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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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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: 252] [Impact Index Per Article: 63.0] [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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LI J, CUI W, SUN W, WEN J. Effect of electroacupuncture on egg quality and tumor necrosis factor -α of patients with polycystic ovarian syndrome. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2014. [DOI: 10.1016/s1003-5257(15)60003-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang Y, Fu Y, Han F, Kuang H, Hu M, Wu X. The effect of complementary and alternative medicine on subfertile women with in vitro fertilization. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:419425. [PMID: 24527047 PMCID: PMC3914344 DOI: 10.1155/2014/419425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/13/2013] [Accepted: 12/15/2013] [Indexed: 02/06/2023]
Abstract
About 10-15% of couples have difficulty conceiving at some point in their reproductive lives and thus have to seek specialist fertility care. One of the most commonly used treatment options is in vitro fertilization (IVF) and its related expansions. Despite many recent technological advances, the average IVF live birth rate per single initiated cycle is still only 30%. Consequently, there is a need to find new therapies to promote the efficiency of the procedure. Many patients have turned to complementary and alternative medical (CAM) treatments as an adjuvant therapy to improve their chances of success when they undergo IVF treatment. At present, several CAM methods have been used in infertile couples with IVF, which has achieved obvious effects. However, biologically plausible mechanisms of the action of CAM for IVF have not been systematically reviewed. This review briefly summarizes the current progress of the impact of CAM on the outcomes of IVF and introduces the mechanisms.
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Affiliation(s)
- Yuehui Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
- Center for Post-Doctoral Studies, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Yiman Fu
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Fengjuan Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Hongying Kuang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Min Hu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
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Uysal S, Ozbay EPÖ, Ekinci T, Aksüt H, Karasu S, Işık AZ, Soylu F. Endometrial spiral artery Doppler parameters in unexplained infertility patients: is endometrial perfusion an important factor in the etiopathogenesis? J Turk Ger Gynecol Assoc 2012; 13:169-71. [PMID: 24592032 DOI: 10.5152/jtgga.2012.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/21/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Uterine perfusion, particularly the endometrial blood flow, may have an important role in endometrial receptivity. In order to assess the contribution of sub endometrial blood flow in the etiopathogenesis of unexplained infertility mid luteal- peri-implantation period spiral artery transvaginal color Doppler parameters were measured and compared with fertile controls. MATERIAL AND METHODS Forty-two consecutive patients admitted to Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetric and Gynecology with the diagnosis of unexplained infertility after standard diagnostic work up constituted the study group and they were compared with a fertile control group admitted to hospital with non specific gynecological complaints or for check-up in the same period. Mid luteal transvaginal color Doppler ultrasonography was applied to each patient by the same radiologist who was blind to the diagnosis of the particular patient and, RI (resistance index) and PI (pulsatility index) values were calculated. RESULTS There were no significant differences between the two groups, in respect to age, body mass index, basal hormonal and mid luteal progesterone levels (p>0.05). For the fertile control group, mid luteal-peri-implantation phase endometrial spiral artery mean RI values were calculated as 0.48±0.08 SD and mean PI values as 0.65±0.18 SD. For the study group, mean RI values were calculated as 0.54±0.07 SD, PI values were calculated as 0.80±0.16 SD. The differences for RI (p=0.009) and PI (p=0.004) were statistically significant. CONCLUSION According to Doppler parameters, unexplained infertility patients have high impedance blood flow in spiral arteries which means that peri-implantation blood flow in these patient is lower than fertile controls. These findings suggest that endometrial perfusion may have an important contribution to etiopathogenesis of unexplained infertility.
