Subendometrial Vascularization Research Articles

ENDOMETRIAL VOLUME AND SUBENDOMETRIAL VASCULARITY BY THREE-DIMENSIONAL POWER DOPPLER AND ITS CORRELATION WITH PREGNANCY OUTCOME IN FRESH EMBRYO TRANSFER ICSI CYCLES

Endometrial vascularity is essential in the early endometrial response to embryo implantation, and vascular changes can affect the uterine receptivity. The study aims to evaluate the role of endometrial volume and subendometrial blood flow measured by 3D power Doppler (3DPD) as predictors of pregnancy in fresh embryo transfer ICSI cycles. A prospective cohort study included 122 women undergoing their first ICSI cycles was performed between October 2018 and April 2020. On the day of maximum follicular growth; endometrial thickness, endometrial volume and subendometrial blood flow was assessed using 3DPD, and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained and compared between the pregnant and the non-pregnant group. Primary outcome was the clinical pregnancy rate. Out of 122 women, 41 (33.6 %) became pregnant, while 82 (66.4%) failed to become pregnant. The endometrial volume was comparable between the two groups (4.02 ± 1.08 vs. 4.50 ± 1.49, p=0.117). Similarly, the endometrial thickness was not different between both groups (9.48 ± 1.42 vs. 9.71 ± 1.53, p=0.197). Additionally, no significant differences in subendometrial VI, FI and VFI between both groups (p= 0.761, 0.265, 0.728 respectively). Evaluation of endometrial volume and subendometrial vascularity by 3DPD are not useful predictors of pregnancy in fresh embryo transfer ICSI cycles

HYSTEROSCOPIC CORRECTION OF INTRACAVITARY LESIONS DOES NOT AFFECT THE ENDOMETRIAL VOLUME AND SUBENDOMETRIAL VASCULARITY BEFORE ICSI

To evaluate the endometrial volume and subendometrial blood flow measured by three-dimensional power Doppler (3DPD) at the day of ovum pick-up after hysteroscopic correction of intracavitary lesions. A prospective cohort study enrolled 106 women undergoing their first ICSI cycles. All women had a history of previous hysteroscopic surgery for correction of intracavitary lesions within six months before ICSI trial. Fifty-five (51.9%) women had a history of polypectomy; 29 (27.4%) metroplasty, 12 (11.3%) adhesiolysis and ten (9.4%) had a history of myomectomy. A control group of 122 women with normal uterine cavity diagnosed by office hysteroscopy were included. On the day of ovum pick-up; endometrial volume and subendometrial blood flow was assessed using 3DPD, and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated and compared between both groups. Additionally, pulsatility index (PI) and resistance index (RI) of uterine vessels were assessed. The endometrial volume was comparable between both groups (4.28 ± 1.62 vs. 4.78 ± 1.44, p=0.055). Additionally, no significant differences in subendometrial VI, FI and VFI between both groups (p= 0.44, 0.13, 0.717 respectively). Finally, the uterine PI and RI were comparable between both groups (0.83 ± 0.06 vs. 0.84 ± 0.05 and 2.39 ± 0.57 vs. 2.38 ± 0.50, p= 0.981 and 0.577 respectively) Hysteroscopic correction of intracavitary lesions does not affect the endometrial volume and subendometrial vascularity before ICSI cycles

Impact of color Doppler assessment and interventions on the outcome of frozen-embryo transfer in infertile women

Context: A good blood supply is essential for endometrial receptivity which in turn impacts the outcome of frozen-embryo transfers (FETs) in infertile women. With the advent of Doppler ultrasound, studying endometrial blood flow has emerged as an important means of evaluating endometrial receptivity. Aim: This study was undertaken to assess the usefulness of color Doppler as a marker of predictor of outcome in FET cycles. Settings and Design: This was a retrospective study conducted at the Southend Fertility and IVF Centre on all women who underwent FET cycle as part of the infertility management at the center. Materials and Methods: A total of 400 women were recruited in the study with 200 in case group (Group A) and 200 in control group (Group B). Statistical analysis: Statistical analysis was carried out using data analysis software system, SPSS V27 and Microsoft excel. Results: In Group A, 70 (35%) women became pregnant and 130 (65%) did not conceive. On the other hand, in Group B, 55 (28%) women became pregnant, and 145 (72%) did not conceive. Conclusion: Endometrial and subendometrial vascularity as measured by color Doppler is a useful predictor for pregnancy in FET cycles. However, there is still no larger consensus as to whether measurement of endometrial and subendometrial blood flow using color Doppler is useful and whether it plays any role in predicting of the pregnancy cycle outcome. Further large randomized trials are required to reach to definite conclusion on this topic.

