title: The effect of fertility stress on endometrial and subendometrial blood flow among infertile women.
abstract: BACKGROUND
  To investigate the effect of fertility stress on endometrial and subendometrial blood flow among infertile women.
  
  
  METHODS
  This case-control study was conducted in The First Affiliated Hospital of Zhengzhou University. The fertility problem inventory (FPI) was adopted to evaluate fertility stress. Three-dimensional power Doppler ultrasonography (3D PD-US) was performed during the proliferative phase of the menstrual cycle (days 5-11) to measure endometrial thickness, pattern, endometrial and subendometrial volume (V), the vascularization index (VI), the flow index (FI) and the vascularization-FI (VFI) index. Then, 300 infertile women were separated into two groups (high-score group and low-score group) based on total FPI scores and 80 healthy women were selected as controls.
  
  
  RESULTS
  No differences were found among all three groups with regard to general characteristics, endometrial thickness, pattern, endometrial and subendometrial V, VI and VFI. The endometrial and subendometrial FIs associated with different stress levels significantly differed among the three groups (F = 33.95, P < 0.001; F = 44.79, P < 0.001, respectively). The endometrial and subendometrial FIs in the control group were significantly higher than those in the high-score group and low-score groups. The endometrial and subendometrial FIs in the low-score group were significantly higher than those in the high-score group. The total FPI score was closely related to the endometrial and subendometrial FIs (r = -0.304, P < 0.001; r = -0.407, P < 0.001, respectively).
  
  
  CONCLUSIONS
  Fertility stress was associated with endometrial and subendometrial flow index. Whether fertility stress might affect pregnancy outcome by reducing endometrial and subendometrial blood flow requires further research.
authors.affiliation: Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yuezhi
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yanna
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yurong
authors.initials: Y
authors.lastname: Xing
authors.affiliation: Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China. syp2008@vip.sina.com.
authors.forename: Yingpu
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004717:Endometrium / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005298:Fertility / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007247:Infertility, Female / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler / Q000379:methods*
keywords: 3D power Doppler ultrasound; Infertility; Stress; Subendometrial flow index