Abstract
PurposeThis pilot study aimed to evaluate the potential synergistic role of three-dimensional power Doppler angiography ultrasound and the expression of Leukemia Inhibitory Factor (LIF) protein in predicting the endometrial receptivity of fresh In-Vitro Fertilization (IVF) cycles.Materials and methodsThis prognostic cohort study involved 29 good prognosis women who underwent fresh IVF cycles with fresh blastocysts transfer. Serial measurements of sub-endometrial parameters including vascularity index (VI), flow index (FI), and vascularization flow index (VFI) were conducted consecutively via power Doppler angiography on the day of oocyte maturation trigger, oocyte retrieval, and blastocyst transfer. Aspiration of endometrial secretion was performed on the day of embryo transfer.ResultsThe mean index of VI and VFI on the trigger and oocyte retrieval day and also LIF protein concentration at the window of implantation were significantly higher in clinically pregnant women than that of the non-pregnant women (p < 0.05). The area under the curve (AUC) of VI and VFI was shown to have a powerful predictive value to forecast receptive endometrium on either trigger day (0.788 and 0.813, respectively) or oocyte retrieval day (0.813 and 0.818). Likewise, LIF concentration on the day of embryo transfer was adequate to become a predictor for endometrial receptivity (AUC 0.874). A combination of the VI and VFI on the trigger day and LIF concentration at specific cut-off values (VI > 5.381, VFI > 1.483, LIF 703.5 pg/mL) produced an algorithm with high AUC (0.881) and high specificity (94.4%) for an adequate prediction of non-receptive endometrium.ConclusionVI and VFI index assessed on maturation trigger day and the expression of LIF protein concentration at the window of implantation provided sufficient information to predict endometrial receptivity. A large randomized control trial is needed to validate these findings.
Highlights
Successful implantation reflects an excellent bi-directional communication and interaction between embryos and maternal endometrium at the receptive phase through a molecular pathway
Endometrial receptivity which is reflected by clinical pregnancy is defined as endometrium with high implantation potential characterized by histological changes that are driven by consecutive actions of steroid hormones, estradiol, and progesterone, in the midluteal phase [1]
Likewise the Leukemia Inhibitory Factor (LIF) protein concentration in endometrial secretion collected on the day of embryo transfer
Summary
Successful implantation reflects an excellent bi-directional communication and interaction between embryos and maternal endometrium at the receptive phase through a molecular pathway. Endometrial receptivity which is reflected by clinical pregnancy is defined as endometrium with high implantation potential characterized by histological changes that are driven by consecutive actions of steroid hormones, estradiol, and progesterone, in the midluteal phase [1]. Despite various clinical and laboratory improvements in In-Vitro Fertilization (IVF) treatment for infertile couples, the search for markers in predicting endometrial receptivity remains inconclusive. Adequate endometrial blood flow and perfusion are prerequisites of endometrial preparation for embryo implantation and is essential to endometrial receptivity. Kupesic and Coworkers indicated that lack of sub-endometrial perfusion measured with 3D power Doppler during peri-ovulation was associated with implantation failure in IVF cycles [3]. Despite the promising predictive value of this marker in various studies [4, 5], correlating it with the implantation potential remains controversial [2, 6, 7]
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