Endometrial Thickness and Subendometrial Vascularity in Anovulatory Polycystic Ovarian Syndrome Patients Treated by Metformin

Abstract Background PCOS, the commonest endocrinalogical disorder affecting women of age group between 18 and 44 years. PCOS compromises fertility through various pathways as hyperandrogenism, insulin resistance and impedance of the uterine and endometrial blood flow. Metformin improves the blood flow to the endometrium through reducing androgen level and correction of insulin resistance. The commonest parameters used to detect the endometrial receptivity outcome are endometrial vascular indices. Aim of the Work to evaluate the outcome of metformin administration in anovualtory PCO patients and its effect on the endometrium, including its role in ovulation and improvement of pregnancy rates. Patients and Methods this study included 85 patients from Ain Shams University outpatient gynecology and infertility clinic during the period from January 2018 till June 2018. These patients were investigated before treatment with ultrasound on day 14, 21 to evaluate the endometrial receptivity parameters such as endometrial thickness, uterine artery vascularity, endometrial and subendometrial vascularity. The patients received metformin 500mg three times per day for three months. After this duration they were reevaluated by ultrasound at days 14, 21 to detect any improvement. Results metformin therapy resulted in a significant increase of endometrial thickness and had a significant effect on uterine RI and PI. On the endometrial level, the endometrial and subendometrial R.I and P.I were significantly reduced after metformin treatment indicating better blood flow. Conclusion Metformin therapy improves endometrial vascularity, in addition to increasing endometrial thickness and improved impedance observed in uterine artery flow.

Assessment of Endometrial and Sub-endometrial Vascularity Before and After PRP Infusion in Frozen Embryo Transfer Cycles

Assessment of Endometrial and Sub-endometrial Vascularity Before and After PRP Infusion in Frozen Embryo Transfer Cycles

Subendometrial resistence and pulsatility index assessment of endometrial receptivity in assisted reproductive technology cycles

ObjectiveTo evaluate Subendometrial and Uterine artery resistance and pulsatility index continuous analysis as a predictor of Endometrial receptivity in Assisted Reproductive Technology (ART) Cycles.DesignSerial 2D transvaginal coloured power doppler ultrasound performed in women on ART cycle to evaluate a pattern that better predicts implantation rates. One hundred sixty-nine subjects on a prospective case control study were assessed. Uterine artery and Subendometrial resistance and pulsatility index was performed to all subjects at baseline (prior to ovarian controlled stimulation), at day 6, 8 and 10 of controlled ovarian stimulation, at trigger day and at embryo transfer day. Also the ratio of fluxometric parameters between Subendometrial blood flow and uterine artery was measured.ResultsNo statistical difference was noted between two groups in terms of demographics and ART procedures and scores. Uterine artery resistance and pulsatility index showed statistical difference between the two groups (implantation versus non-implantation group). Also statistical significance was obtained between two groups in terms of Subendometrial vascularization. Ratio between Subendometrial and Uterine artery showed lower values of fluxometric parameters in all range for the Subendometrial territory.ConclusionsSerial Subendometrial and Uterine artery fluxometry may be a useful tool for clinicians in predicting endometrial receptivity enhancing elective embryo transfers in the same ART cycle.

The Role of Endometrial Volume and Endometrial and Subendometrial Vascularization Parameters in a Frozen Embryo Transfer Cycle.

