Abstract
BackgroundThere is much value in identifying non-invasive ways of measuring endometrial receptivity, as it has the potential to improve outcomes following in vitro fertilization (IVF). It has been suggested that endometrial echogenicity on the day of hCG administration was a good marker of endometrial receptivity. In the daily practice, we notice that patients with non-homogeneous hyperechoic endometrium on the embryo transfer day usually have lower pregnancy rates. We therefore extended the research onward transformation of echo pattern after hCG trigger to analyze the relationship between endometrial echogenicity transformation and IVF outcomes.MethodsA total of 146 infertile women undergoing their first IVF cycle were recruited in the prospective cohort study from August 2017 through August 2018. A series of endometrial echo pattern monitoring was carried out in these patients after hCG trigger: hCG day, from 1 through 3 days after ovum pick-up (OPU + 1, OPU + 2, OPU + 3).ResultsThe endometrial echogenicity value was calculated as the ratio of the hyperechogenic endometrial area over the whole endometrial area. Clinical pregnancy rate and embryo implantation rate had positive relationship with echogenicity value. The ROC curve analysis of endometrial echogenicity showed the area under curve was greatest on the second day after oocyte retrieval (OPU + 1, 2, 3 were 0.738, 0.765, 0.714 respectively) versus pregnancy. Endometrial echogenicity value on OPU + 2 had a higher predictive efficiency, and the cutoff value was 76.5%. The sensitivity was 61.3% and specificity was 82.0%. When putting the cut-off at <60%, the sensitivity was 93.8% and the specificity was 23.1%.ConclusionsThe endometrial echogenicity value on OPU + 2 was recommended to evaluate endometrial receptivity. It seemed appropriate for clinicians to provide a ‘freeze all’ IVF cycle and transfer in a subsequent frozen-thawed embryos cycle when echogenicity value <60% on OPU + 2.Trial registrationThe registration number was ChiCTR-OOC-17012214 and the registration date was August 1st, 2017.
Highlights
Endometrium is a highly dynamic tissue undergoing striking physiological changes in response to ovarian steroid hormones
It is commonly accepted that the embryo, the endometrium and the “cross-talk” between these two collaborators account for one-third of implantation failure respectively [2]
The use of endometrial receptivity array (ERA) and personalized embryo transfer in women with recurrent implantation failure (RIF) led to similar ongoing pregnancy rates compared to women with standard embryo transfer [8, 9]
Summary
Endometrium is a highly dynamic tissue undergoing striking physiological changes in response to ovarian steroid hormones. It is a general opinion that the endometrium is less important than embryos for the final IVF outcome. The recent data reported by Dr Brannstrom regarding the IVF clinical pregnancy rate after the embryo transfer in the transplanted uterus were impressive: 100% [3]! The use of endometrial receptivity array (ERA) and personalized embryo transfer (pET) in women with recurrent implantation failure (RIF) led to similar ongoing pregnancy rates compared to women with standard embryo transfer [8, 9]. There is much value in identifying non-invasive ways of measuring endometrial receptivity, as it has the potential to improve outcomes following in vitro fertilization (IVF). We notice that patients with non-homogeneous hyperechoic endometrium on the embryo transfer day usually have lower pregnancy rates. We extended the research onward transformation of echo pattern after hCG trigger to analyze the relationship between endometrial echogenicity transformation and IVF outcomes
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