Endometrial Blood Flow Research Articles

Comparative Evaluation of Sildenafil Citrate and Estrogen as an Adjuvant Therapy for Treatment of Unexplained Infertility in Women.

Uterine blood flow determines endometrial thickness. This study examined how vaginal sildenafil citrate and estradiol valerate altered endometrial thickness, blood flow, and fertility in infertile women. This study observed 148 infertile women whose infertility was unexplained. Group 1 comprised 48 patients who received oral estradiol valerate (Cyclo-Progynova 2 mg/12 h white tablets) from day 6 till ovulation was initiated with clomiphene citrate. A number of 50 participants in group 2 received oral sildenafil (Respatio 20 mg/12 h film-coated tablets) for 5 days starting the day after their previous menstrual period and finishing on the day they ovulated with clomiphene citrate. Group 3 was the control group, with 50 patients receiving clomiphene citrate (Technovula 50 mg/12 h tablets) ovulation induction from the 2nd to 7th day of cycle. All patients had transvaginal ultrasounds to determine ovulation, follicle count, and fertility. Miscarriage, ectopic pregnancy, and multiple pregnancies were monitored for three months. The three groups' mean ETs differed statistically at p = 0.0004. A statistically significant difference was found between the three groups in terms of the number of follicles, with 69% of patients in group 1 having one and 31% having two or more, 76% of patients in group 2 having one and 24% having two or more, and 90% of patients in the control group having one and 10% having two or more (p = 0.038). The clinical pregnancy rates of the three groups were 58%, 46%, and 27%, respectively (p = 0.005). The distribution of all side effects was not statistically different between the three groups. It is possible to claim that adding oral estrogen to clomiphene citrate therapy as an adjuvant therapy can improve endometrial thickness and, as a result, increase the pregnancy rates in unexplained infertility compared to sildenafil, especially in cases where the infertility has lasted less than two years. Most people who take sildenafil end up with a mild headache.

Novel application to evaluate endometrial blood flow using transvaginal superb microvascular imaging: A preliminary study describing physiological changes from ovulation to mid-luteal phase.

We aimed to describe physiological changes in endometrial blood flow (minute arterioles running through the endometrium) from ovulation to the mid-luteal phase using superb microvascular imaging. The study involved 17 women (median age, 32.5 years; first to third interquartile range, 29.8-40.0 years) with regular menstrual cycles who were managed in our institute from 2020 to 2021. The uterus was delineated at the sagittal section using transvaginal ultrasonography incorporated with superb microvascular imaging. For each participant, a total of 28 cycles were observed; 17 cycles observed within one day of ovulation and the implantation period, 5-7 days (D5-7) after ovulation in the same cycle, and nine cycles in which only ovulation was observed, and two cycles in which only D5-7 was observed. Therefore, 26 and 19 images at ovulation and D5-7, respectively, were acquired. Endometrial blood flow was evaluated by depth of the vascular signal in the endometrium and categorized as follows: signals only in the basal layer of the endometrium (grade 1), reaching up to half the endometrium (grade 2), and covering the whole endometrium (grade 3). Changes in the grade of endometrial blood flow from ovulation to D5-7 after ovulation, and the relationship between the grade of endometrial blood flow and the endometrial thickness on ovulation and D5-7 after ovulation, were analyzed. Statistical significance was set at p < 0.05. The endometrial blood flow from ovulation to D5-7 after ovulation during the same menstrual period showed a downgrade in 14 of 17 cycles (82.3%) and no change in the remaining three cycles (17.6%), indicating a decrease in the endometrial blood flow from ovulation to D5-7 after ovulation (p = 0.001). There were differences between the grade of endometrial blood flow and median endometrial thickness on ovulation (grade 1: 5.9 mm, grade 2: 9.1 mm, and grade 3: 11.2 mm); however, no differences in the endometrial thickness were found between the grades on D5-7 after ovulation. In the normal menstrual cycle, endometrial blood flow decreased from ovulation to the mid-luteal phase, and the endometrial thickness in the ovulatory phase was related to the endometrial perfusion.

Uterine artery Doppler and endometrial blood flow in frozen embryo transfer: A cohort study.

