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Wu J, Sheng J, Wu X, Wu Q. Ultrasound‑assessed endometrial receptivity measures for the prediction of in vitro fertilization‑embryo transfer clinical pregnancy outcomes: A meta‑analysis and systematic review. Exp Ther Med 2023; 26:453. [PMID: 37614426 PMCID: PMC10443051 DOI: 10.3892/etm.2023.12152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
At present, there are currently no reliable and consistent conclusions regarding transvaginal ultrasound assessment of endometrial receptivity in predicting clinical pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET). Thus, in the present study, a meta-analysis was performed on multiple endometrial receptivity indices detected by vaginal ultrasound, aiming to provide a diagnostic basis for clinical practice. PubMed, Embase, and Cochrane Library databases were searched for studies published between the establishment of the databases through to January 2023. Studies that reported infertile women undergoing IVF-ET and undergoing vaginal ultrasound were included, but repeat publication, studies where the full text was not obtainable, studies where there was incomplete information provided or data extraction was not possible, studies on animals, case reports, reviews, and systematic reviews were excluded. STATA 15.1 was used to analyze the data. The pooled results showed that the endometrial thickness [Weighted mean difference (WMD)=0.03, 95% CI: 0.00-0.06; P=0.022] and endometrial volume (WMD=0.41, 95% CI: 0.07-0.74; P=0.017) of the pregnancy group after receiving IVF-ET were all significantly higher than that of the non-pregnancy group. The pooled results also showed that the vascularization index (VI) (WMD=0.79, 95% CI: 0.56-1.03; P=0.000), flow index (FI) (WMD=1.82, 95% CI: 0.83-2.81; P=0.000) and vascularization flow index (VFI) (WMD=1.58, 95% CI: 0.91-2.24; P=0.000) of the pregnancy group after receiving IVF-ET was significantly higher than that of the non-pregnancy group. Systolic/diastolic (S/D) (WMD=-4.92, 95%CI: -8.28- -1.56; P=0.004) of the uterine artery of the pregnancy group after receiving IVF-ET was significantly lower than that of the non-pregnancy group. However, the differences between the resistance index (RI) and pulsatility index (PI) in the pregnancy group vs. the non-pregnancy group after receiving IVF-ET were not statistically significant. Vaginal ultrasound can be used to predict the outcomes of pregnancy in infertile women undergoing IVF-ET by measuring the thickness and volume of the endometrium, combined with the S/D, VI, FI, and VFI of the uterine artery.
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Affiliation(s)
- Jianhang Wu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Junfa Sheng
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Xiaoying Wu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Qiumei Wu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian 350000, P.R. China
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2
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Yang X, Tian X, Liu H, Wang J, Wang F. Homocysteine increases uterine artery blood flow resistance in women with pregnancy loss. J Gynecol Obstet Hum Reprod 2023; 52:102533. [PMID: 36610604 DOI: 10.1016/j.jogoh.2023.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/08/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Uterine arterial blood flow is an important factor in embryonic development. Increased uterine artery blood flow resistance may be related to vascular damage. Homocysteine (HCY) can induce injury of endothelial through various pathways. Therefore, we investigate the association between serum HCY levels and uterine artery blood flow in the non-pregnant state in women who have experienced pregnancy loss (PL). METHODS 364 women eligible for PL were included in the study. The detection of HCY was completed by the Laboratory of Lanzhou University Second Hospital. We divided the patients into three groups: Low-HCY (HCY<10 umol/L, n = 144), Medium-HCY (HCY 10∼15 umol/L, n = 174) and High-HCY (HCY>15 umol/L, n = 46). The patients were subjected to vaginal color Doppler ultrasonography to measure bilateral uterine artery resistance index (RI), pulsatility index (PI) and peak systolic velocity/end diastolic velocity (S/D). RESULT Among 364 women, the right uterine artery RI in L-HCY, M-HCY, and H-HCY groups were 0.78±0.08, 0.79±0.07 and 0.81±0.07, respectively (P = 0.04). The left uterine artery RI in L-HCY, M-HCY, and H-HCY groups were 0.78±0.08, 0.81±0.07 and 0.81±0.07, respectively (P = 0.01). The right uterine artery RI level and the left uterine artery RI was significantly associated with HCY level (r = 0.103, P = 0.050; r = 0.104, P = 0.047, respectively). Of these, 177 women experienced their next pregnancy, and 33 patients experienced PL again. The pregnancy rate in l-HCY, M-HCY, and HHCY groups were 47.92% (69/144), 49.43% (86/174) and 47.83% (22/46), respectively (P = 0.95). In next pregnancy, the PL rate in l-HCY, M-HCY, and HHCY groups were 8.70% (6/69), 22.58% (22/86) and 22.73% (5/22), respectively (P = 0.03). CONCLUSION HCY can increase the uterine artery resistance in the non-pregnant state and is associated with the abortion rate of next pregnancy.
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Affiliation(s)
- Xin Yang
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China
| | - Xiuli Tian
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China
| | - Haoxin Liu
- College of LSA, University of Michigan, Ann Arbor, MI 48109, United States
| | - Juan Wang
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China
| | - Fang Wang
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China.
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Ali zarad C, Mohamed MH, Shanab WSA. Role of uterine artery Doppler in assessment of unexplained infertility. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The study aimed to compare the values of uterine artery Doppler indices including resistance index (RI), pulsatility index (PI), and systolic/diastolic (S/D) ratios in fertile female and female with unexplained infertility and investigate their association with unexplained infertility. This study included 70 women divided into two groups. Study group included 40 women with unexplained infertility and control group included 30 fertile women.
Results
The mean ages of study and control groups were 26.9 and 28.5 years respectively. In infertile group, the mean values of uterine arteries resistance index (RI), pulsatility index (PI), and systolic/diastolic (S/D) ratios were 0.9, 2.9, and 8.0 respectively. In the fertile control group, mean RI and PI values and S/D ratio were 0.6, 1.5, and 2.7 respectively. There was statistically significant difference as regards RI, PI, and S/D ratios between study and control groups. The best cut off values of RI, PI, and S/D ratios for predicting increased uterine blood flow impedance were more than 0.67, 1.95, and 3 respectively with sensitivity of 100%, 95%, and 100% respectively, specificity of 96.7%, 86.7%, and 96.7% respectively, and diagnostic accuracy of 98.6%, 91.42%, and 98.57% respectively.
