Subendometrial Flow Index Research Articles

Endometrial Volume, and Sub-Endometrial Blood Flow Indices as Predictors of ICSI Success

Objective: This study designed to evaluate the endometrial volume, and the sub-endometrial flow indices as predictors of ICSI success.Study Design: Fifty infertile women included in this study, and received long pituitary downregulation protocol followed by hMG controlled hyperstimulation until ≥ 3 ovarian follicles 18-20 mm in diameter detected. Ovulation triggered by hCG, followed by oocytes retrieval 34-36 hours after hCG trigger. Day 2 or 3 embryo transfers done for all studied women, followed by quantitative β-hCG 14 days after the embryo transfers, and transvaginal sonography to diagnose clinical pregnancy. Studied women evaluated by the 3D ultrasound, and 3D power Doppler angiography at the day of the embryo transfers to assess the endometrial volume, and the sub-endometrial flow indices as predictors of the ICSI success.Results: The endometrial volume, sub-endometrial vascularization index, flow index, and vascularization flow index were higher in successful ICSI compared to unsuccessful ICSI group, but the difference was not significant. The ROC analysis showed that the endometrial volume and the 3D power Doppler angiography parameters (vascularization index, flow index, and vascularization flow index indices) were not conclusive for prediction of successful clinical pregnancy after the current ICSI trials.Conclusion: The endometrial volume and the 3D power Doppler angiography indices were not predictive for the clinical pregnancy after the current ICSI trials.

Association Between Endometrial/Subendometrial Vasculature and Embryo Transfer Outcome: A Meta-analysis and Subgroup Analysis.

To examine the association between endometrial/subendometrial vasculature and in vitro fertilization-embryo transfer (IVF-ET) and frozen embryo transfer (FET) outcomes. A meta-analysis of studies using endometrial/subendometrial 3-dimensional ultrasound and power Doppler angiography was performed to examine the vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) in pregnant and nonpregnant women. Ten articles were analyzed, including 895 pregnant women and 882 nonpregnant women. A subgroup analysis of the measuring time showed that the endometrial VI (standardized mean difference [SMD], 0.57; 95% confidence interval [CI], 0.40, 0.74; P < .00001), FI (SMD, 0.56; 95% CI, 0.33, 0.78; P < .00001), and VFI (SMD, 0.45; 95% CI, 0.28, 0.61; P < .00001) measured on the ET day, but not on the human chorionic gonadotropin (hCG) trigger day, were significantly higher in pregnant than nonpregnant women. Additionally, the subendometrial FI was significantly increased in pregnant women on the both hCG day (SMD, 0.68; 95% CI, 0.31, 1.06; P = .004) and ET day (SMD, 0.30; 95% CI, 0.08, 0.52; P = .007). A subgroup analysis of cycle type showed that the endometrial VI (SMD, 0.52; 95% CI, 0.30, 0.74; P < .00001), FI (SMD, 0.44; 95% CI, 0.22, 0.66; P = .0001), and VFI (SMD, 0.45; 95% CI, 0.23, 0.67; P = .03) on the ET day were significantly increased in pregnant women in the FET subgroup. The subendometrial FI on the hCG day and endometrial VI, FI, and VFI on the ET day are potentially associated with pregnancy occurrence during IVF-ET. The endometrial VI, FI, and VFI could help identify appropriate timing for FET. However, the accuracy of these indices in predicting pregnancy occurrence must be further evaluated in additional large-scale studies.

The effect of fertility stress on endometrial and subendometrial blood flow among infertile women

BackgroundTo investigate the effect of fertility stress on endometrial and subendometrial blood flow among infertile women.MethodsThis case–control study was conducted in The First Affiliated Hospital of Zhengzhou University. The fertility problem inventory (FPI) was adopted to evaluate fertility stress. Three-dimensional power Doppler ultrasonography (3D PD-US) was performed during the proliferative phase of the menstrual cycle (days 5–11) to measure endometrial thickness, pattern, endometrial and subendometrial volume (V), the vascularization index (VI), the flow index (FI) and the vascularization-FI (VFI) index. Then, 300 infertile women were separated into two groups (high-score group and low-score group) based on total FPI scores and 80 healthy women were selected as controls.ResultsNo differences were found among all three groups with regard to general characteristics, endometrial thickness, pattern, endometrial and subendometrial V, VI and VFI. The endometrial and subendometrial FIs associated with different stress levels significantly differed among the three groups (F = 33.95, P < 0.001; F = 44.79, P < 0.001, respectively). The endometrial and subendometrial FIs in the control group were significantly higher than those in the high-score group and low-score groups. The endometrial and subendometrial FIs in the low-score group were significantly higher than those in the high-score group. The total FPI score was closely related to the endometrial and subendometrial FIs (r = −0.304, P < 0.001; r = −0.407, P < 0.001, respectively).ConclusionFertility stress was associated with endometrial and subendometrial flow index. Whether fertility stress might affect pregnancy outcome by reducing endometrial and subendometrial blood flow requires further research.

