A paradigm of higher success rate of intracytoplasmic sperm injection - preovulatory human chorionic gonadotropin-day serum oestradiol.

Introduction: The aim of the study is to evaluate the correlation between the level of serum oestradiol (E2) on the day of human chorionic gonadotropin (hCG-day) administration and successful intracytoplasmic sperm injection (ICSI) outcome. Material and methods: This prospective study was performed during the period from January 2019 to September 2021, at Zagazig Obstetrics and Gynecology Department, and Al-Azhar Obstetrics and Gynecology Department, and private ART centers. One hundred and fifty women attending the infertility clinic for ICSI cycles. All women were divided into 5 groups according to the serum E2 level on the day of hCG administration: Group A - serum E2 < 1000 pg/ml; Group B - serum E2 1000 to < 2000 pg/ml; Group C - serum E2 2000 to < 3000 pg/ml;Group D - serum E2 3000 to < 4000 pg/ml; Group E - serum E2 ≥ 4000 pg/ml. Results: The highest fertilization rate (58.1%) was among women with E2 ≥ 4000 pg/ml, while the lowest (37%) was in women with E2 1000 to < 2000 pg/ml. Also, the highest pregnancy rate (21.5%) was among women with E2 > 4000 pg/ml, while the lowest (5.3%) was in women with E2 < 1000 pg/ml. In the current study the median serum E2 level on the day of hCG administration was highly significant in women who became pregnant when compared to women who did not. The best cut-off value of serum E2 at hCG administration was ≥ 3682.3 pg/ml. Conclusions: this study suggests that the optimal range of E2 level for achieving a successful pregnancy is > 4000 pg/ml.

Effective supervision model for improved primary healthcare services: case of Egypt.

BACKGROUND: In Egypt, primary healthcare workers (PHCWs) often work in challenging situations and in relative isolation from the health system and specialists' experiences. Supervision is currently applied by PHCWs to present practice, control and upgrade knowledge and skills. OBJECTIVES: To assess the current supervision system in the Ministry of Health and Population (MOHP) at the central, governorate, district, and primary healthcare (PHC) facility levels. METHODS: The research setting is the MOHP-PHC head quarter (HQ) and five governorates. DESIGN: Cross-sectional analytical observational health system research qualitative and quantitative study of Egyptian health service and operations. SAMPLING: The multistage sampling technique was used to select districts (n = 25) units (n = 250), physicians (n = 250), and nurses (n = 250) from five randomly selected governorates that represent four Egypt regions. DATA COLLECTION: Focus group discussions (FGDs) and self-administered questionnaires. RESULTS: Response rate to questionnaires were in total 73% (67% for physicians and 80% for nurses). FGDs demonstrated that PHC has an effective supervision system at central, governorate, and district levels. The effective supervision allowed overcoming barriers related to the shortage in PHCWs needed to cover 5364 PHC units in addition to mobile clinics. Supervisors use a standardized consistent checklist covering all items of service delivery. More than 95% of physicians and nurses appreciated receiving on-the-job training from the district supervisory teams. CONCLUSION: Egypt MOHP-PHC has an effective supervision model in place at the central, governorate and district levels that supports continuous communication between PHC facilities' staff and the health system enabling continuous personal and professional upgrade and development and improved problem-solving skills at the facility level.