Conclusion
Uterine artery Doppler indices mean values were higher in unexplained infertility women than fertile women. Uterine artery Doppler indices have high sensitivity and specificity for diagnosis of high uterine blood flow impedance. High uterine blood flow impedance diagnosed by uterine artery Doppler may contribute in the etiology of unexplained infertility. Uterine artery Doppler should be included in investigation of unexplained infertility.
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4
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Scavello I, Maseroli E, Cipriani S, Di Stasi V, Verde N, Menafra D, Scannerini S, Marchiani S, Rastrelli G, Ricca V, Sorbi F, Fambrini M, Petraglia F, Maggi M, Vignozzi L. Cardiometabolic risk is unraveled by color Doppler ultrasound of the clitoral and uterine arteries in women consulting for sexual symptoms. Sci Rep 2021; 11:18899. [PMID: 34552164 PMCID: PMC8458448 DOI: 10.1038/s41598-021-98336-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/30/2021] [Indexed: 02/06/2023] Open
Abstract
Female sexual dysfunction (FSD) may be a mirror of a poor cardiometabolic state. In a small pilot study enrolling 71 women with FSD, we previously demonstrated that clitoral Pulsatility Index (PI) evaluated by using color Doppler ultrasound (CDU), reflecting vascular resistance, was associated with cardiometabolic risk factors. Data on uterine CDU in this context are lacking. First, to confirm previously reported data on the direct association between clitoral PI and cardiometabolic risk factors on a larger study population of women consulting for sexual symptoms; second, to investigate eventual similar correlations between cardiometabolic risk factors and CDU parameters of the uterine artery. We also ascertained whether uterine artery PI, similarly to what had previously been observed for clitoral artery PI, was directly related to body image uneasiness and psychopathological symptoms, assessed by validated questionnaires. N = 230 women consulting our clinic for sexual symptoms were examined with clitoral CDU and blood sampling and were asked to fill out the Female Sexual Function Index, the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). In a subgroup of women (n = 164), we also performed transvaginal CDU with measurement of uterine artery parameters. At multivariate analysis, we found a direct association between clitoral PI and body mass index (BMI) (p = 0.004), waist circumference (WC) (p = 0.004), triglycerides (p = 0.006), insulin (p = 0.029) and HOMA-IR (p = 0.009). Furthermore, a correlation between obesity and Metabolic Syndrome (MetS) and a higher clitoral PI was observed (p = 0.003 and p = 0.012, respectively). Clitoral PI was also correlated with MHQ-S (p = 0.010), a scale exploring somatized anxiety symptoms, and BUT-B Positive Symptom Distress Index (p = 0.010), a measure of body image concerns. Similarly, when investigating the uterine artery, we were able to demonstrate an association between its PI and BMI (p < 0.0001), WC (p = 0.001), insulin (p = 0.006), glycated haemoglobin (p = < 0.0001), and HOMA-IR (p = 0.009). Women diagnosed with obesity and MetS showed significantly higher uterine PI values vs. those without obesity or MetS (p = 0.001 and p = 0.004, respectively). Finally, uterine PI was associated with BUT-A Global Severity Index (p < 0.0001) and with several other BUT-A subdomains. Vascular resistance of clitoral and uterine arteries is associated with cardiometabolic risk factors and body image concerns in women consulting for sexual symptoms. If further confirmed in different populations, our data could suggest CDU, a common examination method, as a useful tool for an identification—and possible correction—of cardiometabolic risk factors.
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Affiliation(s)
- I Scavello
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S Cipriani
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - V Di Stasi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - N Verde
- Clinical Medicine and Surgery Department, Section of Endocrinology, Unit of Andrology, Reproductive Medicine and Male and Female Sexuality (FERTISEXCARES), Federico II University of Naples, Naples, Italy
| | - D Menafra
- Clinical Medicine and Surgery Department, Section of Endocrinology, Unit of Andrology, Reproductive Medicine and Male and Female Sexuality (FERTISEXCARES), Federico II University of Naples, Naples, Italy
| | - S Scannerini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - S Marchiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Rastrelli
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy.,Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - F Sorbi
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Fambrini
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - F Petraglia
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Linda Vignozzi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy. .,Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Doğulu FF, Aydoğmuş S, Gözüküçük M. Pulsatility and Resistance Indices of Uterine and Ovarian Arteries in Anovulatory Women With Polycystic Ovary Syndrome. Ultrasound Q 2021; 37:248-253. [PMID: 34478423 DOI: 10.1097/ruq.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We aimed to compare the ovarian and uterine artery blood flow of anovulatory patients with polycystic ovary syndrome (PCOS) with those of ovulatory women throughout the menstrual cycle using color Doppler ultrasound. Seventy-one women with PCOS, who were admitted to the infertility outpatient clinic of a training and research hospital, were included in the study. The patients were divided into 2 groups as anovulatory (group 1, n = 23) and ovulatory (group 2, n = 37). Each patient was followed up throughout her menstrual cycle and included in either group 1 or group 2. Anovulatory cycles were determined by consecutive ultrasound examinations, and the progesterone value was measured in the luteal period. Eleven patients were excluded from the study because they did not continue their follow-up. The uterine and ovarian artery pulsatility and resistance indices of all patients in both groups were evaluated 3 times throughout a menstrual cycle: 7th to 10th day, 13th to 17th day, and 21st to 25th day. It was observed that the uterine artery resistances of the patients with anovulatory cycles remained relatively high throughout the menstrual cycle compared with ovulatory cycles. Both pulsatility and resistance indices of uterine and ovarian arteries were significantly higher in anovulatory cycles compared with ovulatory cycles at all evaluation times throughout the menstrual cycle (P < 0.05). Ovarian artery resistance in anovulatory patients did not significantly change during the menstrual cycle. Anovulatory patients with PCOS have higher uterine and ovarian artery resistance than ovulatory artery resistance, and the former shows a significant decrease throughout the cycle.
