Optimal timing of ultrasonographic and Doppler evaluation of uterine receptivity to implantation.
In IVF programmes, transvaginal ultrasonography is used as a non-invasive method to evaluate uterine receptivity. The aim of this study was to determine when to perform this investigation in order to optimize prediction of the likelihood of pregnancy. Over 9 months, 124 patients undergoing IVF or intracytoplasmic sperm injection were studied. The ultrasonographic evaluation included endometrial thickness, endometrial pattern, uterine artery pulsatility index, protodiastolic notch, end-diastolic blood flow, and endometrial-subendometrial blood flow distribution pattern. All patients underwent ultrasonographic investigation on the days of human chorionic gonadotrophin (HCG) administration, oocyte retrieval, and embryo transfer. Statistical analysis was done using recursive-partitioning analysis. The pregnancy and implantation rates per transfer were 33 and 19.8% respectively. In terms of single parameters, women with an end-diastolic blood flow, an endometrial-subendometrial blood flow and a multilayered endometrium were more likely to be pregnant than women without one or more of these signs. The most effective combination for evaluation of uterine receptivity was end-diastolic blood flow, endometrial pattern and endometrial thickness. Sensitivity and specificity of this combination were around 81%, positive predictive value was 68.2%, and negative predictive value 89.7%. The best sensitivity and specificity were obtained on the day of HCG administration: respectively 81.1 and 81.3%.
Dechaud
Herve
H
Department of Reproductive Medicine and Biology, Arnaud de Villeneuve Hospital, 371 avenue du doyen Giraud, 34295 Montpellier Cedex 5, France. h-dechaud@chu-montpellier.fr
Bessueille
Emmanuelle
E
Bousquet
Philippe-Jean
PJ
Reyftmann
Lionel
L
Hamamah
Samir
S
Hedon
Bernard
B
D000328:Adult; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D014599:Uterus / Q000000981:diagnostic imaging*