The role of three-dimensional power Doppler ultrasonography of the endometrium in assisted reproduction is still far from clear. In this retrospective cohort study, transvaginal three-dimensional power Doppler examinations were performed 30 min before frozen-thawed embryo transfer. After pregnancy tests, two cohorts were established: P (pregnant, n = 31) and NP (nonpregnant, n = 31). The study only included nullipara with no uterine abnormalities who were undergoing infertility treatment at the Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria. The main outcome measures were the vascularization flow index (VFI), flow index (FI), and vascularization index (VI) in the endometrium/subendometrium, assessed using Virtual Organ Computer-aided AnaLysis (VOCAL™), and the endometrial volume. A total of 62 patients were enrolled in the study, forming two cohorts (pregnant, P; nonpregnant, NP). There were no significant differences between the two cohorts with regard to demographic data, numbers of embryos transferred, or embryo grading, but there was a significant difference in endometrial volume (cohort P, 3.17 ± 0.84 mL; cohort NP, 2.36 ± 0.9 mL; P = 0.001) and the pregnancy rate rises with larger volume. No differences were observed in the vascularization parameters FI, VFI, and VI in the endometrium and subendometrium. In the cohort of pregnant patients, there were 26 (41.9%) live births, with 21 term deliveries (80.8%). The endometrial volume was larger in the cohort of pregnant patients. Measurements were performed 30 min before embryo transfer, and no differences were observed in vascularization parameters in the subendometrium and endometrium.

The measurement of endometrial volume and sub-endometrial vascularity to replace the traditional endometrial thickness as predictors of in-vitro fertilization success

To assess the value of endometrial thickness, volume, and sub-endometrial perfusion in women undergoing IVF. In 82 women candidate for ICSI, endometrial thickness and sub-endometrial perfusion were measured with a trans-vaginal 2 D ultrasound and 3 D power Doppler respectively on day of hCG trigger and Embryo transfer (ET). The primary outcome was the clinical pregnancy rate. Endometrial volume showing a statistically significant difference between pregnant and nonpregnant women (4.11 ± 1.19 vs. 3.4 ± 1.1 p = .019) on day of triggering and at ET (4.02 ± 1.15 vs. 3.45 ± 0.90, p = .022). VFI was significantly higher in pregnant group at both days of triggering and ET (0.54 ± 0.48 vs. 0.33 ± 0.31 and 0.47 ± 0.22 vs. 0.34 ± 0.2, p = .02). At cutoff values of 3.265 and 2.95 cm3 (70 & 80% sensitivity, specificity 64.5 & 51.6%, a positive predictive value 38.9 & 34.8%, and negative predictive value 87.0 & 88.9%) to predict pregnancy on the day of hCG trigger & ET respectively. Cutoff value for Endometrial VFI on the day of ET was 0.674 (sensitivity of 70%, specificity of 80.6%, PPV 53.8%, and NPV 89.3%). Higher endometrial volume and VFI were associated with pregnancy.

Uses of Ultrasound and Doppler in Assessment of Endometrial Receptivity in Patients of Unexplained Infertility

Background:although the majority of infertile couples was found to have an identifiable male or female factor, 15–30% was categorized as having ‘‘unexplained infertility’’. The endometrium is considered to be a key determinant in successful implantation. Endometrial receptivity is regulated by many factors including endometrial perfusion. Aim of the Work: this study aimedto detect the role of the two dimensional ultrasound and Doppler ultrasonographic uterine markers of implantation in patients of unexplained infertility compared to fertile participants. Patients and Methods: the study was performed on 50 patients presented to the outpatient clinic in Al-Hussein, Bab El-Shearia (Sayed Galal) Hospitals, Al-Azhar University from October 2017 to August 2018 and they were categorized into two groups: Group A (Patients group): it was included 30 participants presented with unexplained infertility. Group B) (Control group) who included 20 fertile women coming for contraception. Results: there was a significant statistical difference as regard the endometrial thickness between cases and controls, and the controls had a thicker endometrium. Lower pulsatility index (PI) in uterine artery in the controls compared to the infertile group. Increased sub endometrial vascularization in the controls compared to the infertile group. Conclusion:ultrasound as well as Doppler studies of the endometrial and subendometrial vascularization had a role in predicting endometrial receptivity. Uterine artery Doppler study and the endometrial thickness measurement had a role in detection of uterine receptivity.

Uses of Ultrasound and Doppler in Assessment of Endometrial Receptivity in Patients of Unexplained Infertility

