الفهرس 
INFERTILITYOnly 14 pages are availabe for public view
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Abstract
I
nfertility is defined by the World Health Organisation (WHO) as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse and is estimated to affect as many as 48.5 million couples worldwide.
Unexplained infertility (UI) constitutes an important portion of the infertility reasons (up to 30%) and is diagnosed when the causes of male or female infertility remains unknown.
The success of ICSI-ET predominantly depends on embryo quality, endometrial receptivity and embryo endometrial interface. The endometrial characteristics including endometrial pattern, endometrial blood flow, and endometrial thickness (EMT) have been regarded as prognostic factors of IVF–ICSI treatment.
Doppler parameters have been evaluated as markers of receptivity. Doppler ultrasound seems the most popular technique among clinicians because of its reproducibility. Uterine blood flow can be assessed by Doppler ultrasound in the uterine arteries and there is evidence of an association between abnormal uterine artery blood velocities and infertility. Increase in the resistance of uterine, endometrial and subendometrial arteries is detected in patients with UI during peri-implantation period.
The current study is a prospective case control study, which was conducted at the Assisted Reproduction Technology unit of Ain Shams University Maternity Hospital during the period from September 2017 to July 2019.
It included two groups of patients one group is unexplained infertility attending the Assisted Reproduction Unit and the other is control fertile group each group consists of 51 women. The aim of the study was to to compare ovarian, uterine artery and subendometrial vessels resistance by measuring PI and RI of patients diagnosed as UI undergoing ICSI in the day of embryo transfer and control group diagnosed as fertile by having at least one livebirth in peri-implantation period from day 19 to day 21.
There was statistically significant difference between the Unexplained infertility group and control fertile group as regard Uterine and subendometrial artery PI, RI and ovarian artery RI in which resistance indexes were significantly higher in the UI group than control group.
The cut off values of PI, RI between unexplained infertility and fertile group are ≥1.88, ≥0.8 for Uterine artery, and ≥ 0.87, ≥0.53 for subendometrial arteries, and ≥ 0.59 for ovarian artery RI.
Among the unexplained infertility undergoing ICSI patients the pregnancy rate is 23.5%. There was no statistically significant difference between the two groups (pregnant group and non-pregnant group) as regard the age, BMI, duration of infertility or the basal hormonal profile.
There was statistically significant difference between the two groups (pregnant group and non-pregnant group) as regard Uterine artery PI and Ovarian artery PI, RI and subendometrial RI, PI.
There was no statistically significant difference between the two groups (pregnant group and non-pregnant group) as regard Uterine artery RI.
This clinically mean that uterine, ovarian and subendometrial blood flow is impaired in unexplained infertility patients compared to fertile women. Uterine artery PI, ovarian and subendometrial arteries PI, RI differ in pregnancy outcome in unexplained infertility patients. Cut off value ≤ 2.43 for uterine artery PI, ≤1.13, ≤ 0.59 for Ovarian artery PI,RI and ≤ 0.89, ≤ 0.56 for subendometrial arteries PI,RI can be used as valuable tests in predicting pregnancy and UI patients who will undergo IVF treatment having PI and RI values higher than these values, may have the embryo transfer in the cycles following the ovulation stimulation and treatment can be planned to reduce the vascular resistance.
CONCLUSION
Doppler parameters are useful tools to assess endometrial receptivity in unexplained infertility patients undergoing ICSI. This study found that Uterine, Ovarian, subendometrial arteries pulsatility index (PI) and resistance index RI measured on the day of embryo transfer higher than fertile women and have value in judging endometrial receptivity and predict the final outcome of IVF/ ICSI- ET.
Uterine, ovarian and subendometrial blood flow assessed by measuring PI, RI of these arteries was impaired in unexplained infertility patients compared to fertile women. Also, uterine artery PI, ovarian and and subendometrial arteries PI, RI differ in pregnancy outcome in unexplained infertility patients undergoing ICSI.