Colour Doppler ultrasound in controlled ovarian stimulation with intrauterine insemination

Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility

PURPOSE

Hysterosalpingo-contrast sonography (HyCoSy) is the preferred method for evaluating fallopian tubal patency, and it is associated with improved rates of natural pregnancy among infertile patients. However, the mechanism underlying the improvement in pregnancy rates following HyCoSy remains unclear. This study aimed to investigate the effect of HyCoSy examination on endometrial receptivity as well as pregnancy rates among infertile women.

METHODS

This prospective study included 120 women with unexplained infertility who visited our department between June 2018 and February 2021. These patients were classified into the study group (n = 60) and the control group (n = 60) depending on their willingness to undergo three-dimensional HyCoSy in the present cycle (study group) or 6 months later (control group). Endometrial characteristics, including endometrial thickness and pattern as well as the endometrial blood flow distribution pattern, were measured twice by transvaginal Doppler ultrasonography in the preovulatory phase before and after HyCoSy examination. Participants were followed for 6 months to observe the outcome of spontaneous conception.

RESULTS

Compared with the control group, the study group had a significantly higher cumulative pregnancy rate at 6 months after HyCoSy (21.6% [13/60] vs 5.0% [3/60], P = 0.007). More patients in the study group showed improved endometrial blood flow distribution (P = 0.021, χ² = 7.699), but no differences in endometrial thickness and pattern were observed between the groups (P > 0.05).

CONCLUSION

HyCoSy examination may improve endometrial perfusion and has a therapeutic effect on improving spontaneous pregnancy among women with unexplained infertility.

Ultrasonography and Doppler Study to Predict Uterine Receptivity in Infertile Patients Undergoing Embryo Transfer

PURPOSE

To detect whether ultrasonographic parameters and Doppler analysis of uterine blood flow can be of value in the prediction of endometrial receptivity in infertile female patients undergoing embryo transfer.

METHODS

In this study, a total of 200 women with primary infertility undergoing embryo transfer were analyzed. Transvaginal ultrasonography was done on the 10th day of the menstrual cycle. To assess the uterine receptivity, we analyzed all the ultrasonographic and Doppler parameters. The slightly modified version of Applebaum Uterine Scoring System was used. This uterine scoring system included all the following parameters: endometrial thickness, endometrial morphology, endometrial blood flow within zone 3, myometrial echogenecity, uterine artery pulsatility index (PI), end diastolic blood flow, and myometrial blood flow internal to the arcuate vessels seen on gray-scale examination.

RESULTS

The pregnancy rates were higher in women with thick, distinct five-line endometrium and multifocal endometrial vascularity within zone 3. Absent endometrial flow, despite highest values for the other parameters, was associated with no conception. In our study, no pregnancy occurred with uterine PI values of more than 2.8. Absence or reversal of end diastolic blood flow was associated with no conception. A maximum score of 20 was associated with the pregnancy rate of 97.4 %, whereas scores of 13 or less resulted in no pregnancies.

CONCLUSION

Uterine scoring system will help to perform embryo transfers in only favorable uteri and postpone or cancel those cycles in which poor uterine score is demonstrated.