Endometrial/subendometrial blood flow indexes measured by 3D power Doppler angiography and inherited thrombophilia and in vitro fertilization outcome

Abstract

OBJECTIVE: Endometrial and subendometrial blood flow is involved in embryo implantation.We have investigated the role of inherited thrombophilia in impairing endometrial and subendometrial blood flows during IVF. DESIGN: Prospective, nonrandomized clinical study. MATERIALS AND METHODS: 85 thrombophilic and 50 non-thrombophilic women were included and tested for inherited thrombophilia,including:FV Leiden,MTHFR–CT/-AC, PAI1,HPA1,FII,FXIII, FBG,APOE, PROTEIN C,PROTEIN S.Serial 3D ultrasound scans and power Doppler angiography (PDA) were performed during controlled ovarian hyperstimulation (COH) to measure endometrial and subendometrial blood flow transvaginally monitored by a GE 730Voluson machine.The stored volumes were off line analyzed considering as region of interest the 2mm uterine tissue surrounding endometrium.Endometrial pattern,thickness ,and volume,and PDA indexes of vascularization were calculated on the day of HCG administartion.These measurements were related to embryo implantation.COH was induced by long or short protocol + rFSH.Statistical analysis was performed using the SPSS® software package(SPSS Inc., Chicago, Il, USA). RESULTS: Women affected by inherited thrombophilia showed a marked reduction in vascularization flow indexes compared to the normal ones. In the non-thrombophilic group the all PDA parameters were statistically significantly higher. The number of high grade transferred embryos did not affected implantation/pregnancy rates.Blood flow restrictions appeared to be mostly related to some mutations.Homozigous state worsened the situation.In such women we obtained a very low implantation rate 15% vs 32.8%. CONCLUSION: Endometrial and subendometrial blood flow by 3D power Doppler is a useful tool to evaluate angiogenesis during COH and has been related to IVF outcome.To the best of our knowledge this is the first report regarding inherited thrombophilia and endometrial and subendometrial blood flow indexes.Endometrial and subendometrial blood flow seems to be related to implantation/pregnancy rates.