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Li LJ, Du R, Loy SL, Chong YS, Chan JKY, Wong TY, Eriksson JG, Huang Z, Zhang C. Retinal microvasculature and risk of spontaneous abortion in multiethnic Southeast Asian women. Fertil Steril 2022; 118:748-757. [PMID: 35981917 DOI: 10.1016/j.fertnstert.2022.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To better understand the underlying pathogenesis of spontaneous abortion that affects 10%-20% of recognized pregnancies. We used retinal imaging to study the role of systemic microvasculature and the risk of spontaneous abortion. DESIGN A prospective multiethnic preconception cohort study conducted in Singapore. SETTING Hospital-based. PATIENT(S) A total of 1,032 Southeast Asian women who intended to conceive naturally were screened at study entry, among which 480 women spontaneously conceived within the 12-month observation period. After excluding 24 women who were lost to follow-up, we calculated the spontaneous abortion rate among 456 women. Further, we included 379 women for the final association analysis because 63 women did not undergo preconception retinal imaging examination and 14 had other types of pregnancy loss instead of spontaneous abortion. INTERVENTION(S) Trained photographers performed retinal examination using a 45-degree nonmydriatic retinal camera at study entry during the preconception screening. Using a semiautomated, computer-based program, we assessed quantitative retinal microvascular measurements, including caliber, fractal dimension, curvature tortuosity, and branching angle. Clinical research coordinators collected information on sociodemographic status, menstrual characteristics, and lifestyle, and assessed blood pressure and anthropometry at study entry. MAIN OUTCOME MEASURE(S) We performed a modified Poisson regression model to estimate the relative risk (RR) and 95% confidence interval (CI) for each retinal microvascular feature and its association with spontaneous abortion after adjusting for major confounders such as maternal prepregnancy, body mass index, and previous pregnancy loss history. RESULT(S) We reported a spontaneous abortion rate of 13.4% (61 out of 456). Among all retinal microvascular features, retinal arteriolar caliber, retinal arteriolar, and venular curvature tortuosity were associated with a high risk of incident spontaneous abortion. In the regression model, per SD increase in retinal curvature tortuosity was associated with a 25%-34% increased risk of incident spontaneous abortion (arteriolar: unadjusted RR, 1.29 [95% CI, 1.06-1.56] and adjusted RR, 1.26 [1.04-1.53]; venule: unadjusted RR, 1.30 [1.08-1.55] and adjusted RR, 1.34 [1.09-1.64]). CONCLUSION(S) Our prospective cohort observed an increased risk of spontaneous abortion among Asian women with more tortuous retinal vessels assessed during the preconception phase. Our results indicate a role of vascular inflammatory and oxidative stress in the pathogenesis of spontaneous abortion. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03531658.
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Affiliation(s)
- Ling-Jun Li
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
| | - Ruochen Du
- Biostatics Unit, Yong Loo Lin School of Medicine, National University of Singapore
| | - See Ling Loy
- Duke-NUS Medical School, Singapore, Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jerry Kok Yen Chan
- Duke-NUS Medical School, Singapore, Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Zhongwei Huang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute of Molecular and Cell Biology, Agency of Science, Technology & Research, Singapore, Singapore
| | - Cuilin Zhang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Li R, Qiu X, Chen XF, He M, Wang W, Qiao J, He J, Shi Q. Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility. Arch Gynecol Obstet 2022; 306:893-900. [PMID: 35635620 DOI: 10.1007/s00404-022-06620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Rui Li
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Xia Qiu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Xiao Fen Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Mei He
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Wan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Jing Qiao
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Jing He
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Qi Shi
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China.
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Ota K, Shiraishi S, Takahashi T. Relationship between temporal changes of endometrial blood flow impedance during natural and hormone replacement cycles and prediction of pregnancy during vitrified-warmed embryo transfer. J Obstet Gynaecol Res 2021; 47:1052-1063. [PMID: 33395733 DOI: 10.1111/jog.14637] [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: 08/14/2020] [Revised: 11/20/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to examine the relationship between the temporal changes in endometrial blood flow impedance during natural and hormone replacement therapy (HRT) cycles and clinical outcomes of vitrified-warmed embryo transfer (ET). METHODS This retrospective observational cohort study included 60 women, 28 with natural, and 32 with HRT cycles, who underwent vitrified-warmed ET. Uterine radial artery resistance index (RA-RI) was measured during the natural and HRT cycles at the following time points: early follicular phase, day of the human chorionic gonadotropin injection during a natural cycle or day of progesterone administration during an HRT cycle, and day of ET. RESULTS The clinical pregnancy rates of the natural and HRT cycles were 32.1% and 34.4%, respectively. The RA-RI at the early follicular phase was significantly lower in the pregnant group than in the nonpregnant group with natural but not HRT cycles (p = 0.04). The odds ratio for pregnancy was 0.70 (95% confidence interval [CI], 0.52-0.95) when the RA-RI value at the early follicular phase was increased by 0.01 in the natural cycle. With the natural cycle, the area under the receiver-operating characteristic curves for the RA-RI at the early follicular phase with a threshold of 0.68 was 0.75 (95% CI, 0.57-0.93), and the positive and negative predictive values were 0.53 (95% CI, 0.37-0.59) and 0.92 (0.74-0.99), respectively. CONCLUSION RA-RI at the early follicular phase might be an effective and useful tool for deciding between natural or HRT cycles for vitrified-warmed ET.
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Affiliation(s)
- Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Satoru Shiraishi
- Department of Obstetrics and Gynecology, Nasu Red Cross Hospital, Tochigi, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
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Blastocyst-stage embryos provide better frozen-thawed embryo transfer outcomes for young patients with previous fresh embryo transfer failure. Aging (Albany NY) 2020; 12:6981-6989. [PMID: 32294624 PMCID: PMC7202481 DOI: 10.18632/aging.103055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/29/2020] [Indexed: 02/05/2023]
Abstract
Older patients or patients with a reduced ovarian response have a low number of embryos, which limits the opportunity for embryo selection. However, for young patients undergoing frozen-thawed embryo transfer (ET), it remains unclear whether embryo stage affects pregnancy outcomes. In the present study, a total of 2952 patients undergoing their first frozen-thawed ET were divided into two groups: patients who had experienced one failed fresh ET (Group A) and patients who had not received fresh ET because of the high risk of ovarian hyperstimulation syndrome (OHSS) (Group B). Our results show that Group B patients had a significantly higher clinical pregnancy rate (CPR) and live birth rate (LBR) than Group A patients. However, Group A patients who underwent blastocyst-stage frozen-thawed ET had a significantly higher CPR and LBR and a lower ectopic pregnancy rate (ePR) than did those who underwent cleavage-stage frozen-thawed ET. In Group B, CPR, ePR, LBR and spontaneous abortion rate (sAR) were similar with blastocyst-stage and cleavage-stage frozen-thawed ET. These results suggest that blastocyst-stage frozen-thawed ET is more appropriate for young patients who had previously undergone one failed fresh ET cycle.
