acceptance in infertility medicine.
In the same context, the ideal market for ovarian reserve is one that can be performed in a basal state with high sensitivity and specificity for identifying patients who will have live pregnancy outcomes. Ongoing efforts to identify such a prognostic test are warranted so patients can be counseled regarding various treatment options.
Over the past two decades, a number of so-called ovarian reserve tests (ORTs) have been designed to determine oocyte predict the outcome of IVF in terms of oocyte yield and occurrence of pregnancy. Many of these tests have become part of routine diagnostic procedure for infertility patients who undergo assisted reproductive techniques. The unifying goals are traditionally to find out how patient will respond to stimulation and what their chances of pregnancy are.
Evaluation of ovarian reserve has become an essential part of the pre-treatment assessment of a woman about to undergo ART.
The appropriateness of many investigations for subfertility will continue to be of debate for some time yet. Of most benefit to the concerned couple would be a process that is diagnostically accurate, expeditious and reliable.
It should be non invasive and provide both patient and clinician with useful prognostic information regarding possible future treatment.
This has been most commonly achieved through recognition of the woman’s age and quantification of her serum FSH level and serum E2 level during the early follicular phase of the menstrual cycle.
The current retrospective analytical study was carried out at the assisted reproductive technology unit of Ain Shams University Maternity Hospital. All the patients who underwent intracytoplasmic sperm injection (ICSI) procedure during the period from January 2006 to January 2010 were included in this study. A total of 264 women out of > 3000 women were included in the study.
The patients who were excluded including all the patients who had not completed their stimulation cycles and/or fulfilled the special sheet designed for the study.
A specially designed sheet for the study was filled for every participant and it was including all the data related to the study namely: patient’s name, patient age, basal serum FSH, basal serum LH, serum prolactin, basal serum E2, total dose of HMG, total days of stimulation by HMG, number of follicle ≥17 mm by (TUS), and number of oocytes retrieved. Then the ratio of basal serum E2/FSH was calculated.
The primary end point was the number of follicles ≥17 mm detected by transvaginal U/S (TUS) on day of HCG administration. While the secondary end point was the number of oocytes retrieved. The results were tabulated and statistically analyzed by suitable statistical methods after completion of the study.
The final results of this study showed that Basal serum Estradiol/FSH Ratio can be used as a significant predictor for ovarian response in patients undergoing Intra Cytoplasmic Sperm Injection (ICSI).