الفهرس 
Assisted reproductive technique (ART)Only 14 pages are availabe for public view
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Abstract
This was a clinical prospective observational study
that was performed in assisted reproduction unit at Ain
Shams University Maternity Hospital. The study included
57 patients to whom ICSI or IVF was performed for
treatment of their infertility.
Patients included in the study were infertile couples
undergoing their first ICSI trial for male and female factor
infertility.
A total of fifty seven (57) patients were included in
the study.
Twenty six (n=26) patients became pregnant and was
labled as group (A) for descriptive purpose and thirty one
(31)patient was not pregnant and labled as group (B) for
descriptive purpose . Pregnancy was confirmed by serum
hCG (positive pregnancy test 18 days after Ovulation
induction.) and vaginal ultrasound scan at 8 weeks’
gestation. We subcategorized the pregnant patients in group
(A) into two groups preclinical abortion (n=3) and clinical
pregnancy (n=23).
All patient included in the study were subjected to
clinical history taking, Complete physical examination for
all patient with special emphasis on Weight, height and
body mass index (BMI). Gynecological examination as
well as Routine laboratory investigation according to the
protocols applied in the unit, this investigations included,
estimation of serum FSH, LH, Prolactin, TSH levels and initial transvaginal ultrasound (TVS) to exclude the
presence of any uterine or ovarian abnormality.
In this study, we aimed to determine whether
estradiol/progesterone (E2/P) ratios at the day of embryo
transfer (ET) have an effect on implantation and pregnancy
rate in in vitro fertilization (IVF) cycles and
intracytoplasmic sperm injection (ICSI).
In this study age was significantly higher in non
pregnant group (B) (31.1+ 6.0) who were older compared to
pregnant group (A) (26.6+5.5) who were younger.
There was significantly higher BMI in non pregnant
group (B) (29.2+ 3.6) compared to pregnant group (A)
(26.4+4.3). Also BMI was significantly higher in
subcategorized preclinical abortion group compared to
pregnant group.
There was significantly higher number of embryos
transfered in pregnant group (3.0+0.6) compared to non
pregnant group (2.5+1.1).
As regard estradiol our study showed that, high
estradiol (E2) in pregnant group (909.9+593.2) than non
pregnant group (880.6+ 700.8) but it did not reach
statistical significance or affect the pregnancy outcome or
implantation rate.Although high estradiol (E2) level had a negative
effecting on implantation rate as shown in subcategorized
preclinical abortion and non pregnant group compared with
clinical pregnant group but it did not also reach statistical
significance
There was a significant positive correlation between
high serum E2 levels and increased number of mature
follicles and mature oocytes retrieved.
There was high progesterone (P) level in pregnant
group (337.4+396.1) than non pregnant group (199.3+
203.7) but it did not reach statistical significance.
There was significantly higher E2/P ratio on day of
embryo transfer in non pregnant group (5.7+ 4.1) compared
to pregnant group (3.8+2.5).
Serum E2/P ratios were evaluated for clinical
pregnancies, non-conception cycles by using the receiveroperator
curve analysis (ROC) curve (area under the curve
= 0.63; 95% CI = 0.49–0.75; p = 0.071) on (day 3 after
ovulation induction) to distinguish the significance between
them. At the critical point (4.3) which was the best point to
evaluate the sensitivity and specificity of E2/P ratio on day
of embryo transfer to predict the pregnancy outcome The
sensitivity of E2/P ratio on day of embryo transfer to
predict the pregnancy outcome at this point was 76.9%, and
specificity of E2/P ratio on day of embryo transfer to
predict the pregnancy outcome at this point was 54.8% E2/P ratios were significant difference between
subcategorized clinical pregnancy, preclinical abortion and
non pregnant group. Women with preclinical abortion had
significant higher mean E2/P ratios on day of embryo
transfer compared with those who had either a clinical
pregnancy or failed to conceive.
So We conclude the following
We conclude that high increased P values in the early
luteal phase and low increased E2 values was associated
with low E2/P ratios and better pregnancy outcomes,
whereas a decrease in P values in combination with a
increase in E2values (reflected by a high E2/P ratio) append
to indicate poor reproductive outcome.
Also We conclude that At the critical point (4.3)
which was the best point reported by ROC curve to
evaluate the sensitivity and specificity of E2/P ratio on day
of embryo transfer to predict the pregnancy outcome we
found The sensitivity of E2/P ratio on day of embryo
transfer to predict the pregnancy outcome at this point was
76.9%, and specificity of E2/P ratio on day of embryo
transfer to predict the pregnancy outcome at this point was
54.8%.