The role of three-dimensional power Doppler ultrasound parameters measured on hCG day in the prediction of pregnancy during in vitro fertilization treatment

https://doi.org/10.1016/j.ejogrb.2016.05.016Get rights and content

Abstract

Objective

To investigate the value of ultrasound for the assessment of endometrial receptivity during in vitro fertilization (IVF) and embryo transfer (ET).

Materials and methods

Only those patients in their first IVF cycle, followed a standard long gonadotropin releasing hormone (GnRH) agonist long ovarian stimulation regimen, and had 2 highest scoring embryos transferred on day 3 were included in the study. A 3D ultrasound examination was performed on the day of human chorionic gonadotropin (hCG) injection to determine endometrial thickness, endometrial pattern, peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistance index (RI) of endometrial spiral arteries, endometrial volume, vascularization index (VI), flow index (FI) and vasculariztion flow index (VFI) of endometrial and subendometrial region. Analyses were carried on between pregnant and non-pregnant groups, and miscarriage and ongoing pregnant groups.

Results

435 patients were included in the study, in which 235 (58.8%) got clinical pregnancy, and 49 suffered miscarriage. Patients in both pregnant group and non-pregnant group, and miscarriage and ongoing pregnant group did not show significant difference in endometrial thickness, endometrial volume, endometrial pattern, uterine PI, RI, S/D, endometrial and subendometrial VI, FI and VFI. In relative thin endometrium group, pregnant patients had similar endometrial thickness, endometrial volume, endometrial pattern, uterine PI, RI, S/D, endometrial and subendometrial VI, FI and VFI with non-pregnant patients.

Conclusion

3D PDUS parameters of endometrium measured on hCG day were not good predictors of pregnancy in IVF treatment, neither good predictors of ongoing pregnancy.

Introduction

For assisted reproductive technologies, the establishment of pregnancy requires competent embryos as well as synchronized endometrium that can accommodate embryo implantation. In IVF-ET, endometrial receptivity accounts for more than 60% failed implantations [1]. Over the decades, variable methods were used to evaluate endometrial receptivity, such as histological evaluation of an endometrial biopsy [2], endometrial proteins in uterine flushing [3], and ultrasound examination of the endometrium [4], [5].

Ultrasound examination of the endometrium provides a non-invasive and convenient way to evaluate endometrial receptivity [6]. An endometrial thickness greater than 7 mm and a triple-layer endometrial pattern have been proposed as markers of endometrial receptivity while have yielded a high percentage of false-positive results [5]. Uterine blood flow has been supposed to be associated with endometrial receptivity [7], while others prefer to propose endometrial and subendometrial blood flows more proper to predict pregnancy because the endometrium is the site where embryonic implantation takes place [8].

Three-dimensional ultrasound and power Doppler angiography (3D US PDA) is a useful clinical examination which can provide a fast, simple means of obtaining a great many ultrasound endometrial parameters associated with endometrial receptivity, including endometrial thickness, endometrial pattern, endometrial volume and Doppler study of uterine arteries and endometrial vascularity [5]. The aim of our study was to evaluate the 3D PDUS parameters as possible implantation markers and pregnancy predictors in an IVF/ICSI and embryo transfer program.

Section snippets

Materials and methods

Infertile patients who underwent a first IVF/ICSI-ET cycle with a GnRH long protocol with stimulation by recombinant follicle stimulating hormone (rFSH) between April 2014 and June 2015 in the Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China were prospectively recruited. All patients with congenital uterine abnormalities, adenomyosis, endometriosis, endometrial polyps, uterine myomata or hydrosalpinxwere excluded. The serum basal

Results

During the study period, a total of 529 patients received ovarian stimulation for their first IVF cycle, and 506 patients proceeded to oocyte retrieval (cycle cancellation in 23patients due to poor ovarian response). Fifteen patients were excluded after ultrasound scanning because of uterine abnormality (6 with congenital uterine abnormality, 6 endometrial polys, and 3 uterine fibroids). 32 patients had less than two embryos to transfer, and embryo transfer was postponed in 24 cycles because of

Discussion

Over the decades, researchers tried to explore the value of 3D US PDA in evaluating endometrial receptivity, but still remains controversial. Reviewing of relevant literatures, we found that most of the studies were with quite limited sample size, and many of them were carried out several years before, even with varied hyper stimulated methods and different time point of ultrasound examination which may compromise the reliability to some extent. [9], [10], [11], [12].

Here our study evaluated

Conclusions

Taken together, our study reveals that 3D PDUS parameters of endometrium measured on hCG day were not good predictors of pregnancy in IVF treatment, neither good predictors of ongoing pregnancy.

Author disclosure statement

No competing financial interests exist.

Acknowledgements

This work was supported by The National Basic Research Program (973 Program; Grant No. 2014CB943300), the Research Special Fund of National Health and Family Planning Commission, China (Grant No. 201402004) and the National Natural Science Foundation of China (81571499).

References (17)

There are more references available in the full text version of this article.

Cited by (0)

1

These authors contribute equally to this study.

View full text