Abstract
This is a prospective study of 182 women (38 yrs or younger) undergoing IVF-ET. Endometrial thickness, echo pattern and blood flow on transvaginal ultrasonography were recorded eight hours prior to hCG administration. The patients were divided into three groups: A (n = 10) with undetectable endometrial blood flow; B (n = 82) with sub-endometrial blood flow; C (n = 90) with both endometrial and sub-endometrial blood flow. According to IVF-ET outcomes, all patients were re-divided into three groups: 1 non-pregnancy (n = 92); 2 intrauterine pregnancy with live fetus (n = 70); 3 others (n = 20 including biochemical pregnancy, embryonic diapause, ectopic pregnancy and miscarriage). Intrauterine pregnancy with live fetus in Group C (62.2%) was much higher than that in Group A and B (0% and 17.1%, p less than or equal to 0.001). The implantation rate (33.2%) was much higher than that in Group A and B (0% and 19.90%, p less than or equal to 0.001). The pulsatility index, resistance index, and S/D of endometrial spiral arteries were 0.1 +/- 0.2, 0.6 +/- 0.1 and 2.5 +/- 0.4 in Group 2, which were much lower than those in Group 1 and Group 3 (p1-2 less than 0.001, p2-3 less than 0.05). The patients with detectable endometrial blood flow had higher clinical pregnancy rates and implantation rates.
Highlights
In the menstrual cycle, the endometrium has no adhesive qualities until the implantation window phase, during which for a very short time, the endometrium allows the implantation of gestational sacs
Past studies related to endometrial receptivity were mainly focused on histopathological investigation of the endometrium, presented as endometrial dating by Noyes dating [2], or investigation of the receptors for estrogen, progesterone and other known factors related to endometrial receptivity
The parameters were analyzed by software [4] for: (i) resistance index (RI): the difference between maximal systolic blood flow and minimal diastolic flow divided by the peak systolic flow (S-D/S); (ii) pulsatility index (PI): the difference between maximal systolic blood flow and minimal diastolic flow divided by the mean flow throughout the cycle (S - D/mean); (iii) the ratio between peak systolic flow and lowest diastolic flow (S/D)
Summary
The endometrium has no adhesive qualities until the implantation window phase, during which for a very short time, the endometrium allows the implantation of gestational sacs This feature is referred to as endometrial receptivity [1]. The advantages of ultrasonography including its non-invasiveness, repeatability, real-time monitoring and predictability, have gained more medical attention; ultrasonographic findings indicating changed endometrial receptivity have not yet been acknowledged. In this prospective study, we aim to examine the value of ultrasongraphic technology in the assessment of endometrial and subendometrial blood flow and clarify its relationship with in-vitro fertilization and embryo transfer (IVF-ET) outcomes, in the clinical setting
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