الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Infertility is a condition in which successful pregnancy has not occurred, despite normal intercourse over 12 months. Approximately, 9 to 18% of normal couples are infertile.
Unexplained infertility refers to the absence of a definable cause for a couple’s failure to achieve pregnancy.
The relation between thrombophilia and infertility has drawn the attention of researchers in last few years. Most studies investigating the effect of inherited thrombophilia on infertility studied the relationship between thrombophilia and implantation failure. It was found to be a possible cause of impaired implantation in some subgroups of infertile women.
Thrombophilia is a hereditary or acquired tendency to a hypercoagulable state that increases the risk of venous thromboembolism and primarily deep venous thrombosis because of genetic and environmental risk factors, including a protein S-α mutation in protein S and immobilization, respectively.
This study was aimed to assess the activity of protein S activity in women with unexplained infertility.
This study was a case control study on 60 women were subdivided into two main groups as following:
group 1: Included 30 women with unexplained primary infertility; recruited from the outpatient infertility clinic.
group 2: Another 30 fertile women who got pregnant and delivered at least once in the previous year with no history of recurrent abortions; was recruited from outpatient gynecology clinic as control.
Unexplained infertility was diagnosed by the following:
Absence of male factor: WHO criteria (2010).
Adequate ovulation based on a mid-luteal serum progesterone level greater than 10ng/mL, or serial transvaginal ultrasounds to monitor the development and rupture of a dominant ovarian follicle, AMH and AFC.
Normal FSH, LH, TSH, Prolactin and AMH.
Apparently normal uterine cavity and patent tubes as proved by hysterosalpingography and laparoscopic findings.
The exclusion criteria that not included in this study during selection of cases was:
1. Patients aged less than 18 years or more than 35 years old.
2. Secondary infertility
3. Presence of male factor infertility
4. Anovulatory cycles.
5. Tubal block; Tubal disease is an important cause of infertility and should be specifically excluded.
6. Medical disorder that might affect pregnancy (e.g.: Diabetes, Thyroid dysfunction).
7. Patients with recurrent abortion.
A full history and clinical examination were carried out for each patient with a consent taken from every patient to participate in the study.
Sample Collection: A venous blood sample (3 ml) was collected from every participant at any day of the menstrual cycle.
The samples were collected in (3.2%) sodium citrate labelled tubes, (venous blood must be mixed with the sodium citrate immediately after collection by turning upside down gently the tube 3 or 4 times).
Centrifugation: Performed as fast as possible less than an hour to obtain platelet poor plasma and centrifuged at 2500g for 15 min (Platelet poor plasma).
Protein S activity assay:Using STA-staclot Protein S kit supplied by Stago, France.
This study has shown that the percentage of decreased protein S activity in both studied groups were (0%) and (3.33 %) respectively.
The current study has shown that there was statistically significant difference between the two groups (P value: 0.039) as regard to the percentage of protein S activity, as mean values of protein S in two groups were (98.11±23.86) and (104.22±20.96) respectively.
The present study has shown that the number of patients of cases who had decreased protein S activity was (0) zero and its percentage was (0%), while the number and percentage of controls who had decreased protein S activity was 1 (3.33%) and this difference was of statistically not significant (P value: 0. 157).
In conclusion, there was also no statistically significant difference between the two groups regarding protein S activity or incidence of protein S deficiency and The mean of protein S activity percentage (%) in cases is lower than in controls.