Evidence Based Women’s Health SocietyEvidence Based Women's Health Journal2090-72657220170501Relation of progesterone and luteinizing hormone serum levels and Ultrasound endometrium criteria with intracytoplasmatic sperm injection outcome55662453310.21608/ebwhj.2017.4533ENJournal Article20170925Background: Hormone levels (progesterone "P" and luteinizing hormone "LH) are vitally important to the proper functioning of the female reproductive cycle and together with Ultrasound assessment of endometrial receptivity may predict success of in vitro fertilization/ intracytoplasmatic sperm injection (IVF/ICSI).<br />Objective: to study the effects of serum P and LH levels together with Ultrasound assessment of endometrial receptivity at the day of human chorionic gonadotrophin administration on fertilization and pregnancy rates.<br />Patients and Methods: Thirty patients age ranged 22-38 years underwent ovarian stimulation using a gonadotrophin-releasing hormone (GnRH) agonist for pituitary down-regulation, and then ovarian hyperstimulation was initiated with highly purified human menopausal gonadotrophin (HMG). Final oocyte maturation was triggered 36 hours after human chorionic gonadotrophin (hCG) injection. On the day of hCG administration (Day 0), serum progesterone, LH levels together with Ultrasound assessment of endometrial receptivity (thickness, morphology and the spiral artery resistance index "RI") were evaluated. Fertilization and pregnancy rates were recorded.<br />Results: There was no significant difference between the pregnant and non pregnant women, in respect to age. The pregnancy rate was not affected by the serum LH level but was only 18.75% in cycles in which serum P was more than 1.2 ng/ml on day 0, which was significantly lower than that in cycles in which serum P was less than 1.2 ng/ml on day 0 (64.28%) (P = 0.001). The fertilization rate was lower in the cycles with higher levels of serum P and/or LH than in cycles in which serum P was less than 1.2 ng/ml and serum LH was normal (51.66 vs. 68.85%). Failed cases had altered endometrium and a higher spiral artery RI (resistance index), meaning lower peri-implantation blood flow.<br />Conclusion: This study concluded that the progesterone levels on the day of hCG administration (Day 0) can affect the success of in vitro fertilization, as higher progesterone levels were associated with lower rates of pregnancy and fertilization. Increase serum P level caused advanced endometrial maturation and impaired endometrial receptivity to embryo implantation. The embryo transfer (ET) in such cases can be canceled and freezing all embryos for future transfer must be considered, to increase acceptance of the endometrium and thus increase the success rateEvidence Based Women’s Health SocietyEvidence Based Women's Health Journal2090-72657220170501Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles6368453410.21608/ebwhj.2017.4534ENJournal Article20161124Objectives: To investigate the ability of Anti-Müllerian hormone (AMH) and estradiol (E2) to predict OHSS in women using the GnRH antagonist protocol while undergoing invitro-fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI).<br />Study design: Retrospective analysis of women who had performed IVF/ICSI at assisted conception unit of Kasr Alainy university hospital over a period of 3 years.<br />Patients and Methods: Basal serum AMH, estradiol (E2) level on the day of ovulation trigger and OHSS, among various other parameters were recorded and analyzed.<br />Results: Thirty cases of OHSS (8.54%) were identified. There was no statistical difference in incidence of OHSS among age (p=0.976), FSH (p=0.286), LH (p=0.932), TSH (p=0.277), and prolactin (p=0.283), however, AMH (p=0.04), BMI (p=0.012), AFC (p< 0.001), and E2 before trigger (p<0.001) were significant. The overall clinical pregnancy rate was 27.35 % (n=96). The receiver operator analysis curve had a cut-off value of 4.45ng/ml (80%, sensitivity & 56% specificity). The area under the curve (AUC) was 0.661 with 95% confidence interval (CI) (0.548-0.775) (p=0.003). While for E2 the cut-off value was 4459 pg/ml with 76.7% sensitivity and 55.7% specificity), AUC 0.673 95% (CI) (0.554-0.791) (p=0.002). Combining both AMH ≥ 4.45ng/ml and E2 ≥4459 pg/ml had odds ratio 4.302 (95% CI) (1.795-10.304), relative risk (RR) 0.891 with 95%CI (0.832-0.954) (p<0.001).<br />Conclusion: AMH and serum E2 before trigger are not highly accurate tests alone for the prediction of OHSS. When basal serum AMH was ≥4.45ng/ml and E2 ≥ 4459 pg/ml, the patient was at 4 fold increased risk of developing OHSSEvidence Based Women’s Health SocietyEvidence Based Women's Health Journal2090-72657220170501Comparartive Study on Fetal Renal Artery Doppler Waveforms Between Right and Left Sides, At Proximal And Distal Sites Study6975453610.21608/ebwhj.2017.4536ENJournal Article20161121Objective: To investigate any variability in fetal renal arteries Doppler indices between right and left sides, proximal and distal site.