DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221671

A study of correlation of endometrial morphology and subendometrial vascularity with pregnancy rate in fresh and frozen embryo transfer cycles

Mugdha A. Parasnis, Udaya K. Bandaru

Abstract


Background: Aim of the study was to evaluate the correlation of endometrial morphology and sub endometrial vascularity with pregnancy rate in fresh and frozen embryo transfer cycles.

Methods: Prospective, non-randomized observational study done on 76 women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at a tertiary health care center. Woman with tubal factor, male factor and unexplained infertility were included in the study. Parameters like endometrial thickness, endometrial pattern, endometrial blood flow were correlated to clinical outcomes such as implantation and clinical pregnancy rates. Independent two-tailed t-test and chi-square test was used as a part of statistical analysis.

Results: There is no significant difference in distribution of mean age, mean duration of infertility, cause of infertility, mean basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P4), anti-Mullerian hormone (AMH), total gonadotropin dose, median E2 (on day of trigger), median P4 (on day of trigger), number of embryos transferred and endometrial thickness between group of cases with positive and negative pregnancy in our study group. Whereas body mass index (BMI), blastocyst quality of embryo transferred, triple-line pattern of endometrium and endometrial blood flow reaching zone 4 were found to be significant in the study group.

Conclusions: A combination of endometrial thickness and Doppler analysis of endometrial blood flow was a simple and effective tool to improve pregnancy rates in hormone replacement treatment-frozen embryo transfer (HRT-FET) cycles and should be incorporated into routine clinical practice. In addition, this can help us reduce the number of embryos to be transferred and hence, the multiple pregnancies and the associated complications.

 


Keywords


Frozen-thawed embryo transfer, Power Doppler, Subendometrial-endometrial blood flow

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References


Singh N, Bahadur A, Mittal S, Malhotra N, Bhatt A. Predictive value of endometrial thickness, pattern and sub-endometrial blood flows on the day of hCG by 2D doppler in in-vitro fertilization cycles: A prospective clinical study from a tertiary care unit. J Hum Reprod Sci. 2011;4(1):29-33.

Navot D, Scott RT, Droesch K, Veeck LL, Liu HC, Rosenwaks Z. The window of embryo transfer and the efficiency of human conception in vitro. Fertil Steril. 1991;55(1):114-8.

Duc-Goiran P, Mignot TM, Bourgeois C, Ferre F. Embryo-maternal interactions at the implantation site: a delicate equilibrium. Eur J Obstet Gynecol Reprod Biol. 1999;83(1):85-100.

Simon C, Martin JC, Pellicer A. Paracrine regulators of implantation. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(5):815-26.

Turnbull LW, Lesny P, Killick SR. Assessment of uterine receptivity prior to embryo transfer: a review of currently available imaging modalities. Human Reproduction Update. 1995;1:505-14.

Fanchin R. Assessing uterine receptivity in 2001: ultrasonographic glances at the new millennium. Ann N Y Acad Sci. 2001;943:185-202.

Sardana D, Upadhyay AJ, Deepika K, Pranesh GT, Rao KA. Correlation of subendometrial-endometrial blood flow assessment by two-dimensional power Doppler with pregnancy outcome in frozen-thawed embryo transfer cycles. J Hum Reprod Sci. 2014;7:130-5.

Singh N, Bahadur A, Mittal S, Malhotra N, Bhatt A. Predictive value of endometrial thickness, pattern and sub-endometrial blood flows on the day of hCG by 2D doppler in in-vitro fertilization cycles: A prospective clinical study from a tertiary care unit. J Hum Reprod Sci. 2011;4:29-33.

Kupesic S, Bekavac I, Bjelos D, Kurjak A. Assessment of endometrial receptivity by transvaginal fertilization procedures. J Ultrasound Med. 2001;20:125-34.

Wu HM, Chiang CH, Huang HY, Chao AS, Wang HS, Soong YK. Detection of the subendometrial vascularization flow index by three-dimensional ultrasound may be useful for predicting the pregnancy rate for patients undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2003;79(3):507-11.

Mercè LT, Barco MJ, Bau S, Tryano J. Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome? Fertil Steril. 2008;89(1):111-7.

Scioscia M, Lamanna G, Lorusso F, Serrati G, Selvaggi LE, Depalo R. Characterization of endometrial growth in proliferative and early luteal phase in IVF cycles. Reprod Biomed Online. 2009;18(1):73-8.

Kader MA, Abdelmeged A, Mahran A, Samra MFA, Bahaa H. The usefulness of endometrial thickness, morphology and vasculature by 2D Doppler ultrasound in prediction of pregnancy in IVF/ICSI cycles. Egypt J Radiol Nuclear Med. 2016;47(1):341-6,

Yuan X, Saravelos SH, Wang Q, Xu Y, Li TC, Zhou C. Endometrial thickness as a predictor of pregnancy outcomes in 10787 fresh IVF-ICSI cycles. Reprod Biomed Online. 2016;33(2):197-205.

Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, Broekmans FJ. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(4):530-41.

Sher G, Herbert C, Maassarani G, Jacobs MH. Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET). Hum Reprod. 1991;6(2):232-7.

Bohrer MK, Hock DL, Rhoads GG, Kemmann E. Sonographic assessment of endometrial pattern and thickness in patients treated with human menopausal gonadotropins. Fertil Steril. 1996;66(2):244-7.

Chen SL, Wu FR, Luo C, Chen X, Shi XY, Zheng HY, et al. Combined analysis of endometrial thickness and pattern in predicting outcome of in vitro fertilization and embryo transfer: a retrospective cohort study. Reprod Biol Endocrinol. 2010;8:30.

Bourgain C, Devroey P. The endometrium in stimulated cycles for IVF. Hum Reprod Update. 2003;9(6):515-22.

Friedler S, Schenker JG, Herman A, Lewin A. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update. 1996;2(4):323-35.

Applebaum M. The uterine biophysical profile. Ultrasound Obstet Gynecol. 1995;5:67-8.

Chien LW, Au HK, Chen PL, Xiao J, Tzeng CR. Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2002;78:245-51.

Jaffe R, Warsof SL. Transvaginal color Doppler imaging in the assessment of uteroplacental blood flow in the normal first-trimester pregnancy. Am J Obstet Gynecol. 1992;164:781-8.

Abulafia O, Sherer DM. Angiogenesis of the ovary. Am J Obstet Gynaecol. 2000;182:240-6.