The uselfulness of ultrasound in predicting pregnancy rate in an oocyte donation program

Abstract

One of the limiting steps in ART success, is the relatively low embryo implantation rate. Among important factors in the implantation process, embryo quality and endometrial adequacy are key factors. Many ART programs have correlated endometrial morphology and width, and the uterine perfusion as measured by transvaginal ultrasound and color Doppler (TV-US) with pregnancy. In previos studies differents ultrasound parameters of endometrial receptivity in patients with ovarian stimulation were evaluated with good correlation between them. Which ones are the better predictors of optimal endometrial receptivity in a oocyte donor cycle ? The aim of this study was to evaluate four good sonographic parameters as a useful predictor of endometrial receptivity in terms of pregnancy rate in an oocyte donation program. Prospective , controlled, study. We evaluated sonographic parameters of uterine receptivity, measured on the day when Progesterone supplementation should begin. 78 consecutive patients whose stimulation endometrial cycle resulted in embryo transfer from fresh oocyte donor cycle, were included in this study. Four ultrasonographic parameters of good prognosis were considered as follow: Endometrial thickness ≥ 7mm, trilaminar endometrial pattern, uterine artery Pulsatility index (PI) ≤ 3 and presence of subendometrial vessels ≥ 4 Two groups were formed accordingly to the number of parameters founded (PF) Group I: 62 patients with ≥ 3 PF Group II: 16 patients with <3 PF Epidemiological data, age, number and quality of embryo transfer, Pregnancy rate and clinical pregnancy rate were evaluated between groups. Student and Fisher Test were used. Epidemiological data between groups were comparable. Patients age was in Gr I 42.6±5.4, in Gr II 43.7±6.8 (pNS). The number of embryo transfered was 3,2 ± 0,7 in Group I and 3,1 ± 0,9 in Group II (pNS). Pregnancy rate 71% (44 / 62) in gr I and 12,5% (2/16) in gr II (p 0.0001). Clinic pregnancy rate 61,3% (38 / 62) in GrI and 12,5 % (2/16) in Gr II ( p<0.0001) This data shows sensibility 75.8%, specificity 43.75%, positive predictive value 70.9% and negative predictive value 87.5%. When three or more parameters of good prognosis were present , a higher pregnancy rate was obtained. The sum of good prognostic sonographic criteria offers a useful tool for predicting success in oocyte donation cycles.