El Deeb M.W, Sami S, Sallam A, Ismail E, Mohsen E, Darwish Y, El Sharaki A. INTEGRATED FERTILITY CENTER, ALEXANDRIA, EGYPT.

1. Ultra Short, Highly Economic and
Effective Protocol For ICSI Patients
El Deeb M.W, Sami S, Sallam A, Ismail E, Mohsen E,
Darwish Y, El Sharaki A.
INTEGRATED FERTILITY CENTER, ALEXANDRIA, EGYPT.

2. • Keeping things simple, short and
less costly, without altering success
rate of ICSI is the idea behind our
novel protocol.

3. • This simple protocol aims to reduce
the burden of ICSI procedures and
its related complications, thereby
giving a couple the chances to
conceive using procedures less
costly in terms of physical,
emotional, social and financial costs.

4. Protocols for Ovulation
Induction

6. Intact
hypothalamic
pituitary
ovarian
axis

7. Long luteal protocol

8.  Start hMG on day 3 of menses.
 Antagonist when follicle reach 14-15 mm
◦ Long acting ( single injection )
◦ Short acting (Daily usually 3-4 injections).
 hCG 10,000 when 3 or more follicles > 17mm
 OPU 34-36 hours
 Luteal Support
Antagonist Protocols

9. Antagonist protocol

10.  Agonist 2nd
day
 hMG 3rd
day
 Usually 9 – 10 days
 3 0r more follicles > 17 mm
 hCG 10,000
 Luteal Support.
Short Protocol (Flare up)

11. Short (flare up) protocol

12.  3 or less follicles
 What to do?
1- short protocol (flare up protocol)
2- Antagonist protocol.
3- No down regulation
4- COCpills + short protocol
5- Comiphene citrate
Poor Responders

13. Protocol for poor responders

14. Adjuvant treatment:
 Growth hormone
 Combined oral contraceptive pills
 Clomiphene citrate.

15. • In this case series study, we had 65 cases
underwent ICSI, their age ranges from (23-47)
years.
• CC 3 tablets daily started from the second
day of the cycle for 5 days, in the last day of
CC administration HMG was given in the
form of 2 amps of Menegon 75 (Ferring) or
Merional 75 (Ibsa) + 2 amps of Gonal F 75
(Merck Serono) , till we reach one or more
follicles > 16 mm.

16. The proposed protocol
1 2 3 4 5 6 7 8 9 10 11
Menses
HMG + antagonist
CC

17. • E2 is measured. Next day early morning one
amp. of Cetroide 0.25 mg. and the full HMG
dose was received… HCG 10,000 was
administrated when one or more follicles > 18
m.m as usual.

18. • Average number of oocytes retrieved ranges
from (2-25) oocytes
• Number of embryos transferred (ET) ranges
from (1-5) embryos
• Only one case had no ET.
• In D2-D3 transfer, 19 pregnant cases 31.7%
• 5 cases underwent D5 transfer, all of them got
pregnant (100%).
• Total pregnancy rate (36.9%).

19. Results
Age
Min-max
Mean ± S.D.
23-47
35.91 ± 6.15
Oocytes
Min-max
Median
Mean ± S.D.
2-25
5.0
7.29 ± 5.76
M2
Min-max
Median
Mean ± S.D.
0-20
4.0
4.71 ± 4.82

20. Class A embryos
Min-max
Median
Mean ± S.D.
0-12
2.0
2.68 ± 2.56
Class B embryos
Min-max
Median
Mean ± S.D.
0-6
0.0
0.98 ± 1.35
Embryo Transfer
Min-max
Median
Mean ± S.D.
0-5
3.0
2.91 ± 1.366
Results

21. Stimulation days
Min-max
Median
Mean ± S.D.
4-16
10.0
9.84 ± 2.61
Pregnancy
Yes
Non
24 (36.9%)
41 (63.1%)
Results

22. • These encouraging results of this highly
economic and successful protocol should be
put in consideration as a simple and effective
ICSI procedure.
• Comparison of this protocol with different
induction protocols is mandatory to justify
the results in evidence based clinical trial.

23. Thank you