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Sharma N, Saravanan M, Saravanan Mbbs L, Narayanan S. The role of color Doppler in assisted reproduction: A narrative review. Int J Reprod Biomed 2020; 17:779-788. [PMID: 31911960 PMCID: PMC6906874 DOI: 10.18502/ijrm.v17i10.5484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/06/2019] [Accepted: 05/12/2019] [Indexed: 11/24/2022] Open
Abstract
Color Doppler of perifollicular vascularity is a useful assessment tool to predict the growth potential and maturity of Graafian follicles. Power Angio is independent of the angle of insonation and morphometry and provides reliable clues to predict the implantation window of the endometrium. Color Doppler can be used for the prediction of ovarian hyperstimulation syndrome. It can also be used to identify the hyper responder and gonadotropin-resistant type of polycystic ovaries. The secretory scan of corpus luteum can accurately predict its vascularity and functional status. A corpus luteum with decreased blood flow is a very sensitive and specific indicator of threatened and missed abortions. Color Doppler and Power Angio need to be standardized and identical settings should be maintained if different patients, or if changes over time within the same patient are to be compared.
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Affiliation(s)
- Nidhi Sharma
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Mahalakshmi Saravanan
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Lakshmanan Saravanan Mbbs
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Sindujhaa Narayanan
- Department of Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Law TSM, Cheung WC, Wu F, Zhang R, Chung JPW, Wang CC, Chen X, Li TC. Endometrial Vascularization Characterized by Optical Coherence Tomography and Immunohistochemistry in Women Undergoing In Vitro Fertilization-Embryo Transfer Treatment. ACTA ACUST UNITED AC 2019; 55:medicina55040081. [PMID: 30934763 PMCID: PMC6524031 DOI: 10.3390/medicina55040081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Background and objective: Endometrial angiogenesis is a prerequisite for successful pregnancy. Optical coherence tomography (OCT) is a non-invasive physically optical imaging technique widely used in ophthalmology and cardiology. However, there is no study using OCT to evaluate endometrium. The aim of this study was to use OCT and traditionally histological methods to investigate endometrial vascularization in women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment and to determine the association with the pregnancy outcome. Methods: A total of 47 women were included in this study. OCT was used to assess endometrial vascularization by determining the high signal areas precisely on the seventh day after luteinizing hormone surge in non-conception natural cycles. Endometrial biopsies were obtained following OCT and immunohistochemistry was used to determine micro vessel and expression of vascular endothelial growth factor-A (VEGF-A) in the luminal epithelium, glandular epithelium and stroma, separately. Micro vessel counting was performed and the result was expressed as micro vessel density (MVD). A semi-quantitative H-score was used to determine the staining intensity of VEGF-A. Results: In women who successfully conceived after embryo transfer, the proportion of extensive high signal area in the uterine body detected by OCT (80%, 8/10), MVD (median number of micro vessels/mm2 of 10, range 4–17) and stromal expression of VEGF-A (median H-score of 189, range 72–395) were found to be significantly higher than those of women who did not conceive after embryo transfer in the subsequent IVF-ET treatment (OCT: 30%, 3/10; MVD: median number of micro vessels/mm2 of 7, range 4–10; VEGF-A: median H-score of 125, range 86–299, respectively). In addition, a significantly higher stromal expression of VEGF-A (median H-score of 196, range 84–395) and MVD (median number of micro vessels/mm2 of 9, range 5–16) was found in women with extensive high signal area in uterine body, compared to those with focal or no high signal area (stromal VEGF-A: median H-score of 135, range 92–302; MVD: number of micro vessels/mm2 of 6, range 4-11). Conclusions: Both immunohistochemistry and OCT demonstrated significant difference in vascularization of the peri-implantation endometrium between subjects who did and did not conceive after IVF-ET treatment. Our findings also suggest OCT appears to be a promising non-invasive or minimally invasive alternative to study endometrial vascularity in women with reproductive failure.
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Affiliation(s)
- Tracy Sze Man Law
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Wing Ching Cheung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Fangrong Wu
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Ruizhe Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Jacqueline Pui Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Chi Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong.
- School of Biomedical Science, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Xiaoyan Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Tin Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Use of Letrozole versus clomiphene-estradiol for treating infertile women with unexplained infertility not responding well to clomiphene alone, comparative study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Mayer RB, Ebner T, Weiss C, Allerstorfer C, Altmann R, Oppelt P, Shebl O. The Role of Endometrial Volume and Endometrial and Subendometrial Vascularization Parameters in a Frozen Embryo Transfer Cycle. Reprod Sci 2018; 26:1013-1018. [PMID: 30419800 DOI: 10.1177/1933719118804421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The role of three-dimensional power Doppler ultrasonography of the endometrium in assisted reproduction is still far from clear. In this retrospective cohort study, transvaginal three-dimensional power Doppler examinations were performed 30 min before frozen-thawed embryo transfer. After pregnancy tests, two cohorts were established: P (pregnant, n = 31) and NP (nonpregnant, n = 31). The study only included nullipara with no uterine abnormalities who were undergoing infertility treatment at the Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria. The main outcome measures were the vascularization flow index (VFI), flow index (FI), and vascularization index (VI) in the endometrium/subendometrium, assessed using Virtual Organ Computer-aided AnaLysis (VOCAL™), and the endometrial volume. A total of 62 patients were enrolled in the study, forming two cohorts (pregnant, P; nonpregnant, NP). There were no significant differences between the two cohorts with regard to demographic data, numbers of embryos transferred, or embryo grading, but there was a significant difference in endometrial volume (cohort P, 3.17 ± 0.84 mL; cohort NP, 2.36 ± 0.9 mL; P = 0.001) and the pregnancy rate rises with larger volume. No differences were observed in the vascularization parameters FI, VFI, and VI in the endometrium and subendometrium. In the cohort of pregnant patients, there were 26 (41.9%) live births, with 21 term deliveries (80.8%). The endometrial volume was larger in the cohort of pregnant patients. Measurements were performed 30 min before embryo transfer, and no differences were observed in vascularization parameters in the subendometrium and endometrium.