Background:although the majority of infertile couples was found to have an identifiable male or female factor, 15–30% was categorized as having ‘‘unexplained infertility’’. The endometrium is considered to be a key determinant in successful implantation. Endometrial receptivity is regulated by many factors including endometrial perfusion. Aim of the Work: this study aimedto detect the role of the two dimensional ultrasound and Doppler ultrasonographic uterine markers of implantation in patients of unexplained infertility compared to fertile participants. Patients and Methods: the study was performed on 50 patients presented to the outpatient clinic in Al-Hussein, Bab El-Shearia (Sayed Galal) Hospitals, Al-Azhar University from October 2017 to August 2018 and they were categorized into two groups: Group A (Patients group): it was included 30 participants presented with unexplained infertility. Group B) (Control group) who included 20 fertile women coming for contraception. Results: there was a significant statistical difference as regard the endometrial thickness between cases and controls, and the controls had a thicker endometrium. Lower pulsatility index (PI) in uterine artery in the controls compared to the infertile group. Increased sub endometrial vascularization in the controls compared to the infertile group. Conclusion:ultrasound as well as Doppler studies of the endometrial and subendometrial vascularization had a role in predicting endometrial receptivity. Uterine artery Doppler study and the endometrial thickness measurement had a role in detection of uterine receptivity.

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.

Evaluation of endometrial and subendometrial vascularity in obese women with polycystic ovarian disease

Abstract Introduction The study aims to evaluate the effect of obesity on the endometrium in women with polycystic ovarian disease (PCOD) through evaluation of endometrial and subendometrial vascularity by two-dimensional (2D) ultrasound, Doppler and three dimensional power Doppler (3DPD). Methods A prospective case-control study, conducted in a tertiary University hospital between February 2016 and December 2016. The study included 50 women with PCOD and 50 fertile regular menstruating women divided according to their body mass index (BMI) into normal weight and overweight/obese groups. Endometrial thickness and pattern combined with Doppler examination of the uterine vessels for measurement of Resistance index (RI) and pulsatility index (PI) were assessed. Evaluation of endometrial and subendometrial blood flow was performed by 3DPD using Virtual organ computer-aided analysis program. Results No significant difference in the endometrial pattern or thickness between all study groups. Endometrial volume was significantly lower in the overweight/obese PCOD women and overall in the PCOD women compared to the control group (p Conclusions The endometrium is negatively affected by obesity in women with PCOD. Additionally, PCOD women had lower endometrial and subendometrial blood flow than non-PCOD women. Therefore, overweight/obese PCOD women should be encouraged to reduce their body weight in order to improve the endometrial receptivity.

Effect of clomiphene citrate on uterine hemodynamics in women with unexplained infertility.

PurposeThe aim of the study was to evaluate the effect of clomiphene citrate on uterine artery blood flow using pulsed Doppler and endometrial and subendometrial micro vascularization using 3D power Doppler in unexplained infertility.Patients and methodsIn a prospective observational study at a university teaching hospital, the mid-luteal (peri-implantation) endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were compared between natural and clomiphene citrate stimulated cycles in the same group of 50 patients with unexplained infertility. Statistical analysis was done using paired t-test to compare different study variables.ResultsThe primary outcome, which was the endometrial flow index, was significantly lower in the stimulated cycles (mean ± SD: 23.89±7.96 vs 27.49±8.73, mean difference (95% CI): −3.6 (−2, −5.9); P=0.03). The mean ± SD of endometrial thickness (10.92±3.04 vs 12.46±3.08 mm; P=0.01), volume (4.57±1.28 vs 5.26±1.32 cm3; P=0.009), endometrial VI (0.86±0.15 vs 0.95%±0.21%; P=0.02), VFI (0.25±0.08 vs 0.31±0.12; P=0.004), subendometrial VI (1.93±0.68 vs 2.26%±0.75%; P=0.02), FI (26.81±9.16 vs 30.73±9.87; P=0.04), and VFI (0.68±0.18 vs 0.79±0.21; P=0.006) were significantly lower in the stimulated cycles. However, there were no significant differences in the uterine artery PI (P=0.12) and RI (P=0.08) or serum estradiol (P=0.54) and progesterone (P=0.37) levels between natural and stimulated cycles.ConclusionPeri-implantation endometrial perfusion is significantly lower in clomiphene citrate stimulated cycles when compared to natural ones in patients with unexplained infertility.

