Evaluation of the Role of Follicular Sensitivity Index in the Prediction of IVF/ICSI Outcome
Condition: Subfertility
MeSH terms: Infertility
Study type: Observational

Summary: 
      Records of women who had in vitro fertilization (IVF) or intra-cytoplasmic sperm injection
      (ICSI) in Dar AlTeb sub-fertility center will be reviewed and the follicular sensitivity
      index (FSI) will be calculated and correlated with pregnancy.
    

Detailed description: 
      The investigators study is a retrospective cohort study. Records of women who had in vitro
      fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) in Dar AlTeb sub-fertility
      center from January 2010 to December 2013 will be reviewed. All records with missing data
      will be excluded.

      Triptorelin 0.1mg (Decapeptyl® Ferring, Germany) was used for pituitary down-regulation. It
      was given 7 days after the expected time of ovulation in women with regular cycles. Women
      with irregular cycles were given combined oral contraceptive pills and triptorelin was
      started on day 21 after starting the pills. On the second day of menstruation serum FSH, LH,
      Prolactin and Oestradiol were assessed and the antral follicular count (AFC) was assessed
      using a vaginal ultrasound scan. AFC will be defined as the number of follicles measuring
      3-10mm.

      Controlled ovarian hyperstimulation (COH) was started on the 2nd day of menstruation using
      human menopausal gonadotrophin (HMG) (Merional® IBSA, Switzerland). The initial dose ranged
      between 150-300 IU/day. The COH drug dose was adjusted according to the patient's response
      guided by number and size of the follicles in addition to serum E2 values. COH was continued
      until at least 3 follicles ≥17mm were obtained. This was followed by the administration of
      Human chorionic gonadotrophin (HCG) (Choriomon®, IBSA, Switzerland) 10000 IU. On the day of
      HCG administration, ovarian ultrasound scan will be performed using a transvaginal probe and
      the Preovulatory follicle count (PFC) was assessed, (PFC) was defined as number of follicles
      measuring≥16mm. FSI will be calculated as (FSI =PFC*10000/AFC*Total dose of FSH) Oocyte
      retrieval was guided by transvaginal ultrasound and was done 34-36 hours following HCG
      administration. Fertilization was done by ICSI. 16-18 hours later, fertilization was
      confirmed by the presence of 2 pronuclei.

      The procedure was cancelled if less than 3 follicles ≥17 mm in size are present 12 days after
      starting FSH despite doses reaching 450 IU. The cycle was also cancelled if there is risk of
      ovarian hyperstimulation like massive ovarian enlargement or serum estradiol exceeds 3000pg/L
      The quality of embryos was assessed at day 3 according to the number and evenness of
      blastomeres in addition to the percentage of fragmentation. Embryos were classified into 3
      groups: Excellent embryos containing 6-8 even blastomeres with <10% fragmentation, moderate
      embryos containing 6-8 even or uneven blastomeres with 10-20% fragmentation, and poor quality
      embryos containing less than 6 blastomeres or >20% fragmentation.

      Embryo transfer was done on the 5th day after oocyte retrieval for couples who had IVF/ICSI.
      If possible, 2 embryos were transferred and cryopreservation of the remaining embryos was
      offered.

      Luteal support was given in the form of progesterone vaginal tablets (Prontogest® IBSA,
      Switzerland) 400mg/day starting from the day of oocyte retrieval. A pregnancy test was done 2
      weeks after embryo transfer and clinical pregnancy was defined as the presence of an
      intrauterine gestational sac 5 weeks after embryo transfer.
    

Intervention name(s): ICSI
Intervention type(s): Procedure
Intervention description(s): records of women who had ICSI will be reviewed and analysed for determining FSI
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        The records of women who had IVF/ICSI without PCO will be reviewed to calculate the FSI.