Endometrial Injury and Implantation Rates Before First ICSI Cycle

Does Local Endometrial Injury Improve Implantation Rates in Women Undergoing Their First ICSI Cycle.

Midluteal single endometrial strip will be taken using a Novak curett under general anasthesia to avoid discomfort and cramping and to proceed to cervical dilatation in case of forbidden cervix, the step that will be beneficial to embryo transfer procedure.

Controller ovarian hyperstimulation; will be done using the long luteal phase agonist protocol and the short protocol(as judged by patient,s age ovarian reserve judged by day 3 FSH and antral follicular count and previous history of ovarian response).

Ovarian response will be monitored by vaginal ultrasound and HCG will be given when when there is >=1 follicle >=18 mm. and >=3 follicles >=16 mm. Ultasound guided oocyte retrieval will be carried out 35 hours later. Embryo transfer will be performed on day 2 or day 3 after oocyt retrieval according to number and quality of embryos.

Embryo transfer will be carried out under trans-abdominal ultrasound guidance pregnancy test will be done using qualitative blood HCG detection 2 weeks after the embryo transfer.

Inclusion Criteria:

1. subfertile women indicated for ICSI.
2. normal uterine cavity demonstrated by transvaginal ultrasound and hystrogram.
3. FSH<10mIU/mL on day 3 of her cycle.

Exclusion Criteria:

1. presence of endometrial polyp or fibroid distorting the uterine cavity.
2. hydrosalpinx.
3. ICSI carried out for preimplantation genetic diagnosis.
4. FSH>10mIU\mL.