The implantation rate after assisted reproductive technology depends on 2 important factors, good quality embryo and endometrial receptivity. Endometrial receptivity is mainly assessed by ultrasound measurement of endometrial thickness and morphology. This study aimed to investigate the relationship between uterine artery Doppler indices/endometrial perfusion and pregnancy rate. This cohort study was done on 250 women who were candidates for frozen embryo transfer from January to July 2022. For assessing endometrial receptivity, we performed a Doppler ultrasound of the uterus before embryo transfer with apparently desirable endometrium (endometrial thickness 7 mm and 3 line endometrial pattern). In addition, the women were divided into 2 groups according to assisted reproductive technology outcome (clinical pregnancy), group I positive clinical pregnancy, and group II negative clinical pregnancy, and uterine artery indices and endometrial perfusion were compared between these groups. Uterine artery Doppler showed that the pulsatility index was significantly different between positive and negative clinical pregnancy groups, but resistance index and peak systolic velocity (PSV) did not have statistically significant differences. Also, endometrial perfusion was significantly different between the 2 groups of clinical pregnancy. Endometrial perfusion was significantly better in positive clinical pregnancy groups. Doppler ultrasound can help to assess endometrial receptivity.

Comparison of uterine, endometrial and subendometrial blood flows in predicting pregnancy outcomes between fresh and frozen-thawed embryo transfer after GnRH antagonist protocol: a retrospective cohort study

This retrospective cohort study aimed to compare endometrial receptivity and pregnancy rate between fresh embryo transfer (ET) and frozen-thawed ET after gonadotrophin-releasing hormone (GnRH) antagonist protocol in normal ovarian responders. The patients were divided into two groups: the fresh ET group and the frozen-thawed ET group. Uterine artery resistance index (RI) and endometrial thickness were lower in the frozen-thawed ET group. The proportion of detectable endometrial–subendometrial flow was significantly higher in the frozen-thawed ET group. There was no significant difference in miscarriage rate between the two groups. Frozen-thawed ET group had a significantly higher CPR (56.0% vs. 48.1%), implantation rate (32.2% vs. 26.4%), and LBR (45.4% vs. 36.5%) than the fresh ET group. In GnRH antagonist protocol, elective frozen-thawed ET should be ideally taken, as this could improve embryo implantation rate, clinical pregnancy rate, and live birth rate, thus presenting an effective strategy to enhance the embryo utilization rate. IMPACT STATEMENT What is already known on this subject? The clinical pregnancy rate following fresh embryo transfer (ET) was lower than frozen-thawed ET after GnRH antagonist protocol. IVF success depends on embryo quality, embryo-endometrium interaction and endometrial receptivity. A good blood supply toward the endometrium is generally considered a requirement for implantation. What do the results of this study add? Uterine artery RI and endometrial thickness were significantly lower in the frozen-thawed ET group. The proportion of detectable endometrial–subendometrial flow was significantly higher in the frozen-thawed ET group. Frozen-thawed ET group had a significantly higher clinical pregnancy rate, implantation rate and live birth rate than the fresh ET group after GnRH antagonist protocol. What are the implications of these findings for clinical practice and/or further research? In GnRH antagonist protocol, elective frozen-thawed ET should be ideally taken, as this could improve embryo implantation rate, clinical pregnancy rate and live birth rate, thus presenting an effective strategy to enhance the embryo utilization rate.

Predictive value of 3D ultrasound assessment of endometrial receptivity for PGD/PGS for transfer pregnancy outcome

ObjectiveTo investigate the predictive value of three-dimensional ultrasound assessment of endometrial receptivity in PGD/PGS transplantation patients on pregnancy outcome.Methods280 patients undergoing PGD/PGS transplantation were enrolled and divided into group A and group B according to the patients’ pregnancy outcomes. The general conditions, endometrial receptivity indexes of the two groups were compared. Multifactorial logistic regression analysis was used to determine the factors influencing pregnancy outcome in PGD/PGS transplant patients. ROC curves were plotted to analyze the predictive value of 3D ultrasound parameters on pregnancy outcome. The results of the study were validated with patients who underwent FET transplantation, and the patients in the validation group were treated with the same 3D ultrasound examination method and treatment plan as the observation group.ResultsThe differences in basic situations between two groups were not statistically significant (P > 0.05). The percentage of endometrial thickness, endometrial blood flow, and endometrial blood flow classification type II + II were higher in group A than in group B (P < 0.05). Multifactorial logistic regression analysis showed that endometrial thickness, endometrial blood flow and endometrial blood flow classification were influencing factors of pregnancy outcome in PGD/PGS patients. The sensitivity of predicting pregnancy outcome based on the results of transcatheter 3D ultrasound was 91.18%, the specificity was 82.35%, and the accuracy was 90.00%, which has a high predictive value.Conclusion3D ultrasound can predict pregnancy outcome by assessing the endometrial receptivity of PGD/PGS transplantation, in which endometrial thickness and endometrial blood flow have a good predictive value.

