Follicular Output Rate (Fort) May Predict Intra Cytoplasmic Sperm Injection (Icsi) Outcome.

Background: In IVF/ICSI treatment, basal (follicle stimulating hormone) FSH, antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) concentrations are used to assess the basal ovarian reserves and to predict ovarian response and IVF/ICSI outcome. AFC; a non-invasive method, may well represent functional ovarian reserves and is well correlated to the number of oocytes retrieved. However, it cannot predict the oocyte /embryo quality or outcome in IVF/ICSI treatment. Aim of the Work: The aim of the study is to assess the accuracy and usefulness of the Follicular Output Rate (FORT); which was determined as a ratio of pre-ovulatory follicle count (PFC) on day of HCG administration to (AFC)?100, as a predictor of pregnancy outcome after ICSI treatment cycles in infertile women. Patietns and Methods: This prospective cohort study was conducted on quota sampling used to recruit 100 infertile women undergoing ICSI in each of four study groups: polycyctic ovary syndrome (PCOS) group, tubal factor group, endometriosis group and unexplained infertility group, i.e. a total of 400 women were enrolled in the study in the Assisted Reproduction Unit (ART Unit) of Ain Shams University Maternity Hospital and private IVF centres in the period between February 2017 and July 2018. Results: PFC was significantly higher in the PCOS women compared to the other three groups (11.42 ? 4.54, 7.79 ? 4.12, 6.81 ? 0.81 and 7.53 ? 2.61 respectivily). PCOS women who achieved clinical pregnancy had significantly lower FORT than those who didn?t (0.56?0.21,0.66?0.19;P=0.02). Tubal-factor women who achieved clinical pregnancy had significantly higher FORT than those who didn?t (0.66 ? 0.25, 0.53 ? 0.26; P=0.01). Endometriosis women who achieved clinical pregnancy had non significantly different FORT than those who didn?t (0.46 ? 0.19, 0.46 ? 0.17; P=0.99). Unexplained infertility women who achieved clinical pregnancy had significantly higher FORT than those who didn?t (0.62 ? 0.19, 0.53 ? 0.15; P=0.01). Conclusion: FORT may be a predictor of oocyte competence in terms of number of retrieved, mature and fertilized oocytes. The indicator can be used for prediction of clinical pregnancy rate after ICSI. The FORT predictive value, sensitivity, specificity and cut-off values to define poor ovarian responders and whether FORT can be used to determine when to cancel IVF/ICSI cycles for poor ovarian response are questions to be answered by further large scale research and meta-analysis which will undoubtfullycontribute to broaden its clinical applications.