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Affiliation(s)
| | - Süheyla Aydoğmuş
- Obstetrics and Gynecology Department, SBÜ Ankara Training and Research Hospital, Ankara, Turkey
| | - Murat Gözüküçük
- Obstetrics and Gynecology Department, SBÜ Ankara Training and Research Hospital, Ankara, Turkey
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Camargo Ferreira J, Silva Amaral R, Mara Cardoso L, Panelli Marchió S, Aldrovani Rodrigues M, Fonseca Alves CE, de Meira C. Endometrial angiogenesis induced by uterine insufflation with an oxygen-ozone gas mixture in mares. Reprod Domest Anim 2021; 56:1176-1183. [PMID: 34021934 DOI: 10.1111/rda.13958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022]
Abstract
Ozone (O3 ) therapy has been used to improve peripheral tissue oxygenation in humans and domestic animals. The goal of the present study was to characterize histological changes in the endometria of healthy equines following tissue exposure to gas mixtures enriched with different concentrations of O3 . Cycling mares without endometrial degeneration were divided into three groups according to treatment (n = 9 mares/group). The uteri from the O3 , ½O3 and control groups were insufflated for 3 min with gas containing 42, 21 and 0 μg O3 ml-1 , respectively. Treatments were performed every three days from D0 to D6. Endometrial samples were collected immediately before the first treatment and 24 hr after the last treatment. The following nine histological parameters were evaluated: (i) the number of endometrial blood vessels, (ii) endometrial vascular degree (EVD), (iii) increase rate of blood vessels, (iv) increase rate of EVD, (v) glandular total area, (vi) glandular lumen area, (vii) intraglandular secretion area, (viii) glandular epithelial height and (ix) luminal epithelial height. In the O3 group, a positive effect from treatment (p < .01) was detected for all vascular parameters (i, ii, iii and iv), glandular total area, intraglandular secretion area and glandular epithelial height. Compared to the control group, the ½O3 group had greater (p < .01) EVD (84.1 ± 12%) and a higher increase rate of blood vessels (151.9 ± 47.1%). Uterine insufflation with low or intermediate concentrations of the O2 -O3 gas mixture induced endometrial angiogenesis. Morphometry, but not morphology, of the endometrial glands was affected by local O3 therapy. These findings would be of great significance for the development of new therapies for infertility in mares.
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Affiliation(s)
| | - Rafael Silva Amaral
- Post-graduation Program in Animal Science, University of Franca, Franca, Brazil
| | | | | | | | - Carlos Eduardo Fonseca Alves
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Cezinande de Meira
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
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Craciunas L, Gallos I, Chu J, Bourne T, Quenby S, Brosens JJ, Coomarasamy A. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:202-223. [PMID: 30624659 DOI: 10.1093/humupd/dmy044] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/31/2018] [Accepted: 12/04/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Early reproductive failure is the most common complication of pregnancy with only 30% of conceptions reaching live birth. Establishing a successful pregnancy depends upon implantation, a complex process involving interactions between the endometrium and the blastocyst. It is estimated that embryos account for one-third of implantation failures, while suboptimal endometrial receptivity and altered embryo-endometrial dialogue are responsible for the remaining two-thirds. Endometrial receptivity has been the focus of extensive research for over 80 years, leading to an indepth understanding of the processes associated with embryo-endometrial cross-talk and implantation. However, little progress has been achieved to translate this understanding into clinically meaningful prognostic tests and treatments for suboptimal endometrial receptivity. OBJECTIVE AND RATIONALE The objective of this systematic review was to examine the evidence from observational studies supporting the use of endometrial receptivity markers as prognostic factors for pregnancy outcome in women wishing to conceive, in order to aid clinicians in choosing the most useful marker in clinical practice and for informing further research. SEARCH METHODS The review protocol was registered with PROSPERO (CRD42017077891). MEDLINE and Embase were searched for observational studies published from inception until 26 February 2018. We included studies that measured potential markers of endometrial receptivity prior to pregnancy attempts and reported the subsequent pregnancy outcomes. We performed association and accuracy analyses using clinical pregnancy as an outcome to reflect the presence of receptive endometrium. The Newcastle-Ottawa scale for observational studies was employed to assess the quality of the included studies. OUTCOMES We included 163 studies (88 834 women) of moderate overall quality in the narrative synthesis, out of which 96 were included in the meta-analyses. Studies reported on various endometrial receptivity markers evaluated by ultrasound, endometrial biopsy, endometrial fluid aspirate and hysteroscopy in the context of natural conception, IUI and IVF. Associations were identified between clinical pregnancy and various endometrial receptivity markers (endometrial thickness, endometrial pattern, Doppler indices, endometrial wave-like activity and various molecules); however, their poor ability to predict clinical pregnancy prevents them from being used in clinical practice. Results from several modern molecular tests are promising and further data are awaited. WIDER IMPLICATIONS The post-test probabilities from our analyses may be used in clinical practice to manage couples' expectations during fertility treatments (IUI and IVF). Conventionally, endometrial receptivity is seen as a dichotomous outcome (present or absent), but we propose that various levels of endometrial receptivity exist within the window of implantation. For instance, different transcriptomic signatures could represent varying levels of endometrial receptivity, which can be linked to different pregnancy outcomes. Many studies reported the means of a particular biomarker in those who achieved a pregnancy compared with those who did not. However, extreme values of a biomarker (as opposite to the means) may have significant prognostic and diagnostic implications that are not captured in the means. Therefore, we suggest reporting the outcomes by categories of biomarker levels rather than reporting means of biomarker levels within clinical outcome groups.
