الفهرس | Only 14 pages are availabe for public view |
Abstract Since the introduction of ICSI into the clinical human IVF laboratory, fertilization and development rates have surpassed all previous microsurgical fertilization methods and have further improved as experience was gained in performing the injection. Nevertheless, there are still unexplored aspects of the actual sperm injection that may affect the success of the procedure. Our study was carried out on 40 infertile patients attended the ART unit in Obst. & Gyne. department in Benha University Hospital. All these patients were subjected to the same evaluation program which included history taking, examinations (general, abdominal and local), radiological (pelive ultrasound, hystrosalpingogrophy) and laboratory evaluation Post Coital test (PCT), semen analysis, hormones such as T.S.H, day 3 FSH, LH, E2, PRL. Aetiology of the infertility was tubal factor in 14 cases (35%), ovarian factor in 10 cases (25%), male factor in 8 cases (20%) and unexplained infertility in 8 cases (20%), Regarding the type of infertility, it was primary in 32 (80%) and secondary in 8 cases (20%). The mean age of the patients was 28.1 years, and the mean duration of infertility was 8.67 years. 16 Cases (40%) had done IUI trials before and only 2 cases had previous IVF trials . SUMMARY - 621 - Thirty three cases (82.5%) were subjected to long protocol of ovarian stimulation, 4 cases (10%) were subjected to short protocol while 3 cases (7.5%) had clomid plus HMG stimulation. These patients underwent 52 Cycles of ICSI treatment. Semen samples were obtained by masturbation and were prepared by standard swim up technique in all patients. Oocyte retrieval was done 36 hours after HCG administration. A total number of 422 oocytes were collected, 347 (82.22%) were mature at Mll stage and considered for ICSI while 75 (17.78%) were immature and not included in the study. Out of 422, 267 oocytes were injected at 3 o’clock position (site 1), 40 oocytes midway between 1 o’clock and 3 o’clock (site 2) and 40 oocytes were injected midway between 3 o’clock and 6 o’clock (site 3). The first polar body was positioned at 12 o’clock in all sites of injection . The fertilization rate in site 1 was (77.9%) and cleavage rate of the fertilized oocyte was (87.98%). The fertilization rate in site 2 was (12.5%) and the cleavage rate was (0%) while the fertilization rate in site 3 was (60%) and cleavage rate was (79.1%) . The difference between site 1 and site 2 was statistically highly significant ( P < 0.00l) . There is higher rate of fertilization and cleavage in site I than in site 3.and the difference was statistically significant . SUMMARY - 621 - So from this study we conclude that : 1- The best site of injection during ICSI is at 3 o’clock position of oocyte while the first polar body is at 12 o’clock due to highest rate of fertilization and cleavage than other sites of sperm injection . 1- The first polar body is an accurate marker for spindle location 2- The disturbances in spindle function may predispose oocytes to fertilization arrest . There are still unexplored aspects of the actual sperm injection that may affect the success of the procedure. A greater understanding of cytoplasmic compartmentalization will in turn lead to refinements in manipulative procedures and improvement in the development of manipulated eggs. |