Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility.
BACKGROUND
We used three-dimensional power Doppler angiography (3D-PDA) to examine the periodic changes in endometrial development and subendometrial vascularity during the normal menstrual cycle in 29 women with unexplained subfertility and 19 controls.


METHODS
3D-PDA was performed on alternate days from day 3 of the cycle until ovulation and then every 4 days until menses. VOCAL (Virtual Organ Computer-aided AnaLysis) and shell-imaging were used to define and to quantify the power Doppler signal within the endometrial and subendometrial regions producing indices of their relative vascularity.


RESULTS
Women with unexplained subfertility demonstrated significant changes with time (P<0.001) in the indices of vascularity within the endometrium and subendometrium during the menstrual cycle characterized by a pre-ovulatory peak and post-ovulatory fall. These changes mirrored those observed in the control group but were significantly reduced in the endometrium and subendometrium during the mid-late follicular phase and early luteal phase. There were no differences in endometrial thickness or volume between the groups or in the plasma concentrations of estradiol or progesterone.


CONCLUSIONS
Endometrial and subendometrial vascularity are significantly reduced in women with unexplained subfertility during the mid-late follicular phase irrespective of estradiol or progesterone concentrations and endometrial morphometry.
Academic Division of Reproductive Medicine, School of Human Development, University of Nottingham, Nottingham, UK. nick.fenning@nottingham.ac.uk
N J
NJ
Raine-Fenning
B K
BK
Campbell
N R
NR
Kendall
J S
JS
Clewes
I R
IR
Johnson
D000328:Adult; D000792:Angiography / Q000379:methods; D016022:Case-Control Studies; D004717:Endometrium / Q000098:blood supply* / Q000473:pathology; D004958:Estradiol / Q000097:blood; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000473:pathology*; D008137:Longitudinal Studies; D008597:Menstrual Cycle / Q000502:physiology; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D013152:Splanchnic Circulation; D018608:Ultrasonography, Doppler / Q000379:methods
D012739:Gonadal Steroid Hormones; D011374:Progesterone; D004958:Estradiol