The role of angiogenic factors in first trimester pregnancy losses

Objective: A good blood supply towards the peri-implantation endometrium is an essential requirement for pregnancy. Intermedin (IMD), vascular endothelial growth factor (VEGF), and endothelial nitric oxide synthase (eNOS), are angiogenic and vasoactive agents that play contributory roles in endometrial vascularity. The goal of this study was to immunohistochemically investigate the roles of various vasoactive factors in first trimester pregnancy losses. Materials and Methods: This was a prospective case-controlled study carried out on decidual and placental tissue samples obtained from women with unwanted pregnancies who served as the control group (n=10), and those with missed abortions who were the “missed abortion group”(n = 10). Immunohistochemistry techniques were used to compare IMD, receptor activity modifying protein (RAMP)1, RAMP2, RAMP3, VEGF, and eNOS expression of decidual and placental cells. Immunostaining for these factors was evaluated semiquantitatively by H-score analysis. Results: IMD and RAMPs in decidual cells exhibited higher expression in the control group. However, IMD and RAMP2 had a stronger expression in placental cells in the missed abortion group. In the control group, VEGF and eNOS had a higher expression in decidual cells and on the placental side, especially in syncytiotrophoblasts and cytotrophoblasts. Conclusion: Expressions of vasoactive agents, such as IMD, VEGF, and eNOS, decrease in first trimester pregnancy losses. Additionally, a compensatory mechanism against decreased endometrial and subendometrial vascularity results in the death of the embryo/fetus enhances in missed abortion cases. This mechanism characterized by increased expressions of IMD and RAMP2 initially begins in the syncytiotrophoblasts and cytotrophoblasts.

Can We Predict Menorrhagia with Intrauterine Contraceptive Device (IUCD) Insertion?

Objective: Studying sub endometrial vascularity and blood flow in cases using intrauterine contraceptive devices for contraception with and without menorrhagia compared to cases not using intrauterine contraceptive devices. Methods: Three hundred and fifteen women attending gynecology and family planning outpatient clinics in the maternity hospital, Ain Shams University were included in the study. They were classified into three groups, 105 women using IUCD with menorrhagia (group I), 105 women using IUCD without menorrhagia (group II), and 105 normal controls not using IUCD (group III). After excluding local causes for bleeding, blood disease or any medical disorders, transvaginal ultrasound including three dimensional power Doppler (3DPD) ultrasound was done for all women. Right and left uterine artery pulsatility index (PI) and resistance index (RI) were calculated, subednometrial blood flow RI and PI were obtained then 3DPD Vascular indices (VI, FI and VFI) of subendometrial blood flow were obtained for all cases. Statistical analysis was done to compare between the three groups. Results: A significant statistical difference was found as regards subendometrial vascularity indices, while there was no difference as regards bilateral uterine arteries Doppler indices in the three groups. Conclusion: Subendometrial vascularity in cases of menorrhagia with IUCD was markedly higher than in cases without menorrhagia and cases with no IUCD. 3DPD may be used for selection of cases prior to insertion of IUCD.

Subendometrial vascularity and high sensitive C-reactive protein in patients with unexplainedinfertility undergoing endometrial scratching prior to intrauterine insemination

Subendometrial vascularity and high sensitive C-reactive protein in patients with unexplainedinfertility undergoing endometrial scratching prior to intrauterine insemination

Endometrial and Subendometrial Vascularity by Three-Dimensional (3D) Power Doppler and Its Correlation with Pregnancy Outcome in Frozen Embryo Transfer (FET) Cycles.

To study the role of endometrial and subendometrial blood flow measured by 3D power Doppler as predictors of pregnancy in frozen embryo transfer (FET) cycles. A hospital-based prospective study of two hundred and twenty-one (221) women undergoing FET cycles with a triple-line endometrium ≥7mm on day 14 endometrial and subendometrial blood flow was assessed using 3D power Doppler, and various indices endometrial volume, subendometrial volume and their vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI) were obtained and compared between the pregnant and the non-pregnant group. Primary outcome was clinical pregnancy. Out of 221 women, 97(43.89%) became pregnant, while 124 (56.10%) failed to become pregnant. The endometrial volume was comparable between the two groups. Endometrial VI, FI and VFI were significantly higher in the pregnant as compared to the non-pregnant group. There was a significant difference in subendometrial VI and VFI between the two groups, but FI was similar. Endometrial and subendometrial vascularity by 3D power Doppler can be a useful parameter in predicting pregnancy in FET cycles.