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Affiliation(s)
- Richard Bernhard Mayer
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria.
| | - Thomas Ebner
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria
| | - Christoph Weiss
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria
| | - Christina Allerstorfer
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria
| | - Reinhard Altmann
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria
| | - Omar Shebl
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040, Austria
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Martins MR, Martins WP, Soares CAM, Miyague AH, Kudla MJ, Pavan TZ. Understanding the Influence of Flow Velocity, Wall Motion Filter, Pulse Repetition Frequency, and Aliasing on Power Doppler Image Quantification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:255-261. [PMID: 28736982 DOI: 10.1002/jum.14338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/06/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Although power Doppler imaging has been used to quantify tissue and organ vascularity, many studies showed that limitations in defining adequate ultrasound machine settings and attenuation make such measurements complex to be achieved. However, most of these studies were conducted by using the output of proprietary software, such as Virtual Organ computer-aided analysis (GE Healthcare, Kretz, Zipf, Austria); therefore, many conclusions may not be generalizable because of unknown settings and parameters used by the software. To overcome this limitation, our goal was to evaluate the impact of the flow velocity, pulse repetition frequency (PRF), and wall motion filter (WMF) on power Doppler image quantification using beam-formed ultrasonic radiofrequency data. METHODS The setup consisted of a blood-mimicking fluid flowing through a phantom. Radiofrequency signals were collected using PRFs ranging from 0.6 to 10 kHz for 6 different flow velocities (5-40 cm/s). Wall motion filter cutoff frequencies were varied between 50 and 250 Hz. RESULTS The power Doppler magnitude was deeply influenced by the WMF cutoff frequency. The effect of using different WMF values varied with the PRF; therefore, the power Doppler signal intensity was dependent on the PRF. Finally, we verified that power Doppler quantification can be affected by the aliasing effect, especially when using a PRF lower than 1.3 kHz. CONCLUSIONS The WMF and PRF greatly influenced power Doppler quantification, mainly when flow velocities lower than 20 cm/s were used. Although the experiments were conducted in a nonclinical environment, the evaluated parameters are equivalent to those used in clinical practice, which makes them valuable for aiding the interpretation of related data in future research.
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Affiliation(s)
- Maricy R Martins
- Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos A M Soares
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Andre H Miyague
- Department of Obstetrics and Gynecology, University Hospital Evangelico de Curitiba, Curitiba, Brazil
- Woman and Fetal Medicine Institute, Curitiba, Brazil
| | - Marek J Kudla
- Clinical Department of Oncological Gynecology, Medical University of Silesia, Katowice, Poland
| | - Theo Z Pavan
- Department of Physics, School of Philosophy, Sciences, and Letters of Ribeirão Preto, Ribeirão Preto, Brazil
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Wang L, Huang X, Li X, Lv F, He X, Pan Y, Wang L, Zhang X. Efficacy evaluation of low-dose aspirin in IVF/ICSI patients evidence from 13 RCTs: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7720. [PMID: 28906358 PMCID: PMC5604627 DOI: 10.1097/md.0000000000007720] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis of existing literature to evaluate the different outcomes of low-dose aspirin on patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), including clinical pregnancy rate, implantation rate, live birth rate, miscarriage rate, fertilization rate, number of oocytes retrieved, and so forth. METHODS Electronic databases including PubMed, MEDLINE, and Embase were searched between 1997 and March 2016 to identity eligible studies. The following comparisons between treatment groups were included: aspirin versus placebo; aspirin versus control group; aspirin versus aspirin + prednisolone + control. RESULTS Thirteen randomized controlled trials which included 3104 participants were selected. There were no significant differences in implantation rate (RR = 1.15; 95% CI = 0.78-1.70), live birth rate (RR = 1.06; 95% CI = 0.93-1.21), miscarriage rate (RR = 1.28; 95% CI = 0.93-1.77), fertilization rate (RR = 0.91; 95% CI = 0.75-1.11), and endometrial thickness (WMD = 0.15; 95% CI = -0.38-0.67). But the research showed that aspirin treatment may improve the clinical pregnancy rate (RR = 1.16; 95% CI = 1.04-1.28) compared to placebo or no treatment, and reduce the number of oocytes retrieved (WMD = -0.68; 95% CI = -0.91-0.46). CONCLUSIONS Our findings suggest that low-dose aspirin may improve the pregnancy rate in IVF/ICSI, with the recommended clinical use dose of 100 mg/day. Considering the limitation of included studies, further well-designed large-scaled RCTs are necessary to clarify whether aspirin may improve assisted reproduction outcomes in IVF/ICSI patients.
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Affiliation(s)
- Liping Wang
- Department of Biobank, Clinical Medical College,Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou
| | - Xiaman Huang
- Department of Obstetrical, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong
| | - Xueli Li
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Fang Lv
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Xiao He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Yu Pan
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Li Wang
- The University of Texas MD Anderson Cancer Center, Department of Anesthesiology & Perioperative Medicine, Houston, TX
| | - Xiaomei Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
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11
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Chen X, Saravelos SH, Liu Y, Huang J, Wang CC, Li TC. Correlation between three-dimensional power Doppler and morphometric measurement of endometrial vascularity at the time of embryo implantation in women with unexplained recurrent miscarriage. J Mol Histol 2017; 48:235-242. [PMID: 28451773 DOI: 10.1007/s10735-017-9722-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
Power Doppler in combination with three-dimensional (3D-PD) ultrasonography has been used as a noninvasive tool to evaluate the vascularity. However, it is unclear whether 3D-PD can accurately reflect endometrial vascularization and replace the invasive endometrial biopsy. This study aims to investigate the correlation between 3D-PD and micro vessel morphometric measurement of endometrial vascularity. Twenty-five women with unexplained recurrent miscarriage were recruited for 3D-PD and endometrial biopsy on precisely day LH + 7. Immunohistochemistry using vWF was employed to identify micro vessels in endometrial biopsy specimens followed by the use of morphometric technique to measure the mean vessel diameter and volume fractions. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) assessed by 3D-PD were calculated for both the endometrial and sub-endometrial regions. There were no significant correlations between any of the ultrasonographic measurements (endometrial thickness, endometrial volume, endometrial VI/FI/VFI, sub-endometrial volume, sub-endometrial VI/FI/VFI) and morphometric features (number of micro vessel, mean diameter of micro vessel and volume fraction measurement of vessel). This study indicates that endometrial vascularity assessed by 3D-PD could not be used to reflect changes in micro vessels of the endometrium at the time of embryo implantation in women with unexplained recurrent miscarriage.