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Affiliation(s)
- Laurentiu Craciunas
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Ioannis Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Justin Chu
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Siobhan Quenby
- Tommy's National Centre for Miscarriage Research, University of Warwick, Coventry, UK
| | - Jan J Brosens
- Tommy's National Centre for Miscarriage Research, University of Warwick, Coventry, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Evaluation of endometrial and subendometrial vascularity in obese women with polycystic ovarian disease. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Hwuang E, Vidorreta M, Schwartz N, Moon BF, Kochar K, Tisdall MD, Detre JA, Witschey WRT. Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound. J Magn Reson Imaging 2018; 49:59-68. [PMID: 30390347 DOI: 10.1002/jmri.26229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine artery (UtA) hemodynamics might be used to predict risk of hypertensive pregnancy disorders, including preeclampsia and intrauterine growth restriction. PURPOSE OR HYPOTHESIS To determine the feasibility of 4D flow MRI in pregnant subjects by characterizing UtA anatomy, computing UtA flow, and comparing UtA velocity, and pulsatility and resistivity indices (PI, RI) with transabdominal Doppler ultrasound (US). STUDY TYPE Prospective cross-sectional study from June 6, 2016, to May 2, 2018. POPULATION OR SUBJECTS OR PHANTOM OR SPECIMEN OR ANIMAL MODEL Forty-one singleton pregnant subjects (age [range] = 27.0 ± 5.9 [18-41] years) in their second or third trimester. We additionally scanned three subjects who had prepregnancy diabetes or chronic hypertension. FIELD STRENGTH/SEQUENCE The subjects underwent UtA and placenta MRI using noncontrast angiography and 4D flow at 1.5T. ASSESSMENT UtA anatomy was described based on 4D flow-derived noncontrast angiography, while UtA flow properties were characterized by net flow, systolic/mean/diastolic velocity, PI and RI through examination of 4D flow data. PI and RI are standard hemodynamic parameters routinely reported on Doppler US. STATISTICAL TESTS Spearman's rank correlation, Wilcoxon signed rank tests, and Bland-Altman plots were used to preliminarily investigate the relationships between flow parameters, gestational age, and Doppler US. or RESULTS: 4D flow MRI and UtA flow quantification was feasible in all subjects. There was considerable heterogeneity in UtA geometry in each subject between left and right UtAs and between subjects. Mean 4D flow-based parameters were: mean bilateral flow rate = 605.6 ± 220.5 mL/min, PI = 0.72 ± 0.2, and RI = 0.47 ± 0.1. Bilateral flow did not change with gestational age. We found that MRI differed from US in terms of lower PI (mean difference -0.1) and RI (mean difference < -0.1) with Wilcoxon signed rank test P = 0.05 and P = 0.13, respectively. DATA CONCLUSION 4D flow MRI is a feasible approach for describing UtA anatomy and flow in pregnant subjects. LEVEL OF EVIDENCE Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:59-68.
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Affiliation(s)
- Eileen Hwuang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marta Vidorreta
- Siemens Healthineers, Tarrytown, New York, USA.,Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadav Schwartz
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirpal Kochar
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew Dylan Tisdall
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter R T Witschey
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Dong Y, Cai Y, Zhang Y, Xing Y, Sun Y. The effect of fertility stress on endometrial and subendometrial blood flow among infertile women. Reprod Biol Endocrinol 2017; 15:15. [PMID: 28257641 PMCID: PMC5336671 DOI: 10.1186/s12958-017-0236-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/24/2017] [Indexed: 01/29/2023] Open
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). CONCLUSION 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.
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Affiliation(s)
- Yuezhi Dong
- 0000 0001 2189 3846grid.207374.5Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan China
| | - Yanna Cai
- 0000 0001 2189 3846grid.207374.5Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan China
| | - Yu Zhang
- 0000 0001 2189 3846grid.207374.5Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan China
| | - Yurong Xing
- 0000 0001 2189 3846grid.207374.5Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan China
| | - Yingpu Sun
- 0000 0001 2189 3846grid.207374.5Reproductive Medical Center, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan China
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Chen M, He Y, Zhang P, Geng Q, Liu Q, Kong L, Chen Y, Wei Q, Liu J, Guo S, Liu H. 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? ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:654-663. [PMID: 26723901 DOI: 10.1016/j.ultrasmedbio.2015.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 06/05/2023]
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.
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Affiliation(s)
- Minxia Chen
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Yanni He
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
| | - Pengjie Zhang
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Qiang Geng
- Department of Infertility, Sun-Time Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qiuxiang Liu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Linghong Kong
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Yihan Chen
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Qingzhu Wei
- Department of Pathology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Jianghuan Liu
- Department of Pathology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Suiqun Guo
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
| | - Hongmei Liu
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
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Krasnopol’skaya KV, Nazarenko TA, Ershova IY. Modern approaches to endometrial receptivity assessment (a review). ACTA ACUST UNITED AC 2016. [DOI: 10.17116/repro201622561-69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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13
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Razik MA, Farag MAH, Sheta M. Uterine and ovarian arteries blood flow during the mid luteal phase in women with unexplained infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Guedes-Martins L, Gaio R, Saraiva J, Cerdeira S, Matos L, Silva E, Macedo F, Almeida H. Reference ranges for uterine artery pulsatility index during the menstrual cycle: a cross-sectional study. PLoS One 2015; 10:e0119103. [PMID: 25742286 PMCID: PMC4351196 DOI: 10.1371/journal.pone.0119103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/28/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cyclic endometrial neoangiogenesis contributes to changes in local vascular patterns and is amenable to non-invasive assessment with Doppler sonography. We hypothesize that the uterine artery (UtA) impedance, measured by its pulsatility index (PI), exhibits a regular pattern during the normal menstrual cycle. Therefore, the main study objective was to derive normative new day-cycle-based reference ranges for the UtA-PI during the entire cycle from days 1 to 34 according to the isolated time effect and potential confounders such as age and parity. METHODS From January 2009 to December 2012, a cross-sectional study of 1,821 healthy women undergoing routine gynaecological ultrasound was performed. The Doppler flow of the right and left UtA-PI was studied transvaginally by colour and pulsed Doppler imaging. The mean right and left values and the presence or absence of a bilateral protodiastolic notch were recorded. Reference intervals for the PI according to the cycle day were generated by classical linear regression. RESULTS The majority of patients (97.5%) presented unilateral or bilateral UtA notches. The crude 5th, 50th, and 95th reference percentile curves of the UtA-PI at 1-34 days of the normal menstrual cycle were derived. In all curves, a progressive significant decrease occurred during the first 13 days, followed by an increase and recovery in the UtA-PI. The adjusted 5th, 50th, and 95th reference percentile curves for the effects of age and parity were also obtained. These two conditions generated an approximately identical UtA-PI pattern during the cycle, except with small but significant reductions at the temporal extremes. CONCLUSIONS The median, 5th, and the 95th percentiles of the UtA-PI decrease during the first third of the menstrual cycle and recover to their initial values during the last two thirds of the cycle. The rates of decrease and recovery depend significantly on age and parity.
