الفهرس 
Introduction.Only 14 pages are availabe for public view
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Abstract
Infertility is the third most serious disease worldwide
estimated by the WHO (Santos, 2014). Despite the
worldwide use of ICSI, it still has a low birth rate (∼30%).
In order to maximize its success, exogenous gonadotropins
are used for ovarian stimulation to generate multiple
follicles. However these gonadotropins have been shown to
have deleterious effects on oocyte and embryo quality.
Exposure of the oocyte to supra-physiological
concentrations of gonadotropins has been demonstrated to
disturb oocyte maturation and the completion of meiosis
leading to chromosomal aneuploid oocytes (Santos, 2013).
Moreover, in practice, increasing the oocytes number
retrieved is correlated with lower oocyte quality since not
all oocytes result in healthy embryos (Lamb et al., 2010).
This is due to poor oocyte developmental competence,
which is now referred as “oocyte quality”, which has no
real parameter till now. It is now widely accepted that
oocyte quality affects embryo quality, through the fact that
most of embryo cytoplasm is derived from the oocyte and
this contributes to early embryogenesis and embryonic
genome activation (Gilbert et al., 2015).
Summary & Conclusion
124
Follicular fluid (FF) provides a very important
microenvironment for the development of oocyte and
contains various factors that mediate the growth of follicles
and oocytes (Ducolomb et al., 2013). In addition, E2
enhances the cytoplasmic maturation of oocytes via direct
non-genomic action at the plasma membrane level, in turn
inducing extracellular calcium influx into the cell and a
specific pattern of Ca2+ oscillations (Anifandis et al.,
2005).
Elevated E2 in FF indicate a more advanced stage of
oocyte maturation and have been repeatedly found to be
associated with a higher chance of achieving pregnancy.
The role of estradiol in in vitro fertilization (IVF) is well
known up to the fertilization stage (Devroey et al., 2004).
The current study was prospective study that included
180 women underwent Intra-cytoplasmic sperm
injection (ICSI) procedure. Using Flexible Antagonist
protocol. During oocyte retrieval, follicular fluids of
mature follicles (>17 mm) aspirated.
Follicular fluid concentrations of 17β-estradiol was
determined using the enzyme immunosorbent assay kits
(Immunospec Corporation, Canoga Park, USA).
Summary & Conclusion
125
Upon retrieval, oocytes were analyzed for hallmarks of
maturity and classified as GV, MI, or MII based on
appearance (Muasher et al., 2006).
Fertilization status observed at 24 h and the nutrient
solution renewed, morphology of the dividing embryo
was observed and „embryo grading‟ done (Gardner et
al., 2004).
At least in the two-cell stage embryo transfer were be
done at second to third day after the oocyte collection.
Only patients with freshly transferred embryos included.
Quantitative S.B HCG measured at 14 days post transfer,
followed by a vaginal ultrasound 2 weeks later
demonstrating an embryonic cardiac pulse.
The number of retrieved oocytes ranged from (1 to 33
oocytes) mean number 10±7. Follicular fluid E2
concentration ranged from 246±199 (0 to 700) (ng\ ml).
Serum E2 concentration ranged from 2361±1583 (100 to
7589) pg\ml. The mean of total number oocytes was 10
with 53% of MII of good quality. And (47%) were of bad
quality. All cases had normal fertilization.
Number of transferred Embryos ranged from one to
three embryos (good quality was of 63.9%), (bad quality
Summary & Conclusion
126
was of 36.1) and 103 of cases had embryo transfer on day 5
,77 had transfer on day 3.
Chemical pregnancy was positive in 90 cases (50%)
and the clinical pregnancy positive in 66 cases (36.7%).
In follicular fluid E2 concentration ranged from 220 to
476 ng\ml that they had clinical pregnancy and ranges from
36 to 320 ng\ml had no clinical pregnancy.