Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

200 women aged 18-40 years old and attending the IVF unit of Kasr el Aini hospital for management of infertility were included in the study. All women were scheduled for ICSI after controlled ovarian induction with GnRH- agonist protocol.Inclusion criteria were tubal factor of infertility, unexplained infertility, polycystic ovarian syndrome and BMI {u2264} 30 kg/m2.Exclusion criteria were severe male factor infertility, hyperprolactinemic patients, high day 3 E2 >50 pg/ml, high basal FSH > 11 IU/L, frozen embryo transfer cycles, uterine Anomalies or synechia.Patients were divided into two groups according to day 3 FSH/LH ratio: Group A (FSH/LH {u2265} 3) and Group B (FSH/LH <3).Primary outcome parameter included impact of FSH/LH ratio on ICSI outcome, Correlation of serum progesterone on day HCG administration, number of MII oocytes and calculated progesterone/ MII oocyte ratio with success of ICSI. Group A (Day 3 FSH/LH {u2265}3) consisted of 27 patients, group B (FSH/LH <3) included 173 patients. 193 cases underwent embryo transfer, 7cases cancelled (all in group A (FSH/LH {u2265}3). Clinical pregnancy was reported in 52 (27.9%) cases.Our results showed that there was no significant difference in the clinical pregnancy rate after ICSI between the groups (p=0.068). However, the mean number of total oocytes retrieved and MII oocytes was lower with FSH/LH{u2265} 3 (p<0.001). In addition, FSH/LH ratio cut off value 1.6 was the best in predicting a good ovarian response with a sensitivity of 80%, specificity of 62% (p<0.001).In our study higher trigger day serum progesterone was observed in cases who didn{u2019}t get pregnant compared to those who got pregnant (p= 0.01) with cut off value of 1 ng/ml correlated well with the clinical pregnancy rate after ICSI with 61% sensitivity and 59% specificity (p=0.004). We found that significantly lower P-hCG/MII ratio was found in the pregnant women group compared to that found in the non-pregnant group (p=0.001) and cut off value of 0.18 correlated best with clinical pregnancy after ICSI with sensitivity 70.5% and specificity 61.2%(p<0.001)

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