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Affiliation(s)
- Xiaoyan Chen
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sotirios H Saravelos
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Obstetrics and Gynaecology, Imperial College London, London, UK
| | - Yingyu Liu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jin Huang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.,Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong.,School of Biomedical Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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12
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Zhang T, He Y, Wang Y, Zhu Q, Yang J, Zhao X, Sun Y. The role of three-dimensional power Doppler ultrasound parameters measured on hCG day in the prediction of pregnancy during in vitro fertilization treatment. Eur J Obstet Gynecol Reprod Biol 2016; 203:66-71. [DOI: 10.1016/j.ejogrb.2016.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/10/2016] [Accepted: 05/13/2016] [Indexed: 11/25/2022]
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Mishra VV, Agarwal R, Sharma U, Aggarwal R, Choudhary S, Bandwal P. Endometrial and Subendometrial Vascularity by Three-Dimensional (3D) Power Doppler and Its Correlation with Pregnancy Outcome in Frozen Embryo Transfer (FET) Cycles. J Obstet Gynaecol India 2016; 66:521-7. [PMID: 27651656 DOI: 10.1007/s13224-016-0871-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/19/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE OF THE STUDY To study the role of endometrial and subendometrial blood flow measured by 3D power Doppler as predictors of pregnancy in frozen embryo transfer (FET) cycles. METHODS A hospital-based prospective study of two hundred and twenty-one (221) women undergoing FET cycles with a triple-line endometrium ≥7 mm on day 14 endometrial and subendometrial blood flow was assessed using 3D power Doppler, and various indices endometrial volume, subendometrial volume and their vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI) were obtained and compared between the pregnant and the non-pregnant group. Primary outcome was clinical pregnancy. RESULTS Out of 221 women, 97(43.89 %) became pregnant, while 124 (56.10 %) failed to become pregnant. The endometrial volume was comparable between the two groups. Endometrial VI, FI and VFI were significantly higher in the pregnant as compared to the non-pregnant group. There was a significant difference in subendometrial VI and VFI between the two groups, but FI was similar. CONCLUSIONS Endometrial and subendometrial vascularity by 3D power Doppler can be a useful parameter in predicting pregnancy in FET cycles.
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Affiliation(s)
- Vineet V Mishra
- Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Ritu Agarwal
- Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Urmila Sharma
- Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Rohina Aggarwal
- Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Sumesh Choudhary
- Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Pradeep Bandwal
- Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
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Truong A, Sayago MM, Kutteh WH, Ke RW. Subchorionic hematomas are increased in early pregnancy in women taking low-dose aspirin. Fertil Steril 2016; 105:1241-1246. [PMID: 26820772 DOI: 10.1016/j.fertnstert.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the frequency of subchorionic hematomas (SCH) in first-trimester ultrasound examinations of patients with infertility and recurrent pregnancy loss (RPL) and in patients from a general obstetric population. To determine if the method of assisted reproduction utilized or the use of anticoagulants, such as heparin and aspirin (ASA), influenced frequency of SCH. DESIGN Prospective, cohort study. SETTING Fertility clinic and general obstetrics clinic. PATIENT(S) Five hundred and thirty-three women who were pregnant in the first-trimester. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Frequencies of subchorionic hematomas in women based on diagnosis, use of anticoagulants, and fertility treatment. RESULT(S) SCH were identified in 129/321 (40.2%) in the study group compared to 23/212 (10.9%) in the control group. Fertility diagnosis and the use of heparin did not appear to affect the frequency of SCH in the first trimester; however, SCH occurred at an almost four-fold increase in patients taking ASA compared to those not taking ASA, regardless of fertility diagnosis or method of fertility treatment. CONCLUSION(S) The use of ASA may be associated with an increased risk of developing a SCH during the first trimester. The increased frequencies of SCH in pregnancies of patients attending a fertility clinic compared to women from a general obstetrical practice was highly correlated with the use of ASA.
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Affiliation(s)
- Ashley Truong
- Department of Biochemistry and Molecular Biology, Rhodes College, Memphis, Tennessee
| | | | - William H Kutteh
- Department of Obstetrics and Gynecology, Fertility Associates of Memphis, Vanderbilt University, Memphis, Tennessee.
| | - Raymond W Ke
- Department of Obstetrics and Gynecology, Fertility Associates of Memphis, Vanderbilt University, Memphis, Tennessee
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15
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Tan SY, Hang F, Purvarshi G, Li MQ, Meng DH, Huang LL. Decreased endometrial vascularity and receptivity in unexplained recurrent miscarriage patients during midluteal and early pregnancy phases. Taiwan J Obstet Gynecol 2015; 54:522-6. [DOI: 10.1016/j.tjog.2014.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/28/2022] Open
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Khan MS, Shaikh A, Ratnani R. Ultrasonography and Doppler Study to Predict Uterine Receptivity in Infertile Patients Undergoing Embryo Transfer. J Obstet Gynaecol India 2015; 66:377-82. [PMID: 27651633 DOI: 10.1007/s13224-015-0742-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Rekha Ratnani
- Apollo BSR Hospitals, Junwani Road, Bhilai, 490020 India
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17
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Mayer RB, Ebner T, Yaman C, Hartl J, Sir A, Krain V, Oppelt P, Shebl O. Influence of intracervical and intravaginal seminal plasma on the endometrium in assisted reproduction: a double-blind, placebo-controlled, randomized study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:132-138. [PMID: 25265096 DOI: 10.1002/uog.14669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/27/2014] [Accepted: 09/04/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the effect of intracervical and intravaginal application of seminal plasma on the endometrium, as assessed by endometrial/subendometrial vascularization and endometrial volume between the day of oocyte retrieval and the day of embryo transfer in an in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle. METHODS This was a double-blind, placebo-controlled, randomized study including patients undergoing a first or second IVF/ICSI cycle. Homologous seminal plasma or placebo (sodium chloride) was injected into the cervix and posterior vaginal fornix just after follicle aspiration. Three-dimensional power Doppler examination was performed 30 min before oocyte retrieval and 30 min before embryo transfer. Main outcome measures were changes in vascularization flow index (VFI), flow index (FI) and vascularization index (VI) of the endometrium/subendometrium using VOCAL™ (Virtual Organ Computer-aided AnaLysis) and endometrial volume. RESULTS One hundred patients agreed to participate in the study. Twenty-three patients were excluded, mainly as a result of canceled embryo transfer. Data were analyzed from 40 patients receiving seminal plasma and 37 receiving placebo. No significant differences between the two groups were seen in VFI, FI or VI of the endometrium or subendometrium or in endometrial volume on the day of oocyte pick-up and on the day of embryo transfer. CONCLUSION Neither endometrial/subendometrial vascularization parameters nor endometrial volume seem to be affected by the application of seminal plasma in patients undergoing their first or second IVF/ICSI cycle.