Association between endometrial blood and clinical outcome in frozen single blastocyst transfer cycles.

Background: The success of embryo transfer cycle depends mainly on the quality of embryo and endometrial receptivity. Ultrasound examination is still the most widely used non-invasive evaluation method for its advantages of convenience, non-invasiveness and repeatability. Ultrasound-measured endometrial blood flow is one of the important evaluation indicators of morphology. Aims: To investigate the effect of the number of endometrial blood flow branches on pregnancy outcome of frozen-thawed embryo transfer cycles which have undergoing hormone replacement therapy (HRT-FET). Material and methods: A retrospective cohort study was performed looking at a total of 1390 HRT-FET cycles from our reproductive medicine center between January 2017 to December 2021, which transferred one blastocyst frozen on day 5 with good quality in morphology. Associations between endometrial blood flow branches and pregnancy outcomes were evaluated with multivariable linear regression analysis. Results: The number of endometrial blood flow branches was independently associated with clinical pregnancy (OR 1.10; 95% CI 1.02-1.20). After adjusting for potential confounders, the effect size (odds ratio) was 1.09 (95% CI 1.00-1.19), and the results showed that the clinical pregnancy rate and live birth rate of T2 and T3 groups were significantly higher than those in group T1 (p < 0.05). Subgroup analysis showed that a consistent association between the endometrial blood flow branches and clinical pregnancy in all subgroups. Conclusion: Our study provided evidence for the influence of endometrial blood flow on pregnancy outcomes. There may be an independent association between the number of endometrial blood flow branches and pregnancy outcomes in frozen-thawed single blastocyst transfer cycles.

Effectiveness of growth hormone in promoting endometrial growth in patients with endometrial dysplasia in frozen embryo transfer.

This study was designed to investigate the effect of growth hormone (GH) in promoting endometrial thickness, blood flow, and pregnancy outcome in patients with thin endometrium for frozen embryo transfer. Thirty-eight patients were recruited in the reproductive center of Jingzhou Hospital affiliated to Yangtze University who cancelled fresh embryo transfer due to thin endometrium and planned to undergo frozen-thawed embryo transfer (FET) from May 2019 to May 2020. The patients were randomly divided into the GH injection group (19 cases, endometrium preparation with hormone replacement therapy (HRT) and GH by subcutaneous injection) and the control group (19 cases, endometrium preparation with HRT). Both groups were similar in socio-demographic characteristics. After treatment, the thickness and volume of endometrium in the HRT & GH group were significantly increased (p < 0.05), and the growth rate was significantly higher than that in the control group (p < 0.05). The proportion of type A & B endometrium increased from 78.9% to 94.7% in the HRT & GH group. Moreover, the proportion of type Ⅰ and Ⅱ of endometrial blood perfusion in the HRT & GH group significantly increased compared with that before treatment. The human chorionic gonadotropin (hCG) positive rate (47.4 vs. 42.1%) and clinical pregnancy rate (36.8% vs. 31.6%) were slightly higher in the HRT&GH group than that in the control group. In conclusion, for patients with thin endometrium, HRT combined with subcutaneous injection of GH can increase the thickness and volume of the endometrium, improving the blood perfusion of the endometrium. This may play a positive role in improving endometrial receptivity and pregnancy outcome.

Uterine artery Doppler and Sub-Endometrial blood flow and Serum Progesterone level in patients with Unexplained Recurrent Miscarriage

