Vaginal color Doppler assessment of uterine artery impedance correlates with immunohistochemical markers of endometrial receptivity required for the implantation of an embryo.
OBJECTIVE
To investigate the correlation between uterine artery impedance with immunohistochemical histologic, and ultrasonographic markers of uterine receptivity.


METHODS
A prospective study of subfertile women undergoing a frozen embryo replacement cycle.


METHODS
A tertiary infertility clinic.


METHODS
The study was based on 86 patients who had failed to become pregnant during a standard IVF treatment cycle and who had at least two good quality embryos cryopreserved.


METHODS
All patients had pituitary desensitization with the GnRH analogue buserelin acetate, followed by E2 and P replacement therapy. Vaginal color Doppler images of both uterine arteries were obtained on days 7, 14, and 21 of the first (trial) cycle. On day 21, an endometrial biopsy was taken for dating a 24-kd protein, placental protein 14, and E2 receptor assessment. After a menstrual bleed had been induced, administration of estrogen and P was reinstituted and embryos transferred to the uterus on the 3rd or 4th day of P administration.


METHODS
The mean pulsatility index of the left and right uterine arteries, a semiquantitative score of endometrial 24-kd protein, PP14, and E2 receptor assessment, endometrial histologic dating, and pregnancy outcome.


RESULTS
Nineteen of 76 patients who had a successful ET became pregnant. The pulsatility index on day 14 of both the trial and ET cycles was significantly lower in those who achieved pregnancy as compared with those who did not conceive: 2.65 (range 1.3 to 3.4) versus 3.85 (1.8 to 6.8) and 2.85 (1.4 to 3.6) versus 4.15 (2.1 to 6.8), respectively. There were significant correlations between pulsatility index and 24-kd protein, E2 receptor, and endometrial histology but not with PP14 and endometrial thickness.


CONCLUSIONS
Uterine artery impedance has a significant correlation with biochemical markers of uterine receptivity and accurately predicts the probability of pregnancy in frozen embryo replacement cycles. It is a useful method for assessing uterine receptivity in assisted conception programs.
Steer
C V
CV
King's College School of Medicine and Dentistry, London, United Kingdom.
Tan
S L
SL
Dillon
D
D
Mason
B A
BA
Campbell
S
S
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging; D015415:Biomarkers; D010064:Embryo Implantation; D004717:Endometrium / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D000071816:Glycodelin; D006023:Glycoproteins; D006801:Humans; D007150:Immunohistochemistry; D011247:Pregnancy; D011256:Pregnancy Outcome; D011257:Pregnancy Proteins / Q000378:metabolism; D011446:Prospective Studies; D011674:Pulse; D011960:Receptors, Estrogen / Q000378:metabolism; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging*; D014621:Vagina; D014655:Vascular Resistance
D015415:Biomarkers; D000071816:Glycodelin; D006023:Glycoproteins; C045246:PAEP protein, human; D011257:Pregnancy Proteins; D011960:Receptors, Estrogen