الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
مستخلصAssisted reproductive techniques (ART) include treatments and procedures requiring the in vitro handling of both human oocytes and sperm, or of embryos, with the objective of achieving pregnancy and live birth. The most common forms of ART include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART are widely used for the treatment of infertility but success rates remain relatively low, with fewer than 30% of treatment cycles resulting in a live birth.
Despite the escalating clinical and scientific advances in reproductive medicine, implantation failure is a challenging and extremely disappointing problem faced by the clinicians and the couples alike. Various investigations and treatment options have been studied to improve pregnancy outcomes in this cohort.
Successful implantation depends on good hormonal response, good quality embryos, satisfactory endometrial development and good endometrial receptivity.
Altered endometrial receptivity for implantation is one of the key factors associated with unexplained implantation failures. Mechanical manipulation may improve endometrial receptivity by decidual formation, secretion of cytokines, growth factors and altered gene expression. In the last decade, studies have investigated the outcome of subsequent IVF/ICSI following local endometrial injury induced by endometrial scratch (biopsy) or hysteroscopy in the cycles preceding controlled ovarian stimulation (COH).
Hysteroscopy is considered to be the gold standard; however, the World Health Organization (WHO) recommends hysterosalpingography (HSG) alone for management of infertile women. The explanation for this discrepancy is that HSG provides information on tubal patency or blockage. Office hysteroscopy is only recommended by the WHO when clinical or complementary exams (ultrasound, HSG) suggest intrauterine abnormality or IVF failure. Nevertheless, many specialists feel that hysteroscopy is a more accurate tool because of the high false-positive and false negative rates of intrauterine abnormality with HSG.
The aim of this work is to assess the effect of endometrial scratching by office hysteroscope in clinical pregnancy rate in patients undergoing ICSI cycles.
A total of 405 patients complaining of primary or secondary infertility, 150 patients in each group. group A (n=150 patients) endometrial scratching performed using a grasping forceps of the office hysteroscope on the menstrual cycle preceding ICSI cycle. group B (n=150 patients) office hysteroscope done on the menstrual cycle preceding ICSI cycle. group C (n=150 patients) no office hysteroscopy done.
Detailed history including medical, gynecologic, obstetric, and fertility history. Thorough physical general and gynecological examination. Hormonal profile assessment (AMH, Prolactin, TSH, E2), Trans-vaginal ultrasound. Male semen analysis was done.
The results showed that there was no significant difference in the ongoing pregnancy rates between the groups. There were no significant differences in the implantation, clinical pregnancy, live birth, multiple pregnancy and miscarriage rates.
Assisted reproductive techniques (ART) include treatments and procedures requiring the in vitro handling of both human oocytes and sperm, or of embryos, with the objective of achieving pregnancy and live birth. The most common forms of ART include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART are widely used for the treatment of infertility but success rates remain relatively low, with fewer than 30% of treatment cycles resulting in a live birth.
Despite the escalating clinical and scientific advances in reproductive medicine, implantation failure is a challenging and extremely disappointing problem faced by the clinicians and the couples alike. Various investigations and treatment options have been studied to improve pregnancy outcomes in this cohort.
Successful implantation depends on good hormonal response, good quality embryos, satisfactory endometrial development and good endometrial receptivity.
Altered endometrial receptivity for implantation is one of the key factors associated with unexplained implantation failures. Mechanical manipulation may improve endometrial receptivity by decidual formation, secretion of cytokines, growth factors and altered gene expression. In the last decade, studies have investigated the outcome of subsequent IVF/ICSI following local endometrial injury induced by endometrial scratch (biopsy) or hysteroscopy in the cycles preceding controlled ovarian stimulation (COH).
Hysteroscopy is considered to be the gold standard; however, the World Health Organization (WHO) recommends hysterosalpingography (HSG) alone for management of infertile women. The explanation for this discrepancy is that HSG provides information on tubal patency or blockage. Office hysteroscopy is only recommended by the WHO when clinical or complementary exams (ultrasound, HSG) suggest intrauterine abnormality or IVF failure. Nevertheless, many specialists feel that hysteroscopy is a more accurate tool because of the high false-positive and false negative rates of intrauterine abnormality with HSG.
The aim of this work is to assess the effect of endometrial scratching by office hysteroscope in clinical pregnancy rate in patients undergoing ICSI cycles.
A total of 405 patients complaining of primary or secondary infertility, 150 patients in each group. group A (n=150 patients) endometrial scratching performed using a grasping forceps of the office hysteroscope on the menstrual cycle preceding ICSI cycle. group B (n=150 patients) office hysteroscope done on the menstrual cycle preceding ICSI cycle. group C (n=150 patients) no office hysteroscopy done.
Detailed history including medical, gynecologic, obstetric, and fertility history. Thorough physical general and gynecological examination. Hormonal profile assessment (AMH, Prolactin, TSH, E2), Trans-vaginal ultrasound. Male semen analysis was done.
The results showed that there was no significant difference in the ongoing pregnancy rates between the groups. There were no significant differences in the implantation, clinical pregnancy, live birth, multiple pregnancy and miscarriage rates.