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Affiliation(s)
- Luís Guedes-Martins
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Rita Gaio
- Department of Mathematics, Faculty of Sciences, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal; CMUP-Centre of Mathematics, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal
| | - Joaquim Saraiva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; Obstetrics-Gynecology, Private Hospital Trofa, 4785-409 Trofa, Portugal
| | - Sofia Cerdeira
- Gulbenkian Program for Advanced Medical Education, 1067-001 Lisbon, Portugal; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Liliana Matos
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Elisabete Silva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal
| | - Filipe Macedo
- Department of Cardiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Henrique Almeida
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Obstetrics-Gynecology, Hospital-CUF Porto, 4100-180 Porto, Portugal
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Beneventi F, Locatelli E, Giorgiani G, Zecca M, Mina T, Simonetta M, Cavagnoli C, Albanese M, Spinillo A. Adolescent and adult uterine volume and uterine artery Doppler blood flow among subjects treated with bone marrow transplantation or chemotherapy in pediatric age: a case-control study. Fertil Steril 2015; 103:455-61. [DOI: 10.1016/j.fertnstert.2014.10.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 11/25/2022]
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16
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Giugliano E, Cagnazzo E, Vesce F, Giugliano B, Caserta D, Moscarini M, Caldarelli C, Stellin G, Marci R. Doppler velocimetry of the ovarian artery as a tool to detect LH surge in stimulated cycles. Gynecol Endocrinol 2014; 30:627-31. [PMID: 24983776 DOI: 10.3109/09513590.2014.911276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our aim was to assess the velocimetric pattern of the ovarian artery as a possible marker of LH surge in stimulated cycles. A total of 130 women undergoing ovarian stimulation for intrauterine insemination were randomized in two groups. Each woman was stimulated with 75 IU of recombinant FSH starting from the third day of the cycle. Velocimetric indices of the dominant ovarian artery were compared between patients with spontaneous LH surge and those needing HCG administration to trigger dominant follicle rupture. The pulsatility index and the ratio between peak systolic flow and lowest diastolic flow were significantly higher in women that had a spontaneous triggering of ovulation. These parameters had a high and very significant positive correlation with the dosage of luteinizing hormone. Threshold values of 2.60 for PI and 7.68 for S/D had a high sensitivity and specificity to predict LH surge. These velocimetric results demonstrated that an increased resistance in the dominant ovarian artery is correlated to LH surge in stimulated cycles. It may represent a sign of relevant clinical utility in timing of intrauterine insemination and/or natural intercourse.
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Affiliation(s)
- Emilio Giugliano
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara , Ferrara , Italy
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El-Mazny A, Abou-Salem N, Elshenoufy H. Doppler study of uterine hemodynamics in women with unexplained infertility. Eur J Obstet Gynecol Reprod Biol 2013; 171:84-7. [PMID: 24011380 DOI: 10.1016/j.ejogrb.2013.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/20/2013] [Accepted: 08/11/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate uterine artery blood flow using pulsed Doppler, and endometrial and subendometrial microvascularization using three-dimensional (3D) power Doppler, in women with unexplained infertility. STUDY DESIGN In a prospective clinical trial at a university teaching hospital, 40 women with unexplained infertility were compared to 40 fertile parous controls. In the mid-luteal (peri-implantation) phase, the endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were measured in both groups. RESULTS The uterine artery PI (P = 0.003) and RI (P = 0.007) were significantly increased and the endometrial VI (P = 0.029), FI (P = 0.031), and VFI (P = 0.001) and subendometrial VI (P = 0.032), FI (P = 0.040), and VFI (P = 0.005) were significantly decreased in the unexplained infertility group. The endometrial thickness and volume and serum estradiol and progesterone levels, however, were not significantly different between the two groups. CONCLUSION Peri-implantation endometrial perfusion is impaired in women with unexplained infertility: Doppler study of uterine hemodynamics should therefore be considered in infertility work-up.
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Affiliation(s)
- Akmal El-Mazny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt.
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18
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Mohsen IA, Elkattan E, Nabil H, Khattab S. Effect of metformin treatment on endometrial vascular indices in anovulatory obese/overweight women with polycystic ovarian syndrome using three-dimensional power doppler ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:275-282. [PMID: 23124626 DOI: 10.1002/jcu.22006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 09/27/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE Metformin has been shown to be an effective treatment for anovulatory polycystic ovary syndrome (PCOS) patients in terms of menstrual cyclicity, ovulation, and pregnancy, as well as reduction of early miscarriage rate. The aim of the study is to assess the effect of metformin on the endometrial vascular indices in anovulatory obese PCOS women using three-dimensional power Doppler sonography (3DPDUS). METHODS A prospective study was set to determine the beneficial effects of metformin on PCOS patients. Fifty anovulatory obese PCOS patients were compared with another 50 healthy volunteers who were age- and body mass index-matched (control group). PCOS patients were treated with metformin (Glucophage; MerckSerono) 850 mg 3 times a day for 6 months. Assessment of the endometrial thickness and volume, uterine Doppler indices, and Doppler vascular indices of the endometrium and subendometrium in the periovulatory and midluteal phases were performed with 3DPDUS. RESULTS There was a significant increase in the endometrial thickness, endometrial volume, and endometrial and subendometrial vascularity indices (vascularization index, flow index, vascularization flow index) after 6 months of metformin treatment in PCOS women, whereas there was no change in the resistance index and the pulsatility index of the uterine artery in both periovulatory and midluteal phases. CONCLUSIONS Metformin, owing to its metabolic, endocrine, vascular, and anti-inflammatory effects, improves markers of endometrial receptivity.
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Affiliation(s)
- Iman Abdel Mohsen
- Department of Obstetrics and Gynecology, Faculty Of Medicine, Cairo University, Cairo, Egypt
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Zollner U, Specketer MT, Zollner KP, Dietl J. Uterine artery blood flow in the periimplantation period in embryo transfer cycles. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Momeni M, Rahbar MH, Kovanci E. A meta-analysis of the relationship between endometrial thickness and outcome of in vitro fertilization cycles. J Hum Reprod Sci 2012; 4:130-7. [PMID: 22346080 PMCID: PMC3276947 DOI: 10.4103/0974-1208.92287] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/04/2011] [Accepted: 09/21/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE: The objective was to evaluate the relationship between endometrial thickness on the day of human chorionic gonadotropin administration and pregnancy outcome in in vitro fertilization cycles. DESIGN: This was a systematic review and meta-analysis. MATERIALS AND METHODS: We identified 484 articles using Cochrane library, PubMed, Web of Science, and Embase searches with various key words including endometrial thickness, pregnancy, assisted reproductive technology, endometrial pattern, and in vitro fertilization. A total of 14 studies with data on endometrial thickness and outcome were selected, representing 4922 cycles (2204 pregnant and 2718 nonpregnant). The meta-analysis with a random effects model was performed using comprehensive meta-analysis software. We calculated the standardized mean difference, odds ratio (OR), and 95% confidence intervals (CIs). RESULTS: There was a significant difference in the mean endometrial thickness between pregnant and nonpregnant groups (P<0.001), with a standardized mean difference of 0.4 mm (95% CI 0.22–0.58). The OR for pregnancy was 1.40 (95% CI 1.24–1.58). CONCLUSIONS: The mean endometrial thickness was significantly higher in pregnant women compared to nonpregnant. The mean difference between two groups was <1 mm which may not be clinically meaningful. Although there may be a relationship between endometrial thickness and pregnancy, implantation potential is probably more complex than a single ultrasound measurement can determine.