Background: Unexplained Miscarriage that occurs repeatedly is still a difficult issue for couples and professionals. It affects 2–5% of females attempting to conceive and represents a considerable challenge for physicians. Aim of the Work: This study compares women who have unexplained recurrent miscarriages to healthy, fertile women in order to assess uterine artery blood flow, sub-endometrial blood flow, and serum progesterone levels in these women. Patients and Methods: At Al-Galaa Maternity Teaching Hospital, our research was carried out, and patients were divided into two groups. The case group: 50 individuals disclosed a history of recurrent, unexplained miscarriages, and the control group: 50 individuals who had at least one term birth and no history of miscarriage. Results: pulstility index of the uterine artery especially the mean value, and flow index, vascular index and vascular flow index of the endometrial and sub-endometrial area, in addition to the serum progesterone level are crucial factors in case of unexplained recurrent miscarriage. They affect unexplained recurrent miscarriage incidence significantly. The pulstility index of the uterine artery has its influence on unexplained recurrent miscarriage with 74% accuracy. The flow index has 95% accuracy, and the vascular flow index has 86% accuracy in case unexplained recurrent miscarriage. The serum progesterone level has 70% accuracy effect on unexplained recurrent miscarriage. Conclusion: the study documented that the uterine artery Doppler, endometrial and sub-endometrial blood flow level and serum progesterone level affect the incidence of unexplained recurrent miscarriage with accuracy ranging between 70% and 95%.

Evaluation of tubal patency and its impact on ovarian blood flow and function: a comparison of hysterosalpingography and HyCoSy

Objective: To investigate Hysterosalpingo Contrast Sonography (HyCoSy) as a safe, effective, easy, and cheaper approach to measure tubal patency than hysterosalpingography (HSG) and to correlate better ovarian function, endometrial and ovarian blood flow, and conception rates in infertile women. Methodology: This cross-sectional study included 40 infertile women between 22 and 42 years age; 20 of them had HSG on day 6 or 7 of cycle and 20 HyCoSy with normal saline and 100 mg hydrocortisone. All underwent the protocol of 75 iu gonal F sc on days 2 and 3, with clomiphene 50 mg twice daily from days 2 to 7 or letrizole 2.5 twice daily from days 3 to 8 (around day 14). Evaluated criteria: resistance index (RI) and perfusion index (PI) of ovarian vessels by Doppler ultrasound, number and size of follicles for both groups, endometrial thickness, endometrial pattern, zones of blood flow to endometrium. Then HCG to promote ovulation and progesterone to support luteal phase. Results: HSG group mean age was 29.7 6 HYCOSY group age was 29 6 years. 82.1% of HSG females and 90.1% of HyCoSy females had 2nd infertility. Females undergoing HSG had 42.9% I zone and 65.6% IV zone. Females undergoing HSG and HyCoSy had 1 follicle, respectively. 68.8% of HyCoSy females were pregnant. HSG and HyCoSy had different RI, thickness. HyCoSy was thicker and had less RI than HSG. HSG and HyCoSy had similar numbers and sizes of follicles. Conclusion: HyCoSy was a safe, effective, easy, and cheaper way to evaluate tubal patency than HSG, less RI and increase endometrium thickness.

Endometrial microstimulation effects on endometrial receptivity assessed by transvaginal color Doppler sonography.

This study investigated the effect of endometrial microstimulation (EM) on endometrial receptivity using transvaginal color Doppler sonography (TVCDS). Women of childbearing age who were preparing to conceive (n = 90) were randomly divided into the EM group (n = 30), who were examined by EM on days 3-5 of the menstrual cycle, and the control group (n = 60). TVCDS was conducted during the implantation window phase, and endometrial thickness, endometrial pattern, endometrial movement, blood flow type, and uterine and spiral arterial hemodynamic parameter measurements were made. The groups were compared to identify differences. Endometrial thickness (0.97 ± 0.18cm and 0.95 ± 0.17cm), endometrial movement (type 1: 46.7% and 51.7%; type 2: 30.0% and 28.3%; type 3: 6.7% and 5.0%; type 5: 16.7% and 15.0%), and hemodynamic parameters of the uterine (pulsatility index [PI]: 2.46 ± 0.50 and 2.41 ± 0.48; resistance index [RI]: 0.85 ± 0.05 and 0.84 ± 0.05) and spiral (PI: 1.11 ± 0.32 and 1.19 ± 0.33; RI: 0.48 ± 0.11 and 0.51 ± 0.08) arteries did not differ significantly between groups (P > 0.05). However, the endometrial pattern (a trilaminar pattern: 80.0% and 58.3%; P = 0.041) and blood flow type (type I: 16.7% and 43.3%; type II: 63.3% and 40.0%; type III 20.0% and 16.7%; P = 0.038) differed significantly between groups. Endometrial microstimulation did not alter endometrial pathological staging, endometrial thickness, or movement, nor did it affect uterine and spiral arterial blood flow parameters. However, it may be able to abrade abnormal endometrial tissue, optimizing the endometrial pattern. Endometrial microstimulation may support local spiral artery regeneration and increase endometrial blood supply in new cycles.