Decreased endometrial vascularity in patients with antiphospholipid antibodies–associated recurrent miscarriage during midluteal phase

To explore uterine arterial impedance and endometrial-subendometrial vascularity determined by two-dimensional Doppler ultrasonography (2D-DU) and three-dimensional ultrasonography and power Doppler angiography (3D-PDA) between patients with antiphospholipid antibodies-associated recurrent miscarriage (aPL-RM) and normal fertile women, and to further investigate the relationship between these parameters and endometrial microvessel density (MVD). Prospective observational study. Tertiary-care fertility center. A total of 109 aPL-RM patients (aPL-RM group) and 49 normal fertile women (control group). Uterine measurement by transvaginal ultrasonography and endometrial MVD in the midluteal phase was assessed for both groups. Endometrial thickness, volume, and MVD, uterine arterial pulsatility index (PI) and resistance index (RI), and the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrial and subendometrial regions were measured on day 7 of a natural cycle after ovulation. Both groups had similar endometrial thickness, volume, and MVD and uterine arterial PI and RI. Endometrial VI, FI, VFI, and subendometrial FI were significantly reduced in the aPL-RM group compared with the control group. None of the uterine arterial 2D-DU and endometrial-subendometrial 3D-PDA parameters correlated with the endometrial MVD in both groups. Endometrial and subendometrial vascularity was significantly impaired in aPL-RM patients during natural midluteal phase compared with normal fertile women, and endometrial MVD did not correlate with any of the acquired vascularity parameters.

A comparison of endometrial and subendometrial vascularity assessed by three-dimensional ultrasonography and power Doppler angiography between healthy fertile women and women with unexplained primary recurrent miscarriage

We compared the characteristics of endometrial-subendometrial vascularity 7 days after ovulation of a natural cycle by transvaginal three-dimensional ultrasonography and power Doppler angiography between 88 patients with unexplained recurrent miscarriage and 46 healthy fertile women. Endometrial vascularization index, flow index, and vascularization flow index, as well as subendometrial vascularization index and vascularization flow index, were reduced significantly in the group with unexplained recurrent miscarriage.

Recurrent miscarriage associated with antiphospholipid antibodies: assessment of endometrial and subendometrial characteristics by three-dimensional ultrasonography and power doppler angiography

OBJECTIVE: The antiphospholipid antibodies (APA) are recognized being closely related to recurrent miscarriage (RM). The aim of this study was to evaluate endometrial and subendometrial parameters by three-dimensional ultrasonography and power Doppler angiography (3D-PDA) in primary RM patients with APA (aPL-RM). DESIGN: A prospective observational study of vaginal 3D-PDA assessment for endometrial-subendometrial area in mid-luteal phase. MATERIALS AND METHODS: Out of 1109 primary RM patients between August, 2007 and January, 2010, 107 non-pregnant patients with anticardiolipin antibodies and/or lupus anticoagulant (aPL-RM group) and 46 fertile Control women without APA who have had one or more live births and no history of spontaneous abortions were enrolled. All subjects underwent a screening protocol to exclude the common genetic, anatomical, endocrine, immunological, behavioral and infectious factors associated with RM. Uterine arteries flow indices and endometrial-subendometrial vascularity were measured on the 7th day after the ultrasonographically confirmed ovulation by GE Voluson i machine. Endometrial volume (EV), subendometrial volume (sEV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the VOCAL (Virtual Organ Computer-aided AnaLysis) software. RESULTS: No significant differences were observed in EV,sEV, uterine arteries pulsatility index and resistive index between the two groups. aPL-RM patients had significantly lower subendometrial FI (P=.000), endometrial VI (P=.048) and FI (P=.000) as well as endometrial and subendometrial VFI (P=.000 and .011,respectively) than the Control group; but no significant difference in subendometrial VI (P=.260) could be detected between the two groups. CONCLUSION: A decrease in endometrial and subendometrial blood flows detected by 3D-PDA may demonstrate the impaired implantation environment in aPL-RM patients.

Comparison of endometrial and subendometrial blood flows among patients with and without hydrosalpinx shown on scanning during in vitro fertilization treatment

To compare endometrial and subendometrial blood flows among patients with and without hydrosalpinx (HSP) during in vitro fertilization treatment as measured by a three-dimensional power Doppler ultrasound. A prospective observational study. A tertiary assisted-reproduction unit. Twenty-one patients with HSP were compared with 42 matched controls without HSP. None. Endometrial thickness, endometrial pattern, endometrial volume, pulsatility index (PI) and resistance index (RI) of uterine vessels, and the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrial and subendometrial regions were measured on the day of oocyte retrieval. The proportion of the non-multilayered endometrial pattern was significantly higher in the HSP group than in the non-HSP group. Patients in the HSP group had significantly lower endometrial and subendometrial VI and VFI. Endometrial thickness, endometrial volume, uterine PI, uterine RI, and endometrial and subendometrial FI were similar between the two groups. No significant differences were observed in endometrial and subendometrial VI, FI, and VFI among patients with unilateral and bilateral HSP. A change in endometrial pattern and a decrease in endometrial and subendometrial blood flows may be the reasons for impaired implantation in patients with HSP.