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Affiliation(s)
- R B Mayer
- Landes Frauen und Kinderklinik Linz, Medizinische Fakultät Universität Linz, Linz, Austria
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18
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Koo HS, Kwak-Kim J, Yi HJ, Ahn HK, Park CW, Cha SH, Kang IS, Yang KM. Resistance of uterine radial artery blood flow was correlated with peripheral blood NK cell fraction and improved with low molecular weight heparin therapy in women with unexplained recurrent pregnancy loss. Am J Reprod Immunol 2014; 73:175-84. [PMID: 25339113 DOI: 10.1111/aji.12316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/06/2014] [Indexed: 01/17/2023] Open
Abstract
PROBLEM To investigate whether peripheral blood natural killer (pbNK) cell levels are associated with uterine blood flow, and low molecular weight heparin (LMWH) treatment is effective to improve uterine blood flow in women with decreased uterine blood flow and unexplained recurrent pregnancy loss (RPL). METHOD OF STUDY This was a prospective controlled study. Study population included 33 pregnant women (between 5 and 7 weeks gestation) with ≥ 2 RPL and controls were 47 healthy pregnant women. pbNK cell fractions (CD3(-)/56(+)/16(+)) of peripheral blood mononuclear cells were measured by flow cytometry. Uterine color-pulsed Doppler ultrasound was performed to evaluate uterine radial artery resistance index (URa-RI). In RPL women with elevated URa-RI (≥ 0.5), LMWH (ranges 40-60 mg/day) was administered subcutaneously daily and URa-RI was reassessed 1 week later. Pregnancy outcome was analyzed at 12 weeks gestation. RESULTS URa-RI was significantly higher in pregnant women with RPL than controls (0.60 ± 0.14 versus 0.54 ± 0.12, P = 0.039). In pregnant women with RPL, pbNK cell fractions displayed a positive correlation with URa-RI (Pearson's r = 0.429, P = 0.013). URa-RI was significantly decreased 1 week after LMWH treatment as compared to that of pretreatment (pretreatment RI: 0.65 ± 0.11 versus post-treatment RI: 0.56 ± 0.13, P = 0.011). Pregnancy outcome of RPL women with LMWH treatment was not different from that of pregnant controls (73.3% versus 85.0%, P = NS). CONCLUSION Increased pbNK cells are associated with decreased uterine radial artery blood flow. LMWH treatment effectively decreases URa-RI with improved pregnancy outcome in women with RPLs and elevated URa-RI. A larger scale study is needed to verify these findings.
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Affiliation(s)
- Hwa Seon Koo
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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Lai CWS, Yung SSF, Ng EHY. Endometrial vascularity is lower in pregnancies with pregnancy-induced hypertension or small-for-gestational-age fetus in live birth after in-vitro fertilization. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:455-460. [PMID: 24452850 DOI: 10.1002/uog.13309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/01/2014] [Accepted: 01/10/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the relationship between endometrial/subendometrial vascularity and the risk of pregnancy-induced hypertension (PIH) or small-for-gestational-age (SGA) fetuses in women who had a live birth following in-vitro fertilization (IVF). METHODS This was a retrospective study of women who had a live birth after IVF from November 2002 to December 2004. Only women with a singleton pregnancy (n = 104) were included for analysis. Three-dimensional ultrasound measurement with power Doppler of the endometrial and subendometrial regions was performed on the day of oocyte retrieval in stimulated IVF cycles or on luteinizing hormone surge + 1 day in frozen-thawed embryo transfer cycles to measure the endometrial volume and the vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of the endometrial and subendometrial regions. Pregnancy outcomes were also reviewed. RESULTS Eight women (7.7%) had PIH or an SGA fetus. Women in the PIH/SGA group had significantly lower endometrial VI (0.504 vs 1.051; P = 0.023) and VFI (0.121 vs 0.253; P = 0.023) than those in the non-PIH/SGA group. However endometrial FI was significantly higher in the PIH/SGA group (23.04 vs 22.71; P = 0.028). There were no significant differences in subendometrial indices between the two groups. CONCLUSION Women who had a live birth following IVF and whose pregnancy was complicated by PIH or an SGA fetus had significantly lower endometrial vascularity in terms of VI and VFI than did women without PIH or SGA.
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Affiliation(s)
- C W S Lai
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Sardana D, Upadhyay AJ, Deepika K, Pranesh GT, Rao KA. Correlation of subendometrial-endometrial blood flow assessment by two-dimensional power Doppler with pregnancy outcome in frozen-thawed embryo transfer cycles. J Hum Reprod Sci 2014; 7:130-5. [PMID: 25191027 PMCID: PMC4150140 DOI: 10.4103/0974-1208.138872] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/14/2014] [Accepted: 02/26/2014] [Indexed: 11/20/2022] Open
Abstract
CONTEXT: Various markers have been proposed to evaluate endometrial receptivity, such as molecular markers and sonographic markers. Commonly used sonographic markers include endometrial thickness and pattern. A good endometrial blood flow is considered necessary for improved pregnancy outcome. AIM: The aim of the present study is to evaluate the role of subendometrial endometrial blood flow with two-dimensional-power Doppler (2D-PD) in predicting pregnancy outcome in hormone replacement frozen-thawed embryo transfer (FET) cycles. SETTING AND DESIGN: Prospective, non-randomized observational study. A total of 165 patients undergoing their first FET cycle were evaluated for subendometrial-endometrial blood flow by 2D-PD once the endometrium was ≥7 mm thick. Group A consisted of 127 women showing the presence of subendometrial-endometrial blood flow. Group B comprised of 38 women in whom subendometrial blood flow was absent. Progesterone supplement was added and transfer of 2-3 cleavage stage good quality embryos was done after 3 days. STATISTICAL ANALYSIS: Independent two-tailed t-test and Chi-square test. RESULTS: There was no significant difference in body mass index, endometrial thickness, follicle stimulating hormone, luteinizing hormone levels, number of mature oocytes, semen parameters and the number of good quality embryos in the two groups (P > 0.05). The mean age in Group A was 32.05 years and 33.73 years in Group B, and the difference was statistically significant (P = 0.04). Overall pregnancy rate (PR) was 30.90%. PRs were significantly higher in the presence of subendometrial-endometrial blood flow than in its absence (35.43% vs. 15.78%, P = 0.02). Furthermore, clinical pregnancy rate and implantation rate were significantly higher in Group A when compared to Group B (31.49% and 14.79% vs. 13.15% and 6.52%, P = 0.02 and 0.03, respectively). CONCLUSION: The presence of endometrial blood flow significantly improves cycle outcome in hormone replacement therapy-FET cycles.