Executive Editor-in-Chief’s introduction for This Special Issue

Executive Editor-in-Chief’s introduction for This Special Issue

Use of biological and chemical molecules in regulating embryo implantation and endometrial receptivity

This review summarizes the drugs and chemicals that may modulate embryo implantation. Non-hormonal molecules, including aspirin, improved endometrial blood flow, while low molecular weight heparin, vitamin E, sildenafil, and atosiban modulated the expression of endometrial genes. Hormonal factors, including human chorionic gonadotropin and growth hormones, can regulate the expression of endometrial receptivity markers. Other immunomodulatory molecules, including granulocyte colony-stimulating factor, peripheral blood mononuclear cells, autologous platelet-rich plasma, and intralipid and intravenous immunoglobulins, may improve implantation rate by modulating endometrial immune functions. Medicinal extracts of the Chinese herbs Paeonia lactiflora and Perilla frutescens increased the expression of leukemia inhibitory factors in endometrial epithelial cells. Recently, the use of the commercially available Library of Pharmacologically Active Compounds with a high-throughput screening method has provided an approach to screen for compounds that may potentially enhance or suppress embryo implantation. Whether these biomedical findings translate into clinical effects that enhance or suppress embryo implantation requires further investigation.

Value of transvaginal three-dimensional ultrasound in evaluating the curative effect of Yangmo decoction in the treatment of uterine adhesion.

Intrauterine adhesions (IUA) is the damage of the basal layer of the endometrium caused by various reasons, resulting in adhesion of the uterine muscle walls to each other, which is manifested as clinical symptoms such as spanomenorrhea, amenorrhea, and infertility. Hysteroscopic adhesiolysis (HA) is the main treatment, for patients with moderate or severe adhesion or angular adhesion, the incidence of postoperative adhesion is high. Traditional Chinese medicine "Yangmo decoction" can promote endometrial growth. Three-dimensional transvaginal ultrasonography (3D-TVUS) can judge IUA and evaluate uterine receptivity through three-dimensional imaging. This study aims to investigate the value of 3D-TVUS in judging the efficacy of Yangmo decoction in the treatment of intrauterine adhesions. The clinical data of patients who underwent HA at two different centers in department of Gynecology of Third Xiangya Hospital of Central South University and Changsha Jiangwan Hospital from January 2021 to August 2021 were retrospectively collected. A total of 275 eligible patients were included. According to the postoperative management measures, the selected patients were divided into two groups. Yangmo decoction group (n=138): the use of Yangmo decoction and uterine-shaped silicon stent post HA; Hormone group (n=137): the use of estrogen, progesterone and uterine-shaped silicon stent post HA. The preoperative general data, preoperative and postoperative 3D-TVUS parameters of the two groups were analyzed. The endometrial thickness of Yangmo decoction group was thicker than that of hormone group (P<0.001), the intercornual distance was wider (P=0.016), the endometrial echo was more homogeneous (P=0.018), the percentage of bilaterally visible tubal opening was higher (P<0.001), the endometrial morphology was better (P=0.012), and endometrial blood flow, endometrial motility and uterine motion were better in Yangmo decoction group than that in the hormone group (all P<0.001). The endometrial thickness, echo, blood flow, and peristalsis, the number of visible tubal opening, uterine motion, and the intercornual distance obtained by 3D-TVUS examination are important factors to evaluate the prognosis of postoperative drug treatment for IUA. 3D-TVUS is of great significance in evaluating the efficacy of Yangmo decoction in the treatment of IUA.

The Effect of Magnesium Sulfate Administration At Day of Embryo Transfer on Improving Subendometrial Blood Flow, Endometrial Receptivity ,Implantation Rate and Clinical Pregnancy Rate.

