Role of Follicular Output Rate in the Prediction of in Vitro Fertilization and Intracytoplasmic Sperm Injection in Women With Unexplained Infertility
Role of Follicular Output Rate in the Prediction of in Vitro Fertilization and Intracytoplasmic Sperm Injection in Women With Unexplained Infertility
300 women with unexplained infertility who are already decided to be treated with ICSI will
 be recruited from Cairo university hospitals and Dar Al-Teb subfertility centre.

 On the second day of menstruation serum FSH, LH, Prolactin and Oestradiol will be assessed
 and the antral follicular count (AFC) will be assessed using a vaginal ultrasound scan. AFC
 will be defined as the number of follicles measuring 3-10mm.

 All patients will have standard pituitary down-regulation followed by (Human menopausal
 gonadotrophin (HMG) stimulation until the day of (Human chorionic gonadotrophin (HCG)
 administration. On the day of HCG administration, ovarian ultrasound scan will be performed
 using a transvaginal probe and the Preovulatory follicle count (PC) will be assessed, (PFC)
 is defined as number of follicles measuring≥16mm. FORT will be calculated as: (PFC) *
 100/AFC.
Our study is observational, we are observing data from routine measurements during IVF/ICSI.
 Our study does not assess IVF/ICSI as an intervention, we are evaluating the role of FORT
 which is calculated by observing routine measurements during the IVF/ICSI procedure.

 300 women with unexplained infertility who are already decided to be treated with ICSI will
 be recruited from Cairo university hospitals and Dar Al-Teb subfertility centre.

 All women fulfilling the inclusion criteria will be invited to participate in the study. A
 written informed consent will be taken and only women signing the consent will be included in
 the study. Patients included in the study will be subjected to full history taking and
 clinical examination including general, abdominal and gynecological examination. This will be
 followed by a vaginal ultrasound scan to assess uterus, ovaries and any pelvic masses.

 All women will go through the usual IVF/ICSI procedure explained below, our aim is to observe
 the antral follicle count, the pre-ovulatory count and calculate the FORT then correlating
 this with pregnancy.

 On the second day of menstruation serum FSH, LH, Prolactin and Oestradiol will be assessed
 and the antral follicular count (AFC) will be assessed using a vaginal ultrasound scan. AFC
 will be defined as the number of follicles measuring 3-10mm.

 All patients will have standard pituitary down-regulation protocol with GnRHa (Triptorelin
 0.1mg, Decapeptyl® Ferring, Germany) day 7 after ovulation of previous cycle or on day 21 of
 the oral contraceptive cycles. GnRHa will be continued for 2 weeks. Human menopausal
 gonadotrophin(HMG) (Merional ®IBSA) 150-300 IU/day will be administered until the day of HCG
 administration.

 On the day of HCG administration, ovarian ultrasound scan will be performed using a
 transvaginal probe and the Preovulatory follicle count (PC) will be assessed, (PFC) is
 defined as number of follicles measuring≥16mm. FORT will be calculated as: (PFC) * 100/AFC.

 FORT values will be classified into 3 categories: low, medium and high the 3 groups will be
 compared regarding the clinical pregnancy rate, number of retrieved oocytes, number and
 quality of embryos The procedure will be cancelled if less than 3 follicles 16-20 mm in size
 are present 12 days after starting FSH despite doses reaching 450 IU. The cycle will be also
 cancelled if there is risk of ovarian hyperstimulation like massive ovarian enlargement or
 serum estradiol exceeds 3000pg/L Transvaginal oocyte retrieval will be performed 34-36 h
 after the administration of HCG. Oocytes will be fertilized either via IVF or ICSI based on
 the couple's history. Fertilization will be assessed 16-18 h after IVF or ICSI. Embryo
 transfers will be performed 3 days after oocyte retrieval. No more than three embryos per
 patient will be transferred; vaginal tablets containing progesterone (Prontogest® IBSA)
 administered 400 mg/day as luteal support from the day of the oocyte retrieval. Clinical
 pregnancy will be defined as Visualization of an intrauterine gestational sac 5 weeks after
 embryo transfer.
Inclusion Criteria:

 -  Unexplained infertility

 -  Both ovaries are present

 -  Day 2 FSH <10 mIU/L

 -  Day 2 Estradiol <80 pg/L

 Exclusion Criteria:

 -  Known other cause of subfertility

 -  Expected poor responders according to Bologna criteria (9)

 -  Abnormalities affecting the uterine cavity

 -  Uncontrolled diabetes

 -  Allergy to gonadotrophins

 -  Cancelled cycles during the study