Analysis of endometrial blood flow with color Doppler energy in predicting outcome in GnRH antagonist down regulated ICSI/IVF cycles: a prospective cohort study setting
Keywords:Doppler study, Endometrial blood flow, IVF
Background: The study was conducted to assess the association between endometrial blood flow pattern assessed with colour Doppler around the day of HCG administration and IVF outcome following GnRH antagonist down regulated cycles.
Methods: It was a prospective, cohort study. Total of sixty-eight patients undergoing IVF-ET/ICSI were recruited in the study. All the patients underwent controlled ovarian stimulation with a step-up protocol, and GnRH antagonists were used for down-regulation. Transvaginal ultrasound measurements of all patients were performed on the day of HCG injection. A 6.5 MHz pulsed Doppler system was used for blood flow analysis. Bilateral uterine arteries, pulsatility index and resistance index were calculated along with uterine artery peak systolic velocity on both sides. Endometrial blood flow was analysed by detecting flow in the intra-endometrial or the adjacent sub-endometrial regions.
Results: Baseline FSH in pregnant group was lower (6.29) than non-pregnant group (7.36). The overall pregnancy rate was 45.6% (n=31) and the ongoing pregnancy rate was 41.1% (n=28). Total of 57 patients out of 68 patients had both good endometrial and sub-endometrial blood flow. The overall pregnancy rate in this group was 47.3%. Similarly, in patients who had minimal endometrial and sub-endometrial blood flow the pregnancy rate was 37.5%. There was no significant correlation between pregnancy outcomes and the color flow Doppler parameters such as average uterine PI, average uterine RI and right/left uterine peak systolic velocity.
Conclusion: Uterine artery PI, RI and PSV has no role in predicting endometrial receptivity and thus pregnancy outcome in IVF-ET cycle, however those patient with good endometrial and sub-endometrial flow have higher pregnancy rate than those with minimal flow rate.
Kinay T, Tasci Y, Dilbaz S, Cinar O, Demir B, Haberal A. The relationship between endometrial thickness and pregnancy rates in GnRH down-regulated ICSI cycles. Gynecol Endocrinol. 2010;26(11):833-7.
Wang L, Qiao J, Li R, Zhen X, Liu Z. Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles. Reprod Biol Endocrinol. 2010;8:122.
Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum Reprod Update. 2014;20:530-4.
Aydin T, Kara M, Turktekin N. Relationship between endometrial thickness and in vitro fertilization/intracytoplasmicsperm injection outcome. Int J Fertil Steril. 2013;7:29-34.
Kumbak B, Erden HF, Tosun S, Akbas H, Ulug U, Bahçeci M. Outcome of assisted reproduction treatment in patients with endometrial thickness less than 7 mm. Reprod Biomed Online. 2009;18:79-84.
Levi AJ, Drews MR, bergh PA, Miller BT, Scott RT Jr. Controlled ovarian hyperstimulation does not adversely affect endometrial receptivity in in vitro fertilization cycles. Fertil Steril. 2001;76:670-4.
Orvieto R, Meltzer S, Rabinson J, Zohav E, Anteby EY, Nahum R. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity. Fertil Steril. 2008;90:1294-6.
McWilliams GD, Frattarelli JL. Changes in measured endometrial thickness predict in vitro fertilization success. Fertil Steril. 2007;88:74-81.
Hernandez ER. Embryo implantation and GnRH-antagonists: embryo implantation: the Rubicon for GnRH antagonists. Hum Reprod. 2000;15:1211-6.
Singh N, Bahadur A, Mittal S, Malhotra N, Bhatta 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.
Noyes RW, Hertig AT, Rock J. Dating the endometrium. Fertil Steril. 1950;1:3-35.
Evans GE, Phillipson GT, Sin IL, Frampton CM, Kirker JA, Bigby SM, et al. Gene expression confirms a potentially receptive endometrium identified by histology in infertile women. Hum Reprod. 2012;27(9):2747-55.
Jinno M, Ozaki T, Iwashita M, Nakamura Y, kudo A, Hirano H. Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation. Fertil Steril. 2001;76:1168-74.
Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotropin-releasing hormone antagonists for assisted conception. Cochrane Database Syst Rev. 2006;3:CD001750.