For successful implantation, a high-quality embryo, receptive endometrium, and tight communication between the two are required. The lack of uterine contractions during embryo transfer is one of the characteristics that greatly affects endometrial receptivity. This is because it has been observed that ET may cause uterine contractions, which may be harmful to embryonic apposition and endometrial blood flow .The aim of this study was to assess how magnesium sulfate administration on the day of embryo transfer improve sub endometrial blood flow, endometrial receptivity, and increase implantation rate and clinical pregnancy rate . Eighty infertile women undergoing ART cycles participated in this prospective. Recombinant FSH (Gonal-F) was used in a controlled ovarian hyperstimulation technique. The first group A (n=40) got a 4gm infusion of magnesium sulfate, while the second placebo control group B (n=40) received 200ml of 5% glucose water as a placebo, respectively. While there were no significant changes in body mass index (BMI), endometrial thickness, number of transferred embryos, or embryo transfer day, significant variations were seen in patient mean age (p&lt;0.001) and mean number of grades I embryo (P=0.003). It was significantly different after magnesium sulfate administration with the lowest value in magnesium sulfate group (P=0.024; P &lt;0.001 and P &lt;0.001 respectively). Implantation rate and clinical pregnancy rate both increased after drugs administration although it was non- significant (P= 0.106 and P= 0.348 respectively). It appears that magnesium sulfate injection before to embryo transfer can significantly increase sub endometrial vascularity and endometrial receptivity and improving implantation rate and clinical pregnancy rate non significantly in ICSI cycles by lowering uterine muscular

An endometrial receptivity scoring system basing on the endometrial thickness, volume, echo, peristalsis, and blood flow evaluated by ultrasonography.

BackgroundEstablishing a successful pregnancy depends on the endometrium and the embryo. It is estimated that suboptimal endometrial receptivity account for one-third of implantation failures. Despite the indepth understanding of the processes associated with embryo-endometrial cross-talk, little progress has been achieved for diagnosis and treatments for suboptimal endometrial receptivity.MethodsThis retrospective study included women undergoing their first frozen-thawed embryo transfer (FET) cycles at our reproductive medicine center from March 2021 to August 2021. Transvaginal three-dimensional (3D) ultrasound was performed in the morning on the day of embryo transfer for all the thawed embryo transfer patients, to evaluate endometrial receptivity, including endometrial thickness, echogenicity, volume, movement and blood flow.ResultsA total number of 562 patients of FET with 315 pregnancies (56.0%) was analyzed. It was found that only the echo of the endometrial central line was different between the pregnant group and non-pregnant group. Other parameters, such as endometrial thickness, volume, endometrial peristalsis, or the endometrial blood flow were not statistically different between the two groups. Then, according to the relationship between the different groups and the clinical pregnancy rate, a score of 0 to 2 was respectively scored. The sum of the scores for the six items was the patient’s endometrial receptivity score. It showed that the clinical pregnancy rate increased as the endometrial receptivity score increased, and when the receptivity score reaches at least 5, the clinical pregnancy rate is significantly improved (63.7% versus 49.5%, P=0.001).ConclusionWe developed an endometrial receptivity scoring system and demonstrated its validity. It may aid clinicians in choosing the useful marker in clinical practice and for informing further research.

Nomogram prediction for the prediction of clinical pregnancy in Freeze-thawed Embryo Transfer

BackgroundThis study aimed to identify multiple endometrial receptivity related factors by applying non-invasive, repeatable multimodal ultrasound methods. Combined with basic clinical data, we further established a practical prediction model for early clinical outcomes in Freeze-thawed Embryo Transfer (FET).MethodsRetrospective analysis of clinical data of infertility patients undergoing FET cycle in our Center from January 2017 to September 2019. Receiver operating characteristic (ROC) curve and decision curve analyses were performed by 500 bootstrap resamplings to assess the determination and clinical value of the nomogram, respectively.ResultsA total of 2457 FET cycles were included. We developed simple nomograms that predict the early clinical outcomes in FET cycles by using the parameters of age, BMI, type and number of embryos transferred, endometrial thickness, FI, RI, PI and number of endometrial and sub-endometrial blood flow. In the training cohort, the area under the ROC curve (AUC) showed statistical accuracy (AUC = 0.698), and similar results were shown in the subsequent validation cohort (AUC = 0.699). Decision curve analysis demonstrated the clinical value of this nomogram.ConclusionsOur nomogram can predict clinical outcomes and it can be used as a simple, affordable and widely implementable tool to provide guidance and treatment recommendations for FET patients.