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Affiliation(s)
- Mazdak Momeni
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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21
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Uterine artery Doppler and subendometrial blood flow in patients with unexplained recurrent miscarriage. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2011.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Kim A, Han JE, Yoon TK, Lyu SW, Seok HH, Won HJ. Relationship between endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound and pregnancy after intrauterine insemination. Fertil Steril 2010; 94:747-52. [DOI: 10.1016/j.fertnstert.2009.03.084] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 03/20/2009] [Accepted: 03/20/2009] [Indexed: 11/25/2022]
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23
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Lam P, Johnson I, Raine-Fenning N. Endometrial blood flow is impaired in women with polycystic ovarian syndrome who are clinically hyperandrogenic. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:326-334. [PMID: 19676066 DOI: 10.1002/uog.7314] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To quantify endometrial and subendometrial blood flow in Caucasian women with polycystic ovarian syndrome (PCOS) and to determine whether these values differ according to the phenotypic expression of PCOS. METHODS Transvaginal pelvic ultrasound was performed on the 3(rd)-5(th) day of the menstrual cycle in 36 women with PCOS and 36 controls to examine the endometrial and subendometrial vascularity. The subendometrial and endometrial blood flow indices (vascularizaton index (VI), flow index (FI) and vascularization flow index (VFI)) were measured using three-dimensional power Doppler angiography. Uterine artery blood flow was assessed through analysis of two-dimensional (2D) pulsed-wave Doppler waveforms. Analysis was performed to compare PCOS with non-PCOS women, and subgroup analysis was performed of the PCOS women categorized according to their phenotypic manifestation. RESULTS There were no significant differences in endometrial volume, subendometrial vascularity and uterine artery blood flow between women with PCOS and controls after controlling for body mass index (BMI). On subgroup analysis, compared with anovulatory but clinically normoandrogenic women with polycystic ovaries (PCO) and with controls, women with PCO who were both clinically hyperandrogenic and anovulatory had significantly lower endometrial (VI: 0.57% vs. 1.11% and 0.86%, respectively, both P = 0.01; VFI: 0.14 vs. 0.42 and 0.28, respectively, both P = 0.02) and subendometrial (VI: 1.59% vs. 3.17% and 2.47%, P = 0.01 and 0.02, respectively; VFI: 0.50 vs. 1.67 and 0.96, P = 0.01 and 0.02, respectively) blood flow. Moreover, clinically hyperandrogenic but ovulatory women with PCO also had significantly lower endometrial blood flow (VI: 0.52% vs. 1.11%, P = 0.04) than did anovulatory but clinically normoandrogenic women with PCO. There were no differences in any of the 2D pulsed-wave Doppler measures of blood flow between the subgroups. CONCLUSIONS Subendometrial and endometrial blood flow is significantly impaired in women with PCOS who have clinical signs of hyperandrogenism.
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Affiliation(s)
- P Lam
- Department of Obstetrics & Gynaecology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Lazzarin N, Vaquero E, Exacoustos C, Bertonotti E, Romanini ME, Arduini D. Low-dose aspirin and omega-3 fatty acids improve uterine artery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion. Fertil Steril 2009; 92:296-300. [DOI: 10.1016/j.fertnstert.2008.05.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/28/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
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Quenby S, Nik H, Innes B, Lash G, Turner M, Drury J, Bulmer J. Uterine natural killer cells and angiogenesis in recurrent reproductive failure. Hum Reprod 2008; 24:45-54. [DOI: 10.1093/humrep/den348] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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26
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Uterine blood flow during the first 3 weeks of pregnancy in dairy cows. Theriogenology 2008; 70:1048-56. [DOI: 10.1016/j.theriogenology.2008.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 06/05/2008] [Accepted: 06/07/2008] [Indexed: 11/23/2022]
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Honnens A, Niemann H, Paul V, Meyer H, Bollwein H. Doppler sonography of the uterine arteries during a superovulatory regime in cattle. Theriogenology 2008; 70:859-67. [DOI: 10.1016/j.theriogenology.2008.05.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/19/2008] [Accepted: 05/22/2008] [Indexed: 11/16/2022]
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Ferreira JC, Gastal EL, Ginther OJ. Uterine blood flow and perfusion in mares with uterine cysts: effect of the size of the cystic area and age. Reproduction 2008; 135:541-50. [DOI: 10.1530/rep-07-0447] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vitthala S, Misra PK. Fertility after B-Lynch suture in a patient previously treated for acute myeloid leukaemia. Eur J Obstet Gynecol Reprod Biol 2008; 136:133-4. [PMID: 17141397 DOI: 10.1016/j.ejogrb.2006.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 09/11/2006] [Accepted: 09/13/2006] [Indexed: 10/23/2022]
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30
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Dechaud H, Bessueille E, Bousquet PJ, Reyftmann L, Hamamah S, Hedone B. Optimal timing of ultrasonographic and Doppler evaluation of uterine receptivity to implantation. Reprod Biomed Online 2008; 16:368-75. [DOI: 10.1016/s1472-6483(10)60598-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ozkaya U, Ozkan S, Ozeren S, Corakçi A. Doppler examination of uteroplacental circulation in early pregnancy: can it predict adverse outcome? JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:382-6. [PMID: 17551944 DOI: 10.1002/jcu.20370] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To determine whether spectral Doppler measurements obtained from bilateral uterine, arcuate, radial, and spiral arteries in early gestation correlate with adverse pregnancy outcome. METHODS One hundred five pregnant women underwent transvaginal Doppler sonographic examination of uteroplacental circulation at 6-12 weeks' gestation. Resistance index (RI) and pulsatility index (PI) of bilateral uterine, arcuate, radial, and spiral arteries were measured. Diameters of gestational sac (GS) and yolk sac, crown-rump length (CRL), GS-CRL difference, and GS/CRL ratio were also recorded. Correlation was made with pregnancy outcome. RESULTS Sixteen women developed adverse pregnancy outcome. In these women, right uterine artery PI and RI were significantly higher than in women with normal obstetrical outcome. Spiral artery PI and RI values were also higher, but the difference was not statistically significant. GS-CRL difference, GS/CRL ratio, and yolk sac diameters were significantly lower in this group. CONCLUSION Transvaginal Doppler examination can detect hemodynamic changes in uteroplacental circulation associated with subsequent adverse pregnancy outcome.