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Affiliation(s)
- Divya Sardana
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bengaluru, Karnataka, India
| | - Amit Jitendra Upadhyay
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bengaluru, Karnataka, India
| | - K Deepika
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bengaluru, Karnataka, India
| | - Gautham T Pranesh
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bengaluru, Karnataka, India
| | - Kamini A Rao
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bengaluru, Karnataka, India
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Galliano D, Bellver J, Díaz-García C, Simón C, Pellicer A. ART and uterine pathology: how relevant is the maternal side for implantation? Hum Reprod Update 2014; 21:13-38. [PMID: 25155826 DOI: 10.1093/humupd/dmu047] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Assisted reproduction technology (ART) has become a standard treatment for infertile couples. Increased success rates obtained over the years have resulted primarily from improved embryo quality, but implantation rates still remain lower than expected. The uterus, an important player in implantation, has been frequently neglected. While a number of uterine pathologies have been associated with decreased natural fertility, less information exists regarding the impact of these pathologies in ART. This report reviews the evidence to help clinicians advise ART patients. METHODS An electronic search of PubMed and EMBASE was performed to identify articles in the English, French or Spanish language published until May 2014 which addressed uterine pathology and ART. Data from natural conception were used only in the absence of data from ART. Studies were classified in decreasing categories: RCTs, prospective controlled trials, prospective non-controlled trials, retrospective studies and experimental studies. Studies included in lower categories were only used if insufficient evidence was available. Pooled data were obtained from systematic reviews with meta-analyses when available. The summary of the evidence for the different outcomes and the degree of the recommendation for interventions were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) statement recommendations. RESULTS There is strong evidence that surrogacy is effective for uterine agenesia. For the remaining pathologies, however, there is very little evidence that the established treatments improve outcomes, or that these pathologies have a negative effect on ART. In the presence of an apparently normal uterus, assessing endometrial receptivity (ER) is the goal; however diagnostic tests are still under development. CONCLUSIONS The real effect of different uterine/endometrial integrity pathologies on ART is not known. Moreover, currently proposed treatments are not based on solid evidence, and little can be done to assess ER in normal or abnormal conditions. No strong recommendations can be given based on the published experience, bringing an urgent need for well-designed studies. In this context, we propose algorithms to study the uterus in ART.
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Affiliation(s)
- Daniela Galliano
- Department of Reproduction, Instituto Valenciano de Infertilidad, Barcelona 08017, Spain
| | - José Bellver
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain
| | - César Díaz-García
- Woman's Health Department, Hospital Politécnico y Universitario La Fe, Valencia 46026, Spain
| | - Carlos Simón
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain IVI Foundation, Valencia 46015, Spain
| | - Antonio Pellicer
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain Woman's Health Department, Hospital Politécnico y Universitario La Fe, Valencia 46026, Spain IVI Foundation, Valencia 46015, Spain
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Elevated natural killer cell levels and autoimmunity synergistically decrease uterine blood flow during early pregnancy. Obstet Gynecol Sci 2014; 57:208-15. [PMID: 24883292 PMCID: PMC4038687 DOI: 10.5468/ogs.2014.57.3.208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/17/2013] [Accepted: 10/22/2013] [Indexed: 01/16/2023] Open
Abstract
Objective To investigate whether natural killer (NK) cell and autoimmune antibody acts synergistically, by the action of autoantibodies to increase NK cell number and cytotoxicity, to decrease uterine blood flow during early pregnancy in pregnant women with a history of recurrent spontaneous abortion (RSA). Methods Seventy-five pregnant women (between 5 and 7 weeks gestation) with a history of unexplained RSA were included in the study group. Forty-one pregnant women without a history of RSA were included as controls. All women with a history of RSA were tested for autoantibodies and number of peripheral blood natural killer (pbNK) cell by flow cytometry. Study populations were stratified into four groups by existence of autoantibody and degree of increase of pbNK cells. The uterine radial artery resistance index (RI) was measured by color-pulsed Doppler transvaginal ultrasound. Results The mean RI of the autoimmune antibody-positive (AA+) group (0.63±0.09) was significantly higher than that of the normal control group (0.53±0.10, P=0.001). The mean RI of the AA+/only-NK elevated (eNK) group (0.63±0.09) was significantly higher than those of the only-AA+ group (0.55±0.07, P=0.019) and the only-eNK group (0.57±0.07, P=0.021). Conclusion Concurrent elevation in NK cells and autoimmunity results in decreased uterine blood flow during early pregnancy. However, the majority of cases of RSA remain unexplained and larger scale studies are needed to confirm our conclusion and to develop diagnostic and therapeutic plans for women with a history of RSA.
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Ebrahimi M, Trivedi A. Increased endometrial vascularity and intraoperative haemorrhage among women undergoing surgical evacuation for retained product of conception. Australas J Ultrasound Med 2014; 17:72-74. [PMID: 28191211 PMCID: PMC5024942 DOI: 10.1002/j.2205-0140.2014.tb00109.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to ascertain the incidence of “increased endometrial vascularity” recorded in the ultrasound scan reports, in the context of RPOC and correlate this finding with the incidence of life threatening intra‐operative bleeding. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception or secondary post partum haemorrhage. This raises the possibility of serious intra‐operative haemorrhage in the minds of the junior doctors because of the possibility of arterio‐venous malformation. This retrospective case series was designed to find the incidences of increased endometrial vascularity and severe intra‐operative haemorrhage in the patients with RPOC in the south eastern part of Melbourne population. The study found that the incidence of increased endometrial vascularity was 7.57% and none of these patients suffered severe intra‐operative haemorrhage. A literature survey revealed that there were few studies on this topic.
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Assessment of endometrial and subendometrial blood flow in women undergoing frozen embryo transfer cycles. Reprod Biomed Online 2014; 28:343-51. [DOI: 10.1016/j.rbmo.2013.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/12/2013] [Accepted: 11/13/2013] [Indexed: 11/23/2022]
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Casey MJ, Salzman TA. Therapeutic, prophylactic, untoward, and contraceptive effects of combined oral contraceptives: catholic teaching, natural law, and the principle of double effect when deciding to prescribe and use. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:20-34. [PMID: 24978407 DOI: 10.1080/15265161.2014.919364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Combined oral contraceptives (COC) have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching.