P-729 The cumulative clinical pregnancy and live birth rates of IVF in women treated for genital tuberculosis are similar to those in other infertility etiologies

Abstract Study question Is cumulative clinical pregnancy rate (CPR) and live birth rate (LBR) in infertile patients with treated genital tuberculosis similar to other infertility etiologies undergoing IVF? Summary answer There is no significant difference in cumulative CPR and LBR in women adequately treated for genital tuberculosis undergoing IVF compared to other etiology of infertility. What is known already Female genital tuberculosis (FGTB) is an important cause of infertility in high tuberculosis prevalent countries. The uterine endometrial environment is an important cradle for embryo development. Once violated with infection, the damage to the endometrial blood flow and uterine cavity morphology is likely to be irreversible leading to infertility even after cure with anti-tuberculosis therapy (ATT). Adequate treatment of FGTB involves medical therapy with ATT and surgical treatment of hydrosalpinges and endometrial adhesions. The cumulative CPR and LBR are reported to be lower in the treated endometrial tuberculosis than in non-tuberculosis infertile patients undergoing IVF. Study design, size, duration This is a retrospective analysis of women who underwent IVF with self-oocytes over a period of 4 years from 2015 to 2018. All patients were divided into two groups as: Group-1: All women treated with ATT for FGTB before IVF with all presentations including women who underwent surgery for hydrosalpinges or intrauterine synechiae except with severe intrauterine adhesions and unfit for embryo transfer (ET) Group-2: Patients undergoing IVF other infertility etiologies. Participants/materials, setting, methods Women undergoing ovum pickup along with subsequent fresh and frozen embryo transfer attempts until attained a live birth or all the embryos were used. Exclusion criteria: Main results and the role of chance A total of 948 women underwent OPU during the study period. 171 were excluded from analysis for following reasons: Total of 775 women were included for analysis and results are summarized as: The mean number of embryos per OPU was 7.04 in Group-1 while 6.97 in Group-2. A total of 195 ET procedures were done in Group-1 while 1035 in Group-2. The mean number of ET procedures required for one clinical pregnancy in Group-1 was 3.15 and 2.81 in Group-2.The mean number of ET procedures required for one live birth in Group-1 was 3.42 and 3.02 in Group-2. CPR per ET procedure in Group-I was 31.79% while 35.55% in Group-2. All these differences were statistically insignificant. Limitations, reasons for caution The FGTB has a wide spectrum of presentation from a very early sub-clinical disease to an advanced stage with pelvic organ damage. The prognosis of IVF varies with the extent of disease. This study analyzed overall result while sub categories of FGTB were not analyzed. Wider implications of the findings Infertility after ATT treated FGTB has good IVF outcome. IVF outcome in these patients need to be studied based upon the extent of damage. We recommend undertaking an early IVF with good hope of live birth in ATT treated FGTB. Trial registration number Not applicable

Effect of Dual Trigger with Follicle Stimulating Hormone and Chorionic Gonadotropin Hormone on Ovulation Rate in Infertile Women received Aromatase Inhibitor Superovulation in Kirkuk City, Iraq

A prospective during the period October 2020 to April 2021, a comparative study was conducted at the Al-Nahrain University’s High Institute for Infertility Diagnosis and Assisted Reproductive Technologies (HIIDART). The study’s primary goal was to determine whether using a dual trigger (FSH and hCG) could increase the likelihood of achieving pregnancy. The participants in this study totaled one hundred women. Before taking part in the study, each participant signed a written informed consent form that was approved by the Al-Nahrain University’s Ethics Committee before participating. A total of one hundred and one women participated in the study, who were chosen from among those who attended the consultant clinic of the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in New York City. On the day of the IUI An ultrasound scan of the vaginal cavity was performed after 36 to 48 hours of trigger ovulation to confirm ovulation, measure, and evaluate the endometrial pattern, and assess sub endometrial blood flow. FSH, LH, Progesterone, and E2 levels were determined in a blood sample drawn on the same day for hormonal testing. Luteal phase support was initiated on the day of the IUI and continued for two weeks by administering 400 mg of progesterone vaginal suppository daily to the patient. Estimation of Beta human chorionic gonadotropins 14 days after IUI. The distribution of study groups by general characteristics is shown in Table 1. Study patients’ age was ranging from 19 to 39 years with a mean of 29.98 years and a standard deviation (SD) of ± 5.3 years. The highest proportion of study patients in all groups was aged between 25–34 years, overweighed, and complained from infertility for less than five years’ duration. The comparison in hormonal parameters between study groups at day of IUI is shown in Table 4.5. Mean of FSH level was significantly lower (p = 0.031) in group C than that in groups A and B (6.98 versus 9.06 and 9.3 IU/L respectively). Mean of E2 level was significantly higher (p = 0.001) in-group A than that in groups B and C (69.62 versus 53.32 and 36.65 pg/mL, respectively). The comparison in percentage of change in hormonal parameters at day of IUI compared to that at day of trigger according pregnancy outcome is shown in table (4.16). No significant differences between women who get pregnant than that in those who didn’t, in percentage of change of all other hormonal parameters at day of IUI (p ≥ 0.05) compared to that at day of trigger.