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Affiliation(s)
- Selda Uysal
- Department of Gynecology and Obstetrics, Atatürk Research and Training Hospital, Izmir, Turkey
| | - Elif Pelin Özün Ozbay
- Department of Gynecology and Obstetrics, Atatürk Research and Training Hospital, Izmir, Turkey
| | - Tekin Ekinci
- Department of Gynecology and Obstetrics, Atatürk Research and Training Hospital, Izmir, Turkey
| | - Hayri Aksüt
- Department of Gynecology and Obstetrics, Atatürk Research and Training Hospital, Izmir, Turkey
| | - Sebnem Karasu
- Department of Radiology, Atatürk Research and Training Hospital, Izmir, Turkey
| | | | - Ferit Soylu
- Department of Gynecology and Obstetrics, Atatürk Research and Training Hospital, Izmir, Turkey
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Zhang R, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil Steril 2011; 96:912-6. [DOI: 10.1016/j.fertnstert.2011.07.1093] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/09/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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Guo J, Li D, Zhang QF. [Acupuncture intervention combined with assisted reproductive technology: its different effects at different time points during the in vitro fertilization-embryo transfer course]. ACTA ACUST UNITED AC 2008; 6:1211-6. [PMID: 19063831 DOI: 10.3736/jcim20081201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently the combination of acupuncture with assisted reproductive technology (ART) to increase the outcomes of ART is being widely studied. In this article, the literatures concerning random controlled clinical trials since 2002 are reviewed and the designs of the trials, especially the timing of acupuncture, are evaluated. Over the past 5 years, the related clinical trials have primarily showed that acupuncture done immediately before and after embryo transfer might increase the assisted reproduction rates, but still requiring further high quality trials with large samples; in addition, different stimulation modes could produce different result, and so far there has not been a consensus as to the optimal time-point for the acupuncture intervention during the in vitro fertilization-embryo transfer (IVF-ET) course. Since the effects of acupuncture change with women's endocrine cycles, it is important and possible to make a breakthrough in ART outcomes if acupuncture is performed at a suitable time point during the cycle of IVF/ET combined with ART.
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Affiliation(s)
- Jia Guo
- Department of Traditional Chinese Medicine and Acupuncture, Peking University Third Hospital, Beijing 100191, China.
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Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Ross R. Contrasting patterns in in vitro fertilization pregnancy rates among fresh autologous, fresh oocyte donor, and cryopreserved cycles with the use of day 5 or day 6 blastocysts may reflect differences in embryo-endometrium synchrony. Fertil Steril 2008; 89:20-6. [PMID: 17224151 DOI: 10.1016/j.fertnstert.2006.08.092] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 08/21/2006] [Accepted: 08/21/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the effect of day 5 and day 6 blastocyst transfers on patterns of implantation rates and pregnancy rates (PRs) among fresh autologous, oocyte donor, and frozen ET (FET) cycles. DESIGN Retrospective study. SETTING Private fertility center. PATIENT(S) The study included 377 fresh autologous cycles, 106 autologous FET cycles, and 56 fresh oocyte donor cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Implantation rates and clinical PRs. RESULT(S) The clinical PR for day 5 blastocyst transfers was higher than for day 6 blastocyst transfers in fresh autologous cycles (PRs, 51.0% and 33.3%, respectively). However, there was no significant difference between transfers of blastocysts cryopreserved on day 5 and day 6 in FET cycles (PRs, 63.6% and 58.9%, respectively). Furthermore, day 6 blastocyst transfers significantly outperformed day 5 transfers in donor cycles (PRs, 63.0% and 86.2%, respectively), a reversal of the pattern seen in the fresh autologous cycles. Day 6 blastocysts were associated with a significantly greater PR in FET cycles than in fresh autologous cycles (58.9% and 33.3%, respectively). CONCLUSION(S) The superior PRs with day 5 blastocyst transfers in fresh autologous cycles and with day 6 blastocysts in donor cycles may have resulted from better synchrony with endometrial development. This was further supported by the superior performance of day 6 blastocysts in FET cycles relative to their fresh counterparts. Similar PRs with cryopreserved day 5 and day 6 blastocysts in FET cycles may reflect that, in these cycles, day 5 and day 6 blastocysts had equivalent quality and similar synchrony with the endometrium.
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Affiliation(s)
- Bruce S Shapiro
- Fertility Center of Las Vegas, Las Vegas, Nevada 89117, USA.
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