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Nastri CO, Ferriani RA, Raine-Fenning N, Martins WP. Endometrial scratching performed in the non-transfer cycle and outcome of assisted reproduction: a randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:375-382. [PMID: 23754314 DOI: 10.1002/uog.12539] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/30/2013] [Accepted: 05/31/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To investigate the effect of endometrial scratching, performed during oral contraceptive pill (OCP) pretreatment, on reproductive outcome and on ultrasound markers of endometrial receptivity, and to assess the pain involved in the procedure, in unselected women undergoing assisted reproductive techniques (ART). METHODS Women undergoing ART were randomly allocated to undergo either endometrial scratching with a pipelle de Cornier or a sham procedure, 7-14 days before starting controlled ovarian stimulation (COS). We evaluated subsequent rates of clinical pregnancy, live birth, implantation, miscarriage and multiple pregnancy. Pain during the procedure was evaluated using a 10-cm visual analog scale. Endometrial thickness and volume and three-dimensional power Doppler (3D-PD) indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were assessed during COS when there was at least one follicle ≥ 17 mm in diameter. RESULTS We included 158 women. Endometrial scratching was associated with higher rates of live birth (41.8% vs 22.8%, P = 0.01) and clinical pregnancy (49.4% vs 29.1%, P = 0.01) and higher pain score (6.42 ± 2.35 cm vs 1.82 ± 1.52 cm, P < 0.001), endometrial VI (3.71 ± 1.77 vs 2.95 ± 1.56, P < 0.01) and VFI (0.97 ± 0.51 vs 0.76 ± 0.40, P < 0.01). There was no significant effect of endometrial scratching on rate of miscarriage (15.4% vs 21.7%, P = 0.53) or multiple pregnancy (22.5% vs 25.0%, P = 0.79), or on endometrial thickness (10.12 ± 1.55 mm vs 9.98 ± 1.62 mm, P = 0.59), endometrial volume (6.18 ± 1.63 cm(3) vs 6.01 ± 1.48 cm(3) , P = 0.51) or FI (26.12 ± 2.82 vs 25.91 ± 2.72, P = 0.65). CONCLUSIONS Endometrial scratching performed once, during OCP pretreatment 7-14 days before starting COS, increases the chance of live birth and clinical pregnancy, but might cause considerable pain.
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Affiliation(s)
- C O Nastri
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil; Ultrasonography and Retraining Medical School of Ribeirao Preto (EURP), Ribeirao Preto, Brazil
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Decreased endometrial vascularity in patients with antiphospholipid antibodies–associated recurrent miscarriage during midluteal phase. Fertil Steril 2012; 98:1495-502.e1. [DOI: 10.1016/j.fertnstert.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/23/2012] [Accepted: 08/06/2012] [Indexed: 11/18/2022]
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Cetinkaya K, Kadanalı S. The effect of administering vaginal estrogen to clomiphene citrate stimulated cycles on endometrial thickness and pregnancy rates in unexplained infertility. J Turk Ger Gynecol Assoc 2012; 13:157-61. [PMID: 24592030 DOI: 10.5152/jtgga.2012.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 05/12/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Clomiphene citrate (CC) has some negative effects on the endometrium. We aimed to determine the effect of vaginally administered local estrogen (LE) on endometrial thickness (ET) and pregnancy rates in CC stimulated cycles. MATERIAL AND METHODS This was a prospective randomized crossover study that took place in a university hospital. The patients had received CC due to unexplained infertility (UI). Two different treatment protocols were given sequentially as, either CC+LE or CC alone. Each protocol was planned for two cycles and there was a one-month wash-out period between protocols. The effects of LE on the 3(rd) and 9(th) day, the ovulation day (OD) and 7(th) postovulation day (POD7) were investigated. RESULTS A total of 6 pregnancies were achieved with 3 patients from each protocol. The ET was 7.6±1.4 mm and 8.3±2.1 mm respectively and significantly different in the CC group and the CC+E2 groups on the OD (p=.039), while these values were 9.7±2.3 mm and 10.9±3.0 mm respectively and significantly different on the POD7 (p=.007). There was no significant difference between the groups for arterial PI values on the OD and POD7. The frequency of thin endometrium (<6 mm) was 15.2% and 12.2% respectively in the CC group and the CC+E2 group on the OD (p=.628) and 5.1% and 1.2% respectively on the POD7 (p=.182). CONCLUSION Adding vaginal LE to CC stimulated cycles led to a significant increase in ET on the OD and POD7. However, this difference in thickness was not reflected in the pregnancy rates in this study.
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Affiliation(s)
- Kadir Cetinkaya
- Department of Gynecology and Obstetrics, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Sedat Kadanalı
- Department of Gynecology and Obstetrics, Istanbul Medicalpark Hospital, Istanbul, Turkey
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Colour Doppler ultrasound in controlled ovarian stimulation with intrauterine insemination. APOLLO MEDICINE 2012. [DOI: 10.1016/j.apme.2012.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yaman C, Mayer R. Three-dimensional ultrasound as a predictor of pregnancy in patients undergoing ART. J Turk Ger Gynecol Assoc 2012; 13:128-34. [PMID: 24592022 DOI: 10.5152/jtgga.2012.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/23/2012] [Indexed: 11/22/2022] Open
Abstract
Different ultrasound parameters have been used to assess endometrial receptivity during ART treatment, including endometrial thickness, endometrial pattern, endometrial volume, Doppler of uterine arteries and endometrial blood flow. However, conflicting results have been reported with regard to their role in the prediction of pregnancy in ART treatment. The 3D ultrasound with power Doppler provides a unique tool with which to examine the blood supply of the whole endometrium and subendometrial region. Volume assessment can also be precisely performed by 3D ultrasound. Based on a med-line research and on our experience, the clinical use of 3D ultrasound is discussed in this review article.
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Affiliation(s)
- Cemil Yaman
- Department of Gynecology and Obstetrics, General Hospital of Linz, Akh-Linz, Austria
| | - Richard Mayer
- Department of Gynecology and Obstetrics, General Hospital of Linz, Akh-Linz, Austria
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Abdallah Y, Naji O, Saso S, Pexsters A, Stalder C, Sur S, Raine-Fenning N, Timmerman D, Brosens JJ, Bourne T. Ultrasound assessment of the peri-implantation uterus: a review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:612-619. [PMID: 21910147 DOI: 10.1002/uog.10098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Emerging evidence suggests that early embryo implantation is a more active maternal process than hitherto appreciated, involving active encapsulation of the implanting blastocyst by maternal decidual cells and coordinated changes in the underlying inner myometrium, known as the junctional zone. These concepts raise the possibility that early ultrasound markers predictive of adverse pregnancy outcome could be identified. In this review we assess the role of ultrasound in predicting the likelihood of different pregnancy outcomes and highlight potential novel markers that could be tested.
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Affiliation(s)
- Y Abdallah
- Institute of Development and Reproductive Biology (IRDB), Imperial College London, London, UK.