A Comparative Study of Uterine Artery Doppler Parameters and Endometrial Characteristics in Women with Unexplained Infertility and Fertile Women at a Nigerian Teaching Hospital

Objectives: To investigate the uterine artery Doppler parameters and endometrial characteristics in women with unexplained infertility.&#x0D; Methods: A prospective case-control study of 42 women with unexplained infertility and 42 fertile controls. Their mid-luteal phase transvaginal Doppler parameters of both uterine arteries and endometrial characteristics (endometrial blood flow, thickness and volume) were investigated and analysed. P values &lt; 0.05 was statistically significant.&#x0D; Results: The mean uterine artery pulsatility index (PI) and resistivity index (RI) of the cases (women with unexplained infertility) were significantly higher compared to the values in the fertile controls (PI = 2.81±0.61 vs 2.15±0.65; p=0.001) (RI= 0.87±0.08 vs 0.82±0.07; p=0.003). In addition, the end-diastolic volume (EDV) (6.12±4.17 vs 9.37±5.14; p=0.007) and endometrial-subendometrial blood flow (p=0.036) were significantly lower in the cases compared to the controls. Multivariate logistics analysis showed that PI was independently associated with infertile status (p=0.006). There was no significant difference in the mean PSV (48.69±10.9 vs 50.58±11.30; p=0.602), endometrial thickness (10.30+3.13 vs 10.72+3.10; p=0.544), endometrial volume (7.82+1.56 vs 8.23+1.71; p=0.323), mean age (32.28±4.062 vs 31.91±3.58 years; p=0.502), body mass index (26.15±2.71kg/m2 vs 25.24±2.85 kg/m2; p=0.18) menstrual bleeding days (4.07±0.89 days vs 4.02±0.95 days; p=0.481) duration of menstrual cycle (28.02±1.09 days vs 27.64±1.36 days; p= 0.162), smoking history (p=0.909) and alcohol intake (p=0.507) of the infertile women compared with the fertile controls, respectively.&#x0D; Conclusion: Women with unexplained infertility have increased uterine artery Doppler PI and RI and reduced endometrial-subendometrial perfusion compared with fertile controls.&#x0D; Authors&#x0D; A E Smart 1, G O Obajimi 2, A J Adekanmi 3 4, M O Obajimi 3

Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility

Hysterosalpingo-contrast sonography (HyCoSy) is the preferred method for evaluating fallopian tubal patency, and it is associated with improved rates of natural pregnancy among infertile patients. However, the mechanism underlying the improvement in pregnancy rates following HyCoSy remains unclear. This study aimed to investigate the effect of HyCoSy examination on endometrial receptivity as well as pregnancy rates among infertile women. This prospective study included 120 women with unexplained infertility who visited our department between June 2018 and February 2021. These patients were classified into the study group (n = 60) and the control group (n = 60) depending on their willingness to undergo three-dimensional HyCoSy in the present cycle (study group) or 6months later (control group). Endometrial characteristics, including endometrial thickness and pattern as well as the endometrial blood flow distribution pattern, were measured twice by transvaginal Doppler ultrasonography in the preovulatory phase before and after HyCoSy examination. Participants were followed for 6months to observe the outcome of spontaneous conception. Compared with the control group, the study group had a significantly higher cumulative pregnancy rate at 6months after HyCoSy (21.6% [13/60] vs 5.0% [3/60], P = 0.007). More patients in the study group showed improved endometrial blood flow distribution (P = 0.021, χ2 = 7.699), but no differences in endometrial thickness and pattern were observed between the groups (P > 0.05). HyCoSy examination may improve endometrial perfusion and has a therapeutic effect on improving spontaneous pregnancy among women with unexplained infertility.