الفهرس 
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Abstract
Favourable maternal conditions and embryo quality are important for successful implantation. The endometrium is critical for successful implantation through interaction with the embryo, this interaction can be altered if the embryo is defective, which can result from either paternal sperm factors or oocyte abnormalities.
The 3D power Doppler ultrasound is the most useful diagnostic tool, both for showing and calculating relevant parameters for evaluating restricted tissue angiography. The 3D power Doppler has high sensitivity in assessment of low vascular flow that identifies overlapping vessels and this technique displays total flow in a confined area, providing images similar to angiography. The 3D power Doppler imaging allows clinicians to see dimensions interactively, rather than reconstructing sectional images and endometrial and sub-endometrial blood flows can be more objectively and reliably measured with 3D power Doppler ultrasound.
Some reports revealed a relationship between endometrial thickness and pregnancy rate, while others showed none. Endometrial vascularization is favourable for the effect of endometrial thickness or volume on the pregnancy rate in assisted reproductive technology. Endometrial vasculature is considered to be important in the early endometrial response to blastocyst implantation, and vascular changes can influence uterine receptivity.
This is a prospective study that included a total of 100 women who underwent ICSI at Minia University Hospital and a private infertility centre during the period from July 2019 to June 2020. According to the ICSI outcome, they were classified into two groups:
• group (I) ”successful ICSI” included 39 pregnant women.
• group (II) ”unsuccessful ICSI” included 61 non-pregnant women.
The aim of this study is to evaluate the role of endometrial and subendometrail vascularity by transvaginal 3D power Doppler in predicting of pregnancy outcome in ICSI cycles.
The obtained results are summarized as follows:
• The results showed that there were no significant differences between groups regarding age (p=0.54), body mass index (p=0.66), type of infertility (p=0.89), duration of infertility (p=0.26) and cause of infertility (p=0.99).
• The mean endometrial thickness was 12.07 ± 2.86 mm in pregnant group however it was 12.88 ± 2.46 with no significant difference between groups (p=0.14).
• The results showed that there were no significant differences between pregnant and non-pregnant groups regarding FSH level (p=0.33), LH (p=0.17), TSH (p=0.12), Prolactin (p=0.11) , Estradiol (p=0.13) and AMH (p=0.18).
• The results showed that there were no significant differences between pregnant and non-pregnant groups as regards antral follicle count (p=0.12), total number of follicle (p=0.07), duration of stimulation (p=0.15), No. of retrieved follicles (p=0.12).
• The fertilization rate was comparable between groups (p=0.20) and number of good quality embryos was also similar with no significant difference (p=0.10).
• The endometrial volume was almost similar between pregnant and non pregnant groups (p=0.11). While, Endometrial FI mean was significantly higher in pregnant group compared to non-pregnant group (17.8 ± 1.43 vs. 11.06 ± 1.45, p<0.01). Also, endometrial VI was higher in group (I) compared to group (II), (1.29 ± 0.15 vs. 0.87 ± 0.11, p<0.01) and similar trend of results was found in Endometrial VFI, (0.41 ± 0.07 vs. 0.08 ± 0.03, p<0.01).
• The sub-endometrial volume was comparable between pregnant and non pregnant groups (p=0.08) and no significant differences were noticed between groups regarding sub-endometrial FI (p=0.20), sub-endometrial VI (p=0.09) and sub-endometrial VFI (p=0.08).
• The ROC curve analysis for the predictive value of endometrial and sub-endometrial blood flow parameters for pregnancy showed that the best predictive rate was obtained for endometrial FI >12.9, with a sensitivity of 89.7%, specificity of 81.7% and accuracy of 85.0% followed by endometrial VI >0.93, with a sensitivity of 76.9%, specificity of 75.4 and accuracy of 76.0% and endometrial VFI >0.14 (sensitivity = 66.7%, specificity = 73.8% and accuracy of 71.0%). In addition, the area under the curve was significantly different for endometrial VI, FI and VFI but was not for subendometrial VI, FI and VFI.