European Journal of Obstetrics & Gynecology and Reproductive Biology
The role of three-dimensional power Doppler ultrasound parameters measured on hCG day in the prediction of pregnancy during in vitro fertilization treatment
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.
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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).
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These authors contribute equally to this study.