Endometrial thickness (ET) is one of the best predictors of implantation rate and pregnancy success rate because endometrial growth depends on hormones. Estrogen regulates the proliferative phase, endometrial proliferation induced by estrogen after menstruation is largely dependent on blood flow to the basal endometrium that produces progesterone receptors which are required for progesterone-regulated endometrial growth in the secretory process. To compare the effect of estradiol valerate vs. sildenafil citrate on endometrial receptivity and subsequent pregnancy outcome in unexplained infertility patients receiving letrozole for ovulation induction. Herein, 21 patients with unexplained infertility underwent ovulation induction by letrozole (2.5 mg). Patients were divided into 2 groups; group A (10 patients) were given sildenafil tablets vaginally (25 mg) four times daily and group B (11 patients) were treated with estradiol valerate tablet 2 mg/12 hours. Patients were evaluated by transvaginal ultrasonography (TVS) to determine endometrial thickness, pattern, size, and the number of the dominant follicles, serum assessment of Vascular Endothelial Growth Factor (VEGF) level at trigger day, and chemical pregnancy outcome 14 days later. Results showed that the endometrial thickness, patterns of the endometrium, VEGF, size of the dominant follicle at the trigger day, and pregnancy rates were not significantly different between the two groups. However, the difference in the number of the dominant follicles at trigger day was statistically significant which is more in the sildenafil treated group. The present study confirmed the findings of both Sildenafil and E2 valerate to boost endometrial receptivity and pregnancy rate.

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Intracytoplasmic sperm injection is more being used for non-male factor indications, although it was developed for overcoming infertility of males because pregnancy rate of in vitro fertilization is still < 40%. This work aims at evaluating the vitro sperm injecting cycle fertilization/ Intracytoplasmic efficiency in infertile women and the factors that predicting clinical pregnancy rate. Al-Nahrain University at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, we conducted a randomized clinical trial from 1st Sep. 2018 to 1st Sep. 2020. 40 women complaining from infertility underwent IVF / ICSI protocols were sampled for this work. Positive serum βhCG test were used to evaluate pregnancy r, two weeks following transferring embryo. In this study, 12 infertile women got pregnant with pregnancy rate of 30%. Duration of stimulation, number of mature eggs, fertilized eggs, and grade I transferred embryo, and changes in percentages in endometrial zone at day of pickup in comparison with that at day of hCG were significantly higher (P < 0.05) in pregnant women than those who were not pregnant. Failure rate of pregnancy is still high and the most important factors that associated with failure of IVF/ICSI outcome were short duration of gonadotropin stimulation, few number of mature eggs and embryos, and suboptimal endometrial receptivity. Keywords: IVF, ICSI, infertility, pregnancy rate, predictors, Iraq.

Background: Aspirin low dose or vaginal sildenafil, the two drugs have been shown to be advantageous for women undergoing assisted conception. Using powerful Doppler imaging, it is now possible to identify perifollicular perfusion and hence the accurate selection of oocyte with good intracytoplasmic sperm injection (ICSI) outcome. Objective: The current study aimed to investigate the effects of aspirin and vaginal sildenafil citrate on improvement of the perifollicular blood flow, EG-VEGF and conception in females following ICSI cycles. Subjects and methods: Ninety infertile women were participated in ICSI cycles. Full investigation was made for participating women. Ovarian stimulation protocol was performed. Doppler ultrasonography was used to evaluate the perifollicular blood flow. Serum and follicular fluid EG-VEGF were measured. data analyzed using SSPS program. Results: Total oocytes count was significantly higher in aspirin group in comparison with sildenafil and control group. No significant difference in mean serum and follicular fluid EG-VEGF. Also, no significant difference in the proportions of PFBF and endometrial vascular zones. With respect to endometrial vascular zones, there was significant variation in favor of sildenafil and aspirin groups. Positive pregnancy test was reported in 40.0% of women in aspirin group, in (33.3 %) of women in sildenafil group and in (20.0 %) of women in placebo group, the difference was insignificant. Conclusion: Aspirin treatment resulted in higher number of total retrieved oocytes, aspirin and sildenafil did not improve endometrial thickness, but they resulted in an improvement of sub endometrial vascularity, however, biochemical pregnancy test was not affected by either pharmacological agent.

Stem cell factor (SCF) is one of the first growth factors derived from granulosa cells in the ovarian follicle plays a critical role in hematopoiesis and the generation of melanocytes and germ cells. SCF also serves an important role in the development of the interstitial cells of Cajal in the intestine and the learning functions in the hippocampal region of the brain. This study aimed to investigate the levels of SCF in follicular fluid (FF) and if it can be used as a potential marker for predicting oocyte, embryo quality, and pregnancy rate. A total of 44 infertile couples involved in the study. All of them underwent controlled ovarian hyperstimulation for the ICSI cycle. Antagonist protocol was used as an ovulation induction protocol. Patients were divided into two groups according to ICSI outcomes as pregnant (23 women) and non pregnant (21 women) groups. A comparison was done in both groups based on the oocyte, embryo quality, and other ICSI cycle characteristics, and follicular fluid stem cell factor level. SCF level was measured by using an enzyme-linked immunosorbent assay. Our study showed lack of association between patients' characteristics which included (age, BMI, infertility duration, type of infertility, and causes of infertility, basal hormonal, stimulation characteristics levels), FF SCF level and the oocyte characteristics comparison (total number retrieved oocyte, germinal vesicle oocyte (GV), MI oocyte and MII oocytes, and the number of injected oocytes, fertilization rate, and embryo characteristics) between pregnant and non-pregnant groups. The present study showed that Mean follicular fluid SCF was significantly lower in pregnant women in comparison with that of non-pregnant women, 135.92±38.96 pg/ml versus 185.15±63.58 pg/ml, respectively (P=0.003). Raised SCF level in FF harms ICSI outcome.