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3D-Endometrial volume and outcome of cryopreserved embryo replacement cycles. Arch Gynecol Obstet 2012; 286:517-23. [DOI: 10.1007/s00404-012-2332-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
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Effet du tabagisme sur l’implantation embryonnaire et la placentation précoce et facteurs influençant la toxicité tabagique sur la reproduction (Partie II). ACTA ACUST UNITED AC 2011; 39:567-74. [DOI: 10.1016/j.gyobfe.2011.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/30/2010] [Indexed: 11/22/2022]
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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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A comparison of endometrial and subendometrial vascularity assessed by three-dimensional ultrasonography and power Doppler angiography between healthy fertile women and women with unexplained primary recurrent miscarriage. Fertil Steril 2011; 95:1127-9. [DOI: 10.1016/j.fertnstert.2010.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 08/08/2010] [Accepted: 09/16/2010] [Indexed: 11/23/2022]
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Kuroda K, Kitade M, Kikuchi I, Kumakiri J, Matsuoka S, Kuroda M, Takeda S. Alterations in endometrial vascular density via hysteroscopy evaluated by vascular analysis software during laparoscopic myomectomy on an infertile woman with submucous myoma. MINIM INVASIV THER 2010; 20:58-61. [PMID: 21155634 DOI: 10.3109/13645706.2010.518678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Submucous myomas cause infertility and recurrent pregnancy loss. Several studies have reported successful reproductive outcomes after hysteroscopic myomectomy (HM), but the risk of postoperative intrauterine adhesion is present. We performed laparoscopic myomectomy (LM) for a submucous myoma and second look laparoscopy under observation using a hysteroscope to evaluate the alteration in endometrial vascular density during surgery using vascular analysis software. The patient was a 33-year-old nulliparous infertile woman. She had one submucous myoma of 4 cm in diameter and 50-60% penetration into the myometrium (class T:II; the European Society of Hysteroscopy classification). The surface vascular density of the submucous myoma was 68.6% before the start of surgery, decreased to 51.4% upon vasopressin injection and increased to 67.6% at the end of LM. Intraabdominal and intrauterine adhesions were not seen at second look laparoscopy. The vascular density was 70.8%, and the rate of endometrial blood flow was increased to 112.5% by comparison with the vascular density before the start of surgery. HM is a safe and effective procedure, but carries the risk of scarring the uterine cavity with uterine adhesions. We have to consider LM for women of reproductive age who have a submucous myoma with penetration >50% into the myometrium (class T:II).
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Affiliation(s)
- Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medician, Tokyo, Japan.
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Dechanet C, Anahory T, Mathieu Daude JC, Quantin X, Reyftmann L, Hamamah S, Hedon B, Dechaud H. Effects of cigarette smoking on reproduction. Hum Reprod Update 2010; 17:76-95. [PMID: 20685716 DOI: 10.1093/humupd/dmq033] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cigarette smoking is associated with lower fecundity rates, adverse reproductive outcomes and a higher risk of IVF failures. Over the last few decades, prevalence of smoking among women of reproductive age has increased. This review focuses on current knowledge of the potential effects of smoke toxicants on all reproductive stages and the consequences of smoke exposure on reproductive functions. METHODS We conducted a systematic review of the scientific literature on the impact of cigarette smoking and smoke constituents on the different stages of reproductive function, including epidemiological, clinical and experimental studies. We attempted to create hypotheses and find explanations for the deleterious effects of cigarette smoke observed in experimental studies. RESULTS Cigarette smoke contains several thousand components (e.g. nicotine, polycyclic aromatic hydrocarbons and cadmium) with diverse effects. Each stage of reproductive function, folliculogenesis, steroidogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and uterine myometrium is a target for cigarette smoke components. The effects of cigarette smoke are dose-dependent and are influenced by the presence of other toxic substances and hormonal status. Individual sensitivity, dose, time and type of exposure also play a role in the impact of smoke constituents on human fertility. CONCLUSIONS All stages of reproductive functions are targets of cigarette smoke toxicants. Further studies are necessary to better understand the deleterious effects of cigarette smoke compounds on the reproductive system in order to improve health care, help to reduce cigarette smoking and provide a better knowledge of the molecular mechanisms involved in reproductive toxicology.
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Affiliation(s)
- C Dechanet
- Department of Medicine and Biology of Reproduction, Hôpital Arnaud de Villeneuve, Montpellier Cedex 5, France.
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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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Kilic S, Tasdemir N, Yilmaz N, Yuksel B, Gul A, Batioglu S. The effect of anti-thyroid antibodies on endometrial volume, embryo grade and IVF outcome. Gynecol Endocrinol 2008; 24:649-55. [PMID: 19031223 DOI: 10.1080/09513590802531112] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Thyroid auto-immunity (TAI) has been implicated as the most common cause of hypothyroidism in general population, especially in women. Many studies revealed that increased infertility incidences with TAI. The aim of the present article was to evaluate the effect of thyroid auto-antibody (TAA) positivity on embryological parameters, IVF-outcome and endometrial volume (EnV) in infertile patients who were applied for routine artificial reproductive technologies (ART) programme. This study included prospective, sequential, cross-sectional analyses of parameters obtained from 69 patients with unexplained infertility. It was the first ART application of patients. Patients were homogenous for age, body mass index, basal hormone measurements and underwent same ovulation induction protocol. They were evaluated for thyroid hormone profile and TAAs and divided into three groups; TAA negative group (n = 31), TAA positive group (n = 23) and TAA positive and euthyroid with medication group (n = 15). There were no differences among groups for the number of Grade-1 and Grade-2 embryos, distribution of embryo-grades, number of oocytes retrieved and fertilised, biochemical pregnancy ratios (PR), EnV and miscarriage ratio. However, the clinical PR was significantly lower in the TAA positive group (p = 0.024). In conclusion, the embryo grades and EnV did not differ among groups. But the clinical PR differs and the anti-thyroid peroxides positivity, above the cut-off point, affects the clinical PR.
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Affiliation(s)
- Sevtap Kilic
- Department of Reproductive Endocrinology, Dr. Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey.
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Lee YL, Liu Y, Ng PY, Lee KF, Au CL, Ng EHY, Ho PC, Yeung WSB. Aberrant expression of angiopoietins-1 and -2 and vascular endothelial growth factor-A in peri-implantation endometrium after gonadotrophin stimulation. Hum Reprod 2008; 23:894-903. [DOI: 10.1093/humrep/den004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wu MH, Pan HA, Chang FM. Three-dimensional and Power Doppler Ultrasonography in Infertility and Reproductive Endocrinology. Taiwan J Obstet Gynecol 2007; 46:209-14. [DOI: 10.1016/s1028-4559(08)60022-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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