<br />Study design Prospective observational study conducted on 150 pregnant women . Renal artery velocity waveforms were measured in both the right and left sides proximally and distally.<br />Results: The mean PSV was significantly higher at right proximal site (69.141± 7.6352 vs. 64.064± 5.0714) and at left distal site (62.261 ±4.9222 vs. 59.841 ±4.7978) , the mean EDV was significantly higher at right proximal (5.730± 1.2253 vs. 5.257 ±1.1096 )and distal sites(5.27 ±1.265 vs. 4.089 ±0.8099), The mean PI was significantly higher at right proximal site (2.3840.2863± vs. 2.170 ±0.1953)but, distal to the aorta, it was higher on the left side (2.455± 0.2079 vs. 2.075± 0.1928) (P value <0.001).<br />There is no correlation between the right and left sides. The mean PSV is significantly higher on the right side (64.4914.4203± vs. 63.1633.7369±), the mean EDV is significantly higher on the right side(5.500± 0.8399 vs. 4.673± 0.7150), the mean RI is higher on the left side (0.926± 0.0122 vs. 0.914 ±0.0154), while the mean PI is also significantly higher on the left side (2.419± 0.1764 vs. 2.122± 0.1324).<br />Conclusion: Renal artery Doppler measurement at a given site cannot be used to predict its oppositeEvidence Based Women’s Health SocietyEvidence Based Women's Health Journal2090-72657220170501Do Patients With Blocked Tubes Experience More Pain During Outpatient Hysteroscopy Than Those With Patent Tubes?! A Prospective Comparative Study7684453710.21608/ebwhj.2017.4537ENJournal Article20161111Objective: To study the impact of tubal blockage on pain experienced during and immediately after diagnostic outpatient hysteroscopy.<br />Study design: A prospective comparative study (Canadian Task Force Classification II-2).<br />Setting: Outpatient hysteroscopy clinic at a University Hospital.<br />Patients and Methods: We included 140 women in the childbearing period attending outpatient hysteroscopy clinic for infertility or recurrent miscarriage. Patients were divided into two equal groups; Group- A included those with unilateral or bilateral tubal block (n=70) and Group-B included those with patent tubes on both sides (n =70). All patients had diagnostic outpatient hysteroscopy without the use of anaesthesia or analgesia. Outcomes measured included pain experienced during and immediately after the procedure assessed using a 100 mm -Visual Analogue Scale (VAS) and the successful completion of the procedure.<br />Results: Patients with blocked tubes experienced statistically significant more pain than those with patent tubes both during and immediately after the procedure using a uterine filling pressure of 80 -100 mmHg. However, all procedures were successfully completed with no failures or complications.<br />Conclusion: Blocked Fallopian tubes contribute to pain during and immediately after outpatient hysteroscopy when a uterine filling pressure of 80- 100 mmHg is used. However, this didn’t adversely affect the success rate of the procedure. For this group of patients, strategies to improve patients’ satisfaction need to be studied with a special attention for; the use of lower uterine filling pressures, shortening the procedure duration and/or the use of preemptive analgesics.Evidence Based Women’s Health SocietyEvidence Based Women's Health Journal2090-72657220170501Pregnancy Rate After Fresh Embryo Transfer Versus Vitrified-Thawed Embryo Transfer Cycles: Minia University Experience8590453810.21608/ebwhj.2017.4538ENJournal Article20161029Objective: To study pregnancy rates after vitrified-thawed embryo transfer and fresh embryo transfer.<br />Design: Retrospective study.<br />Setting: Infertility and IVF unit, Minia University Hospital.<br />Patients and Methods: All women undergone ICSI program during the period from first of January 2010 to December 2014, pregnancy rate was compared between two groups, first group (Group I) had fresh embryo transfer, the second group (Group II) had vitrified –thawed embryo transfer .<br />Main outcome: Clinical pregnancy rate.<br />Results: There was insignificant difference between two groups regarding chemical pregnancy rate it was 228 (43%) in (Group I), 36% (186) in the second group (Group II). Clinical pregnancy rate 24.5 % (130) versus 22.1% (114). Implantation rate 28.6 % versus 24% . The rate of single pregnancy was higher in the first group 80% than in the second group 76.4% . The rate of twins was higher in the second group 23.6 %.<br />Conclusion: A program of vitrified-thawed embryo transfer should be adopted by all IVF center especially in low-income countries to maximize the benefit of the single treatment cycle, increase cumulative pregnancy rate and decrease the cost of repeated cycle stimulation, as the pregnancy rate is almost equal in FET and fresh embryo transfer