الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The endocrinologists and gynecologists adevised various methods to assess the ovarian reservoir and the expected responsiveness. Antral follicle count (AFC) is one of the non- invasive methods used for the assessment of the sensitivity of antral follicles to FSH.
AFC represents the number of remaining primordial pool which corresponds to the number of oocytes retrieved; however, it does not influence the number of oocytes, embryo quality and the outcome of ICSI. The number of pre-ovulatory follicle count (PFC) obtained at the end of COH is estimated to be the best indicator of the number of retrieved oocytes.
However, antral follicle count also includes the number of small antral follicles available before treatment. It means that follicular output rate (FORT) determines follicular response to exogenous HMG by the ratio of pre-ovulatory follicles to the existing pool of small antral follicles. The index has been investigated as an indicator of existing ovarian reservoir in response to stimulation and oocyte.
from the previous researches through this study; It seems that FORT is a valuable qualitative indicator of ovarian follicles competence and may have a significant correlation with the outcome of the IVF/ICSI treatment technology.FORT is a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. The indicator can be used for prediction of clinical pregnancy rate after ICSI. It also gives information about the number of cleaved embryos and clinical pregnancy rate which needs to be further explored in large scale studieds.
The current study was conducted in the Assisted Reproduction Unit (ART Unit) of Ain Shams University Maternity Hospital and a private IVF centre in the period between February 2017 and July 2018. A total of 400 infertile women undergoing IVF/ICSI were included in the study, with 100 women in each of the four study groups: PCOS group, tubal factor group, endometriosis group and unexplained infertility group.
All patientswere subjected to pre-enrollment assessment, COH and ICSI procedure by the same protocol. Fort calcaulation was done using the ratio of pre-ovulatory follicles at the day of HCG to the existing pool of small antral follicles (AFC).
A statistically significant heterogeneity in the type of infertility (primary/secondary) between the four groups was noted by chi-square testing.
Antral follicular count was statistically significantly higher in the PCOS group compared to the other three groups; whereas no statistically significant differences were found between the latter three groups (as depicted by Tukey’s post hoc testing).
COH regimen differed significantly among the four groups. Pair-wise comparisons of FSH total dose or duration of stimulation using Tukey’s post hoc testing were all statistically significant, except when comparing PCOS and tubal-factor groups where the lower mean total dose of HMG and duration of stimulation in the PCOS women failed to reach statistical significanceNo significant differences in AFC or COH regimen (either HMG total dose or duration of stimulation) between PCOS women who achieved clinical pregnancy and those who didn’t. However, PCOS women who achieved clinical pregnancy had significantly lower preovulatory follicular count, FORT and number of retrieved oocytes; together with higher number of MII oocytes and good-quality embryo rate compared to women who failed to achieve clinical pregnancy.
No significant differences in AFC or COH regimen (either HMG total dose or duration of stimulation) between tubal-factor women who achieved clinical pregnancy and those who didn’t. However, tubal-factor women who achieved clinical pregnancy had significantly higher preovulatory follicular count, FORT and number of retrieved oocytes, number of MII oocytes and good-quality embryo rate compared to women who failed to achieve clinical pregnancy.
No significant differences in AFC, COH regimen (either HMG total dose or duration of stimulation), preovulatory follicular count, FORT, number of retrieved oocytes, number of MII oocytes or good-quality embryo rate between endometriosis women who achieved clinical pregnancy and those who didn’t.
No significant differences in AFC or COH regimen (either HMG total dose or duration of stimulation) between unexplained infertility women who achieved clinical pregnancy and those who didn’t. However, unexplained infertility women who achieved clinical pregnancy had significantly higher preovulatory follicular count, FORT and number of retrieved oocytes, number of MII oocytes and good-quality embryo rate compared to women who failed to achieve clinical pregnancy.
FORT may be a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. The indicator can be used for prediction of clinical pregnancy rate after ICSI. It also gives information about the number of cleaved embryos and clinical pregnancy rate which needs to be further explored.
The FORT predictive value, sensitivity, specificity and cut-off values to define poor ovarian responders and whether FORT can be used to determine when to cancel IVF/ICSI cycles for poor ovarian response are questions to be answered by further large scale research and meta-analysis.
Moreover, additional studies focusing on other follicle sizes will be helpful to fine-tune alternative relevant cutoffs for the calculation of this new parameter. Together, these FORT characteristics bring out its great flexibility and spurs to further develop this new concept. Future evaluation of alternative ways of calculating the FORT, in particular using different numerator sand including patients treated with weaker and possibly more discriminating exogenous FSH signals, will undoubtedly contribute to broaden its clinical applications.