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Affiliation(s)
- Ummü Ozkaya
- Department of Obstetrics and Gynecology, Kocaeli University, School of Medicine, Tüpraş Sitesi, Güney Mahallesi, 7 Sokak, No. 20, Kat. 2, Körfez Kocaeli 41780, Turkey
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Abstract
Ultrasound imaging can be used to assess the endometrium in a number of ways. In particular, time-lapse video recordings can show that the lining of the uterus undergoes rhythmical contractions that vary in strength and intensity throughout the ovarian cycle. These contractions appear to assist in sperm transport at the time of ovulation, but can decrease the chances of a fertilized egg implanting in the uterus if they persist later in the cycle. They are also the cause of ectopic pregnancies occurring in IVF treatment cycles. In order to reduce these uterine contractions and therefore increase the chances of a successful uterine pregnancy, IVF treatment cycles should incorporate minimal stimulation so as to make them as close to natural cycles as possible.
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Midluteal phase Doppler assessment of uterine artery blood flow in nonpregnant women having a history of recurrent spontaneous abortions: correlation to different etiologies. Fertil Steril 2007; 87:1383-7. [DOI: 10.1016/j.fertnstert.2006.11.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 11/14/2006] [Accepted: 11/14/2006] [Indexed: 11/17/2022]
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Alcázar JL. Three-dimensional ultrasound assessment of endometrial receptivity: a review. Reprod Biol Endocrinol 2006; 4:56. [PMID: 17094797 PMCID: PMC1647280 DOI: 10.1186/1477-7827-4-56] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 11/09/2006] [Indexed: 11/21/2022] Open
Abstract
Three-dimensional ultrasound (3D US) is a new imaging modality, which is being introduced into clinical practice. Although this technique will not probably replace two-dimensional ultrasound, it is being increasingly used. It has been reported that 3D US is a very high reproducible technique. The endometrium has been paid special attention when using this technique. The aim of this paper is to address some technical aspects of 3D US and to review critically its current status in evaluating endometrial function with special focus in its role in predicting pregnancy in assisted reproductive techniques. In spontaneous cycles endometrial volume grows during follicular phase remaining constant through the luteal phase. Endometrial vascularization increases during follicular phase peaking 2-3 days before ovulation, decreasing thereafter and increasing again during mid and late luteal phase. Data from studies analysing the role of 3D US for predicting IVF outcome are controversial. An explanation for these controversial findings might be different design of reported studies, specially the timing of ultrasound evaluation.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
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Gastal EL, Gastal MO, Ginther OJ. Relationships of changes in B-mode echotexture and colour-Doppler signals in the wall of the preovulatory follicle to changes in systemic oestradiol concentrations and the effects of human chorionic gonadotrophin in mares. Reproduction 2006; 131:699-709. [PMID: 16595721 DOI: 10.1530/rep.1.01011] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A duplex grey-scale and colour-Doppler ultrasound instrument was used to study the changes in the wall of the preovulatory follicle in mares. When the follicle reached ≥35 mm (hour 0), mares were randomized into control (n= 16) and human chorionic gonadotropin (hCG)-treated (n= 16) groups. The hCG treatment was given at hour 0. Scanning was done every 12 h until hour 36, every hour between hours 36 and 48, and every 12 h thereafter until ovulation. Blood was sampled every 12 h for oestradiol assay. During the period 0–24 h post-treatment, oestradiol concentrations decreased in the hCG group and increased in the controls (significant interaction). During the period 0–36 h post-treatment, thickness and echogenicity of the granulosa increased in the hCG group but not in the controls. During the period 36 to 12 h before ovulation, granulosa and colour-Doppler end-points increased in the control and hCG groups (hour effects), while oestradiol was decreasing in both groups. The prominence and percentage of follicle circumference with an anechoic band peripheral to the granulosa and colour-Doppler signals in the follicle wall, indicating arterial blood flow, decreased during the period 4 to 1 h before ovulation (hour effects). Results indicated that the ultrasonographic changes of the wall of the preovulatory follicle were not associated temporally with changes in oestradiol concentrations and prominence of an anechoic band, and colour-Doppler signals decreased during the few hours before ovulation. The hypothesis that the latter portion of the ovulatory LH surge has a negative effect on systemic oestradiol was supported by the immediate decrease in oestradiol concentrations when hCG was injected.
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Affiliation(s)
- E L Gastal
- Eutheria Foundation, Cross Plains, Wisconsin 53528, USA
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Lédée N. Uterine receptivity and the two and three dimensions of ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:695-8. [PMID: 16308892 DOI: 10.1002/uog.2659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- N Lédée
- Service de Gynecologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Poissy-St Germain en Laye, Université Versailles-St Quentin en Yvelines, Poissy, France.
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Abstract
PURPOSE OF REVIEW Embryo transfer is arguably the most critical step in assisted reproduction. The purpose of this article is to review the different aspects of the procedure in the light of recent evidence. RECENT FINDINGS Randomized trials have shown that significantly higher pregnancy rates are obtained when embryo transfer is performed under ultrasound guidance, the embryos are deposited in the middle part of the uterine cavity, an atraumatic technique is used and when low-dose aspirin is routinely administered following the procedure. Blood in the catheter and leaving the embryos inside it for more than 120 s diminish the pregnancy rate significantly. Air in the catheter, immediate removal of the catheter, performing two transfers in the same cycle, prolonged bed rest, sexual intercourse after embryo transfer or the use of sildenafil do not affect the results. Based on currently available evidence, Cochrane reviews have concluded that the live birth rate is not increased by delaying embryo transfer from day two to three or to the blastocyst stage, and that single embryo transfer leads to lower live birth rates than the transfer of two embryos. The value of a mock transfer a few days before the actual procedure has been challenged as the position of the uterus may change. The effect of holding the cervix with a volsellum, routinely administering antibiotics and the superiority of one catheter over the others is still to be determined. SUMMARY Recent studies confirm the importance of the various aspects of embryo transfer. More randomized studies are needed to further evaluate them.
