الفهرس 
INTRACYTOPLASMIC SPERM INJECTIONOnly 14 pages are availabe for public view
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Abstract
I
ntracytoplasmicsperm injection (ICSI) involves micro-manipulation techniques to inject a viable sperm into the ooplasm of the egg, after cumulus and corona cell removal (denudation), oocytes are used for microinjection.
Since the birth of Louise Brown in July 1978, IVF has proven to be an efficient treatment to alleviate female factor infertility, especially tubal infertility. In subsequent years IVF was also successfully applied in couples with unexplained infertility, with male infertility as well as endometriosis. Since the second half of 1992, only ICSI has been applied in centers when assisted fertilization was indicated.
ICSI is indicated in any infertile couple in whom there is a significant chance of failed or very poor fertilization following treatment with conventional IVF. Such couples include those with a previous history of a similar event. A group of patients who will benefit from having ICSI at the outset rather than conventional IVF are those who have a marked depression of their semen parameters. This includes patients with moderate to severe oligo-, astheno-, and/or teratozoospermia.
The aim of this study was to assess the relation between serum E2 level on the day of HCG administration and ICSI outcome.
Two hundred patients attended to the Assisted Reproductive Technology unit for ICSI cycles were recruited.
(COH) was performed by the standardized midluteal long protocol, by GnRH agonist (Triptoreline acetate) until ovarian suppression was observed by serum E2 (≤50 pg/ml) on the 2nd day of menstrual cycle and IM injections of HP-urinary-HMG were given. Follicular monitoring was assessed by transvaginal ultrasound and commenced in the 6th day of ovarian stimulation, and IM injection of HP-HCG was administered when more than three leading follicles reach ≥ 18 mm in diameter.
Serum E2 level on day of HCG administration was assessed and categorized into 5 groups:
• Group A (n=67): in whom serum E2 was < 1,000 pg/ml.
• Group B (n=65): in whom serum E2 was 1,000 - < 2,000 pg/ml.
• Group C (n=37): in whom serum E2 was 2,000 - < 3,000 pg/ml.
• Group D (n=28): in whom serum E2 was 3,000 - < 4,000 pg/ml.
• Group E (n=3): in whom serum E2 was ≥ 4,000 pg/ml.
Then transvaginal ultrasound-guided oocytes retrieval was performed 36 hours after HCG injection under general anesthesia. Oocytes were injected with prepared sperms. Fertilization was checked within 18–24h after ICSI. One to three embryos were transferred on the 2nd or 3rd day after oocytes retrieval. Luteal phase support by micronized progesterone was given starting the next day after HCG till occurrence of biochemical pregnancy on 14th day after embryo transfer and clinical pregnancy within 2-3 weeks after pregnancy test.
In our study there was no statistical significant difference between women according to serum E2 levels on day of hCG administration as regard basal hormonal profile.
In the present study women with {E2 3000-<4000 pg/ml}had statistical significant difference versus women with {E2<1000 pg/ml}as regard AFC, also women with {E2 3000-<4000 pg/ml}had statistical significant difference versus other women with different E2 levels as regard total days of stimulation and total dose of gonadotropins administered, while women with {E2≥4000 pg/ml}had statistical significant difference versus women with {E2<1000 pg/ml}as regard endometrial thickness before triggering.
In our study women with {E23000-<4000 pg/ml} had statistical significant difference versus women with {E2<1000 pg/ml} and women with {E2 2000-<3000 pg/ml} as regard No. of retrieved oocytes and No. of fertilized ova.
The highest fertilization rate (69.7%) was in women with {E2 ≥4000 pg/ml}, while the lowest (53.5%) was in women with {E2 2000-<3000 pg/ml}. Also the highest implantation rate (44.4%) was in women with {E2>4000 pg/ml}, while the lowest (1.9%) was in women with {E2<1000 pg/ml}.
In the current study the median serum E2 level on the day of hCG administration was highly significant in women who got pregnant when compared to women who did not.
The highest pregnancy rate (75.5%) was in women with {E2 2000-<3000 pg/ml}, while the lowest (4.5%) was in women with {E2<1000 pg/ml}.
The Receiver operator characteristics (ROC) curve was constructed for estimating the association between serum E2 at hCG administration on the clinical pregnancy outcome. Serum E2 at hCG administration was a significant predictor of successful clinical pregnancy outcome as denoted by a significantly large area under the curve (AUC) [AUC = 0.848, 95% CI (0.790 to 0.907), p<0.001].
The best cutoff value of serum E2 at hCG administration was ≥ 2179.2 pg/ml. A serum E2 at hCG administration ≥ 2179.2 pg/ml was associated with a successful clinical pregnancy outcome with a sensitivity of 81.3%, specificity of 81.6%, PPV of 67.5%, NPV of 90.2% and an overall accuracy of 81.5%.
The serum E2 2000-3000 pg/ml was significantly associated with 6-fold higher chance of successful clinical pregnancy [RR 6.61, 95% CI (3.32 to 13.38)].