Ethical practices by nurses in maternal and child health cebters in selected rural areas - in Itay -Elbaroud city

Abstract

ART has developed over a decade to become useful for couples with infertility which cannot be cured by simple treatments. IVF is an expensive treatment but results in a successful outcome in only a third of treatment cycles, Implantation` failure could be due to a variety of reasons, including embryo quality and uterine receptivity, but remains unexplained in many cases. The presence of uterine pathology may negatively affect the chance of implantation and theprevalence of unsuspected uterine pathology in asymptomatic women with implantation failure has been reported to be as high as 50%. Therefore, one of the common investigations proposed for women undergoing IVF treatment is to evaluate the uterine cavity is hysteroscopy. Structural abnormalities of the uterine endometrial cavity may affect the reproductive outcome adversely, by interfering with the implantation or causing spontaneous abortion. Therefore, exclusion of any intrauterine pathology becomes an important step before subjecting the patient to ART. The aim of our research was to answer the question about whether routine hysteroscopy being an outpatient simple procedure can be used routinely before any case willing to have their first trial of ICSI, and how much diagnostic and therapeutic benefits will we obtain from. We studied 200 patients destined to have ICSI cycles for the first time in Al-Azhar university infertility clinics and Dar Alteb IVF unit. They have done ICSI cycles due to male factor,ovarian,tubal,uterine factors or unexplained infertility. Patients was divided into two groups each one included 100 patient, first group had routine hysteroscopy prior to their cycles assessing the vagina cervix, isthmus and uterine cavity where the second group did not have hysteroscopy before their ICSI trial. The pregnancy rate and live birth rate was estimated in the hysteroscopy group and compared to the the second group. The comparison revealed marked superiority of the hysteroscopy groupin pregnancy rate and live birth rate especially in those having uterine intracavitary lesions; this is added to its therapeutic contribution which can be done in the same setting. The list of abnormalities detected with hysteroscopy involved, endometrial and cervical polyps, sub mucous myomas, small septa, cervical stenosis in addition to intrauterine adhesions and evidence of chronic endometritis. The last two defects are thought to affect infertility in some way. These were detected in 14 women (14%) which is considered a direct additive value of hysteroscopy to diagnosis of infertility in the studied group. However, sub mucous myomas and endometrial polyps (12 cases) might be a cause of implantation failure.