الفهرس 
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Abstract
This study was conducted in Women’s Health Hospital, Assiut University; Assiut, Egypt. The study included 244 women who will be allocated for IVF/ICSI cycle. All women were evaluated taking their history, investigations, and ovarian reserve test, as well as vaginal ultrasonographic evaluation. Women were allocated in two groups. group 1 included 122 women with normal uterine cavity as detected by office hysteroscopy and group 2 included 122 women with corrected intracavitary lesion. During recruitment of these patients, 78 women were observed to have subtle intracavity uterine abnormalities as well as subtle endometrial abnormalities and were taken as a separate or third group and also their reproductive performance was compared with women with normal uterine cavity. The present work basically is a registered prospective comparative cohort study (NCT03680690,www.clinicaltrials.gov) aim to compare the reproductive performance of women with corrected uterine cavitary abnormality with women proved to have no uterine cavitary abnormality by office hysteroscopy. The points of comparison including; implantation rate, clinical pregnancy rate, abortion rate and take home baby rate. All women included in the study were with normal ovarian reserve test results and had no other endocrinopathy or endometriosis other confounding factors that may affect the results of patients in the groups. Women in all groups were comparable with their personal, demographic data, type and duration of infertility except for age and AMH, which were statistically significant higher in the group of patients with corrected lesions. This difference is explained to some extent by the time needed for diagnosis of the abnormality in the group with corrected lesion. As well as to the time needed to take the decision after the operation and the postoperative period allowed for the patients to have a chance to conceive or referred to assisted conception. In The present work the mean duration of infertility at the time of IVF/ICSI is relatively long, more than 7 years in all groups. Which to some extent may decrease the take home baby rate. Although there was no statistically significant difference in the basal endometrial thickness in the group with of women corrected uterine lesions and those with control of normal uterine cavity; there was a statistically increased thickness in the endometrium of corrected lesions. The AMH level as a test for ovarian reserve was lower in women with corrected uterine lesions than those with normal uterine cavity (2.31 ng/ml versus 2.66 ng/ml; respectively). This can be explained by the statistically significant increased age of women in both groups (31.45 years versus 29.57 years; respectively). Throughout the induction period there were no statistically significant differences in both groups. What was interesting in this study is that women with corrected uterine abnormalities had the same results of women with normal uterine cavity with regard to implantation rate, clinical pregnancy rate and take home baby rate. When we investigated the subendometrial blood vessels indices which are considered as markers for endometrial receptivity; there were no statistically significant differences in all the studied indices. So we may conclude that using hysteroscopy in correcting this lesion is not harmful to the subendometrial blood vessels and the flow and resistance in them. In our current study we had observed 78 women with subtle endometrial abnormalities. These abnormalities more including; mucosal elevation, T-shaped uterus. Unicornuate uterus, pale endometrium, endometrial defect, insignificant arcuate uterus, hypervascularization, single adhesions band, micropolyi, and combined lesions. There were no statistically significant difference in reproductive performance in this group in comparison to women with normal uterine cavity. The pregnancy rate and take home baby rate were comparable in both groups. This shows that the presence of these subtle uterine abnormalities did not affect the take home baby rate and hence it does not need any treatment. The presence of these subtle abnormalities did not affect the subendometrial blood vessels indices which are markers of endometrial receptivity. The evaluation of patients with abnormal 2/D US by hysteroscopy is essential to diagnose and to correct any abnormality detected. The correction of these abnormalities during evaluation by hysteroscopy is vital to correct these abnormalities which will restore the normality of the uterine cavity. This study supports the importance of the correction of any significant uterine cavitary lesion to have a successful IVF/ICSI cycle with outcomes comparative to patients with normal uterine cavity. Intervention to correct any subtle uterine abnormalities is not needed as this does not add to the success rate of IVF/ICSI cycle. This study also did not support the use of subendometrial blood vessels assessment to predict the success rate of IVF/ICSI cycle. We recommend to design large sized studies for further evaluation of the benefit of correction of each specific uterine cavitary abnormality and its impact of IVF/ICSI take home baby rate. Subtle endometrial lesions has no effect on IVF/ICSI outcomes with head to head results to normal cavity outcomes. Correction of cavitary abnormalities leads to a very comparable results to those obtained from normal cavity. Early diagnosis and treatment of cavitary lesions is of outmost importance to avoid delayed resort to IVF/ICSI in older age with impaired outcomes.