Three-dimensional power Doppler study of endometrial and subendometrial microvascularization in women with intrauterine device–induced menorrhagia

To evaluate endometrial and subendometrial microvascularization, using three-dimensional (3D) power Doppler ultrasound, in women with intrauterine device (IUD)-induced menorrhagia; and whether those potential findings could predict the risk of bleeding before IUD insertion. Prospective clinical trial. University teaching hospital. One hundred twenty women, who requested the insertion of a copper IUD for contraception. Endometrial thickness and volume, uterine artery pulsatility index and resistance index, and endometrial and subendometrial 3D power Doppler vascularization index, flow index, and vascularization flow index were measured twice: immediately before and 3 months after IUD insertion. Doppler indices before and after IUD insertion. Before IUD insertion, no significant difference was detected in the clinical characteristics, endometrial thickness and volume, and Doppler indices between women who had IUD-induced menorrhagia (n = 47) and those without menorrhagia (n = 73). However, after IUD insertion, there was a significant increase in the endometrial and subendometrial vascularization index, flow index, and vascularization flow index in women with menorrhagia, whereas other parameters remained not significantly different between the two groups. Endometrial and subendometrial microvascularization increases in women with IUD-induced menorrhagia; however, this finding has no predictive value before IUD insertion.

Value of 3-Dimensional and Power Doppler Sonography for Diagnosis of Endometrial Polyps

To investigate whether the endometrial thickness, endometrial volume, and endometrial and subendometrial vascularization index, flow index, and vascularization-flow index were useful for diagnosing endometrial polyps in infertility. Transvaginal and 3-dimesional power Doppler sonography was performed to calculate the endometrial echogenicity, endometrial thickness, endometrial volume, and endometrial and subendometrial vascularization index, flow index, and vascularization-flow index, followed by hysteroscopy in the follicular phase of the menstrual cycle (postmenstrual days 3-7). A total of 555 patients were selected, and 4 groups were defined according to the comparison of sonographic and hysteroscopic diagnoses: group A (sonographically positive but hysteroscopically negative), group B (sonographically and hysteroscopically negative), group C (sonographically negative but hysteroscopically positive), and group D (sonographically and hysteroscopically positive). A total of 426 patients were enrolled in the final analysis. Significantly higher endometrial thickness and volume were found in groups C and D compared with groups A and B (P < .05). There were no significant differences among the 4 groups in terms of the endometrial and subendometrial vascularization index, flow index, and vascularization-flow index (P > .05). The sensitivity, specificity, and positive and negative predictive values of endometrial thickness and volume in predicting endometrial polyps were 62.7%, 69.8%, 26.9%, and 91.9% and 39.3%, 88.2%, 35.8%, and 89.7%, respectively. Combined sonographic evaluation (sonographic echogenicity, endometrial thickness, and endometrial volume) showed higher sensitivity, specificity, and positive and negative predictive values (65.6%, 89.0%, 50.0%, and 93.9%) compared with a single indicator. A combination of endometrial echogenicity, thickness, and volume on sonography may be better than a single indicator for predicting endometrial polyps in infertility. However, the endometrial or subendometrial vascularization index, flow index, and vascularization-flow index are not useful for prediction.

Letrozole and Clomiphene Citrate Effect on Endometrial and Subendometrial Vascularity in Treating Infertility in Women with Polycystic Ovary Syndrome

Objective: Letrozole appears not to have any of the adverse effects on the endometrium that are frequently associated with clomiphene citrate (CC) during ovulation induction. The aim of the study is to compare the effect of letrozole compared to CC on endometrial thickness and endometrial and subendometrial blood flow. Materials and methods: Infertile women with polycystic ovary syndrome (PCOS) were allocated for ovulation induction; 102 women were treated with Letrozole and 99 women with CC. Thirty-five patients from the CC group showed a resistance to or failure of CC with a thin endometrium, and were re-treated with letrozole. The main outcome measures were ovulation and pregnancy rates/cycle, endometrial thickness, detection rates, and resistance index (RI) and pulsatility index (PI) of subendometrial and endometrial blood flow. Results: In spite of a nonsignificant difference in ovulation rate between letrozole and CC groups (70.6% vs. 64.6%), a clinical pregnancy rate was achieved in 29/102 (28.4%) women with letrozole and 20/99 (20.2%) women with CC treatment (p<0.05) and in 6/35 (17.1%) in women re-treated with letrozole after CC resistance or failure. There were significant differences in endometrial thickness, detection rates, and RI and PI of subendometrial and endometrial blood flow between the two groups and between 35 women re-treated with letrozole after CC resistance or failure when compared with CC treatment alone. Conclusions: Letrozole may increase fertility by improving endometrial receptivity compared with CC alone. (J GYNECOL SURG 28:405)