الفهرس 
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Abstract
Summary
This study was conducted to evaluate the relationship between the morphology of corpus luteum and endometrial echo-pattern and thickness in midluteal phase and pregnancy rate among women with regular menstrual cycles either Spontaneous or undergoing induction of ovulation.
This study had included 100 women 20-30 years old with regular menstrual cycles, who attended to outpatient clinic of Benha university hospital . the women were divided to two groups :
Group (1) : 50 fertile women who asked for pregnancy after cessation of contraceptive methods .
Group (2) : 50 women ( with primary or secondary infertility) who asked for pregnancy , with no apparent cause of infertility .
The selected women in group (1): had been followed up only by transvaginal sonography for spontaneous pregnancy. The selected infertile women in group (2): had controlled ovarian stimulation by oral clomiphene citrate (clomid)(*) 100 mg / day for 5 days starting on the third day of the menstrual flow and intramuscular human chorionic gonadotrophin (IM HCG) (Pregnyl)(**) 10.000 IU was administrated when the mean follicular diameter (MFD) is 18 mm to 20 mm for 6 successive cycles unless pregnancy occurred and followed up as group (1).
Midluteal phase sonography was performed 7 days after peak of follicular maturity. Assessment at that time included measurements of the endometrial thickness, grading of its echo pattern and assessment of corpus luteum morphology .
Pregnancy was diagnosed based on β Subunit of HCG on 21st day of menstrual cycle.
Statistical analysis had been performed for variables predicting pregnancy rate including endometrial thickness and echo pattern and corpus luteum morphology ( shape and size) .
In mid luteal phase, 450 cycles were investigated by TVS for assessment of endometrial thickness and echogenicity, and corpus luteum morphology ( shape and size).
The pregnancy rate was higher in those women who exhibited homogenous hyperechogenic pattern (15.06%, 36/239), compared to those women whose endometrium was found to be non homogenous (8.53%, 18/211).
The pregnancy rate was higher in those women who exhibited endometrial thickness more than 9mm (18.2%, 36/198), compared to those women whose endometrium was found to be from 6 to 9mm (10.5%, 18/171), and no pregnancy was recorded with endometrial thickness less than 6mm.
As predictors for pregnancy, homogenous hyperechogenic endometrial pattern shows low sensitivity (66.66%) and low specificity (48.73%). the endometrial thickness when > 9mm as a predictor of pregnancy shows low sensitivity (66.66%) and low specificity (59.09%).
This study revealed that the pattern of corpus luteum was cystic with thick wall in 162 cycles (36%), hypoechoic in 182 cycles (40.44%), cystic with thin wall in 32 cycles (7.11%) and not seen in 81 cycles (16.44%). The pregnancy rate was higher in those women who exhibited thick walled cystic corpus luteum (18.5%, 30/162), compared to those women whose corpus luteum was hypoechoic (6.6%, 12/182), thin walled cystic was (12.5%, 4/32) and it was (10.8%, 8/74) when not seen.
As predictors for pregnancy, thick walled cystic corpus luteum show sensitivity (55.55%) and specificity (66.66%) in diagnosis of pregnancy, hypoechoic corpus luteum show sensitivity (22.22%) and specificity (57.07%), thin walled cystic corpus luteum show sensitivity (7.40%) and specificity (92.90%) and the sensitivity was (14.81%) and specificity was (83.33%) when not seen.
The incidence of corpus luteum, when its size was 18-20mm was (43.35%,163/376) and pregnancy rate was (11.6%, 19/163), when 21- 23mm the incidence was (37.23%, 140/376) and pregnancy rate was (13.57%, 19/140), when corpus luteum size was < 18mm, the incidence was (13.56%, 51/376) pregnancy rate was (13.72%, 7/51) and when corpus luteum size was ≥24mm, the incidence was (5.85%, 22/376) pregnancy rate was (4.54%, 1/22).
As predictors for pregnancy, the corpus luteum show sensitivity (82.60%) and specificity (19.69%) in diagnosis of pregnancy when its size was 18-23mm.
from this study, we can concluded that the pregnancy rate was higher (4%) when the corpus luteum was thick walled cystic and associated with endometrial thickness more than 9mm (19% of cycles). Also, there is a higher incidence of homogenous endometrium among fertile and infertile women, with higher pregnancy rates than nonhomogenous endometrium. There is a higher incidence of corpus luteum when its diameter was 18-23mm among fertile and infertile women and associated with higher pregnancy rates.
Conclusions
from this thesis we can conclude that
• Higher pregnancy rates was detected among women with homogenous hyperechogenic pattern of the endometrium and endometrial thickness > 9mm and corpus luteum morphology was cystic thick walled and its size was < 18 mm.
• Increased pregnancy rates among women with cystic thick walled corpus luteum when associated with endometrial thickness > 9mm, and inspite of being statistically not significant in comparison to other morphological patterns and when endometrial thickness <9mm.
• Further studies are recommended in the future on larger number of patients to evaluate and predict these relationships as predictors for pregnancy.