الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Ovulation is a complex process involving many organs. The three major organs that regulate the female ovulation are the hypothalamus, the pituitary and the ovary. The hypothalamus is a pulsatile generator of reproduction produces and secrets GnRH which by reaching the pituitary evokes the release of FSH and LH. In response to gonadotropin stimulation the ovaries initiate a dynamic process of steroidogenesis which results in the formation of mature ovum ready to be fertilized. Any defect in this group of complex processes results in failure of ovulation.
Infertility affects up to one in seven couples nowadays, a proportion of these couples may be able to ultimately conceive but for the majority conception in unlikely without some form of medical intervention.
Currently, most ICSI cycles are carried out under ovarian stimulation with the goal of achieving multiple folliculogenesis to increase the fertilization rate, more embryos for transfer and cryopreservation and increase the pregnancy rate.
The availability of GnRH agonist changed the management of IVF patients as it induces a mild reversible hypophysectomy and prevents the premature LH surge results in less cycle cancellation.
HMG has been in use for over 30 years in women with WHO group I or II ovulatory disorders. This medication currently represents a widespread, safe and effective treatment choice for ovarian stimulation in ART.
Recently, GnRH antagonists have been made available for clinical use with many advantages for patients with regard to convenience and flexibility of administration. The duration and dose of treatment is shorter Also provide some economic advantages in term of reduced gonadotropin dose which generally improves follicular response and lower cycle cancellation rates.
from this point of view we do this study in order to clarify that the short duration of induction is better as it has some advantage as the short duration of antagonist also with high pregnancy rate and good quality of oocyte retrieved and embryos obtained.
Several studies focused on the role of oocyte quality in predicting treatment outcome as that done by Moraloglu O et al., (2008), Ebner T et al., (2009), Griesinger G et al., (2005). Granularity in the perivitelline space seems to be a physiological phenomenon in oocytes and it could be enhanced by exposure to high dosages of gonadotrophins.
we have also found significantly less oocytes with cytoplasmic abnormalities after administrating GnRH antagonist with shorter duration.
They also found that while the number of oocytes obtained with conventional IVF was higher than with mild IVF, the proportion of embryos with normal morphology was higher after mild stimulation and the proportion of chromosomally abnormal embryos and mosaic embryos per patient was significantly lower following mild stimulation. There is the need to transfer less but more viable embryos to reduce the occurrence of multiple pregnancies.
we can conclude that patients need less HMG ampoules and the length of stimulation is shorter and We also aspirate significantly more follicles and we retrieved significantly more oocytes also decrease the psychological distress of the patient and patient safety with a significant difference in total cost making it more suitable for patients with limited financial resources.
The study was carried out in an Assisted Reproduction Unit (Adam international hospital), from the period of June 2011 to December 2011. It included (80) patients from those attending the unit with the diagnosis of infertility who were assigned for treatment with intracytoplasmic sperm injection (ICSI).
Patients recruited in the study fulfilled the criteria of inclusion set in the unit. Those who were over 35 years old or those with uterine anomalies were also excluded.
A written informed consent was taken for each participant in the study.
Initially a complete history and physical examination were carried out for every participant, including body mass index (BMI) determination.
Routine investigations were performed for all participants, according to the protocols applied in the unite. Down regulation and induction of ovulation were initiated for every patient using the long protocol of induction.
All women started ovarian hyper stimulation with Human Menopausal Gonadotropins (HMG) ampoules and the duration of HMG induction and the number of ampoules given to each patient was calculated.
Serial ultrasound folliculometry was started on cycle day 7 with follow up of follicular count, size and endometrial thickness.
Human chorionic gonadotropins (hCG) was administered in a dose of 10,000 unit deep intramuscularly, when ≥ 4 follicles achieved a diameter of 18mm or more, to induce final maturation of oocyte.
Oocytes were aspirated 34-36 hours after hCG administration, using an ultrasound guided transvaginal aspiration..
Results were presented as means ± SD, statistical analysis was performed with the use of paired or unpaired student t-test as appropriate differences were considered statistically significant(P<0.05).
The current study showed that there was no statistically significant difference between both groups (pregnant and non pregnant) as regards age, BMI, duration and cause of infertility and hormonal profile which constituted of serum FSH, LH, prolactine hormone (P value >0.05).
There was statistically significant difference between both group as regards the dose of gonadotropins used (number of ampoules of HMG) which in turn decrease the cost and duration of treatment also decrease the risk of hyper stimulation syndrome.
The present study showed that there was statistically significant difference (P>0.05) in the pregnancy rate between the short and the long duration as with increased duration of induction the rate of pregnancy is decreased.
The current study showed that there was no statistically significant difference (P>0.05) between both groups as regards total number of oocytes retrieved.
In the present study, there was a significant increase in the total number of fertilized oocytes between both group.
Also there was a significant increase in the number of good embryo (D3 classification) observed in patients with short duration of stimulation.