title: Comparison of Uterine Receptivity between Fertile and Unexplained Infertile Women by Assessment of Endometrial and Subendometrial Perfusion Using Contrast-Enhanced Ultrasound: Which Index is Better--Peak Intensity or Area under the Curve?
abstract: The goal of this study was to compare uterine receptivity between women with normal fertility and those with unexplained infertility during natural cycles by assessment of endometrial and subendometrial perfusion using contrast-enhanced ultrasound (CEUS). We wanted to determine the better index: peak intensity (PI) or area under the curve (AUC). Thirty women with unexplained infertility were recruited into the study group, and 30 women with normal fertility were recruited into the control group. All women underwent CEUS during the late proliferative phase, ovulation phase, and implantation window of a menstrual cycle. Endometrial PI, endometrial AUC, subendometrial PI and subendometrial AUC were analyzed. In the late proliferative phase, the control group had a significantly higher endometrial PI (p < 0.001) as well as subendometrial PI (p < 0.001) and AUC (p = 0.004) than the study group. In the ovulation phase, the control group had a significantly higher endometrial PI (p < 0.001) and AUC (p = 0.021), as well as subendometrial PI (p < 0.001) and AUC (p = 0.003). During the implantation window, there were no significant differences between the two groups. Only subendometrial PI underwent a significant periodic change during the menstrual cycle in both groups. This finding was further confirmed by evaluation of the microvessel density of endometria. In conclusion, CEUS can be used to assess endometrial and subendometrial perfusion to evaluate uterine receptivity. Subendometrial PI was the most sensitive index compared with endometrial PI, endometrial AUC and subendometrial AUC.
authors.affiliation: Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Minxia
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China. Electronic address: 519324096@qq.com.
authors.forename: Yanni
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Pengjie
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Infertility, Sun-Time Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Geng
authors.affiliation: Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Qiuxiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Linghong
authors.initials: L
authors.lastname: Kong
authors.affiliation: Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Yihan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Pathology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Qingzhu
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Pathology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
authors.forename: Jianghuan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China. Electronic address: 1014539690@qq.com.
authors.forename: Suiqun
authors.initials: S
authors.lastname: Guo
authors.affiliation: Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China. Electronic address: hongmeiliu3@163.com.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Liu
mesh_terms: D000328:Adult; D000465:Algorithms; D003287:Contrast Media; D010064:Embryo Implantation / Q000502:physiology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007246:Infertility / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007247:Infertility, Female; D055420:Perfusion Imaging / Q000379:methods*; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced ultrasound; Endometrium; Infertility; Perfusion; Subendometrium