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Affiliation(s)
- Hassan N Sallam
- Department of Obstetrics and Gynaecology, University of Alexandria and Alexandria Fertility Center, Alexandria, Egypt.
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Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge about ultrasound scanning values in monitoring the structural and functional changes of the uterus and ovaries during the menstrual cycle. RECENT FINDINGS The views that ovulation is more frequently right sided have been challenged, with recent data suggesting that ovulation occurs randomly. A 'follicular wave phenomenon', providing a new model for ovarian function during the menstrual cycle, has been described. Follicular development occurs in a wave-like fashion and women with two waves have earlier endometrial development due to earlier increase of the dominant follicle estrogen production. Myometrial contractions during menstrual cycle should be considered in the assessment of endometrial thickness. Uterine-ovarian arterial blood flow impedance is important in understanding the normal physiology of the menstrual cycle and may be of use in assisted conception protocols. SUMMARY At present, ultrasound scanning has an important role in noninvasive assessment of endometrial and ovarian cyclical changes and may be of particular importance in assisted conception procedures. Further work is likely to help in understanding its full diagnostic potential.
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Affiliation(s)
- Ratko Matijevic
- University Department of Obstetrics and Gynecology, School of Medicine, Zagreb University, Sveti Duh Hospital, Zagreb, Croatia.
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Api M, Api O, Yayla M. Fertility after B-Lynch suture and hypogastric artery ligation. Fertil Steril 2005; 84:509. [PMID: 16086573 DOI: 10.1016/j.fertnstert.2005.01.140] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Revised: 01/25/2005] [Accepted: 01/25/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report a case of successful pregnancy after hypogastric artery ligation and the B-Lynch brace suturing technique. DESIGN Case report. SETTING Education and research hospital. PATIENT(S) A 22-year-old woman, whose first pregnancy was terminated by cesarean section owing to abruptio placenta and intrauterine fetal demise diagnosed at the 26th week of gestation, referred to our clinic for uterine atony. INTERVENTION(S) Hypogastric artery ligation and the B-Lynch brace suturing technique. MAIN OUTCOME MEASURE(S) Clinical pregnancy and live birth. RESULT(S) Two years after the surgery, the patient conceived spontaneously and delivered a healthy infant after an uneventful pregnancy. CONCLUSION(S) This is the first reported case of successful pregnancy after hypogastric artery ligation and B-Lynch suturing technique. This life-saving therapeutic option for severe postpartum hemorrhage appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes. The B-Lynch suturing technique seems to be simple and has the capability of preserving the uterus; therefore it may be considered as the first-line surgical treatment for uterine atony before considering hysterectomy.
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Affiliation(s)
- Murat Api
- Department of Obstetrics and Gynecology, Haseki Education and Research Hospital, Istanbul, Turkey.
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Tropea A, Miceli F, Minici F, Orlando M, Lamanna G, Gangale M, Catino S, Lanzone A, Apa R. Endometrial evaluation in superovulation programs: relationship with successful outcome. Ann N Y Acad Sci 2005; 1034:211-8. [PMID: 15731313 DOI: 10.1196/annals.1335.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
It is well known that an adequate endometrial receptivity is required for successful implantation in both natural and assisted reproductive cycles. In particular, a brief "implantation window", during which endometrium undergoes anatomical and molecular changes necessary for embryo implantation, has been observed. The hormonal treatment applied to induce ovulation seems to be able to modify the normal development of the prenidatory endometrium, with possible negative effect on the implantation rate. For this reason, several attempts have been made to identify specific markers of endometrial receptivity, useful for predicting implantation outcome in clinical practice. Even if different histological, immunohistochemical, and ultrasonographic parameters are studied, none unfortunately has been univocally shown to be predictive of pregnancy outcome. Therefore, the evaluation of endometrial receptivity remains a challenge in clinical practice.
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Affiliation(s)
- Anna Tropea
- Cattedra di Fisiopatologia della Riproduzione Umana, Università Cattolica del Sacro Cuore (UCSC), Largo A. Gemelli 8, 00168 Rome, Italy
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Jauniaux E, Johns J, Burton GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:613-624. [PMID: 15861413 DOI: 10.1002/uog.1892] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The advent of high-resolution transvaginal ultrasound (TVS) has revolutionized our understanding of the pathophysiology and the management of early pregnancy failure. Knowledge of the ultrasound appearances of normal early pregnancy development and a good understanding of its pitfalls are essential for the diagnosis and management of early pregnancy failure. Ultrasound imaging has rapidly replaced all other techniques used to study normal human development in the first trimester, and ultrasound features of the early gestational sac have corroborated anatomical studies showing that the first structures to appear are the celomic cavity and the secondary yolk sac. No single ultrasound measurement of the different anatomical features in the first trimester has been shown to have a high predictive value for determining early pregnancy outcome. Similarly, Doppler studies have failed to demonstrate abnormal blood flow indices in the first-trimester uteroplacental circulation of pregnancies that subsequently end in miscarriage. Ultrasound parameters combined with maternal serum hormone levels, maternal age, smoking habits, obstetric history and the occurrence of vaginal bleeding have all been combined in multivariate analyses, with mixed results. Combined ultrasound and in-vitro experiments have demonstrated that the maternal circulation inside the placenta starts at the periphery at around 9 weeks of gestation and that this is associated with a physiological oxidative stress which could be the trigger for the formation of the placental membranes. Abnormal development of these membranes can result in subchorionic hemorrhage and threatened miscarriage with subsequent long-term consequences such as preterm rupture of the membranes and preterm labor, irrespective of the finding of a hematoma on ultrasound. In both euploid and aneuploid missed miscarriages there is clear ultrasound evidence for excessive entry of maternal blood at a very early stage inside the developing placenta resulting in oxidative stress and subsequent degeneration of villous tissue. The finding of blood flow in the intervillous space in cases of first-trimester miscarriage using color Doppler also appears to be useful in the prediction of success of expectant management. Miscarriages with blood flow within the intervillous space are up to four times more likely to complete with expectant management. TVS is considered the gold standard in the diagnosis and management of incomplete miscarriage. Expectant management of miscarriage, using ultrasound parameters to determine eligibility, could significantly reduce the number of unnecessary evacuations of the retained products of conception, depending on the criteria used.
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Affiliation(s)
- E Jauniaux
- Academic Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, London, UK.
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