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Liang X, He J, He L, Lin Y, Li Y, Cai K, Wei J, Lu Y, Chen Z. An ultrasound-based deep learning radiomic model combined with clinical data to predict clinical pregnancy after frozen embryo transfer: a pilot cohort study. Reprod Biomed Online 2023; 47:103204. [PMID: 37248145 DOI: 10.1016/j.rbmo.2023.03.015] [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: 12/22/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
RESEARCH QUESTION Can a multi-modal fusion model based on ultrasound-based deep learning radiomics combined with clinical parameters provide personalized evaluation of endometrial receptivity and predict the occurrence of clinical pregnancy after frozen embryo transfer (FET)? DESIGN Prospective cohort study of women (n = 326) who underwent FET between August 2019 and December 2021. Input quantitative variables and input image data for radiomic feature extraction were collected to establish a multi-modal fusion prediction model. An additional independent dataset of 453 ultrasound endometrial images was used to establish the segmentation model to determine the endometrial region on ultrasound images for analysis. The performance of different algorithms and different input data for prediction of FET outcome were compared. RESULTS A total of 240 patients with complete data were included in the final cohort. The proposed multi-modal fusion model performed significantly better than the use of either image or quantitative variables alone to predict the occurrence of clinical pregnancy after FET (P ≤ 0.034). Its area under the curve, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the proposed model were 0.825, 72.5%, 96.2%, 58.3%, 72.3% and 89.5%, respectively. The Dice coefficient of the multi-task endometrial ultrasound segmentation model was 0.89. Use of endometrial segmentation features significantly improved the prediction performance of the model (P = 0.041). CONCLUSIONS The multi-modal fusion model based on ultrasound-based deep learning radiomics combined with clinical quantitative variables offers a favourable and rapid non-invasive approach for personalized prediction of FET outcome.
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Affiliation(s)
- Xiaowen Liang
- Institution of Medical Imaging, University of South China, Hengyang, China; The Seventh Affiliated Hospital, Hengyang Medical School, University of South China, Changsha, China; The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, China
| | - Jianchong He
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Lu He
- The First Affiliated Hospital, Department of Obstetrics and Gynecology, Hengyang Medical School, University of South China, Hengyang, China
| | - Yan Lin
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuewei Li
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kuan Cai
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun Wei
- Institution of Medical Imaging, University of South China, Hengyang, China
| | - Yao Lu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China.
| | - Zhiyi Chen
- Institution of Medical Imaging, University of South China, Hengyang, China; The Seventh Affiliated Hospital, Hengyang Medical School, University of South China, Changsha, China; The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, China.
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Sakuragi T, Shibata E, Kondo E, Higami S, Fujimoto S, Amimoto S, Mori H, Aramaki S, Tsuji M, Yoshino K. Relationship between placental hemodynamics and placental histological analysis in third trimester. J Obstet Gynaecol Res 2023; 49:560-567. [PMID: 36352774 DOI: 10.1111/jog.15491] [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: 07/03/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
AIM To investigate whether vascularization index (VI), flow index (FI), and vascularization flow index (VFI) correlate with the pathological structure of the placenta and whether there were any differences in VI, FI, VFI, and placental pathological structure between the normal and preeclampsia (PE) groups. METHODS Fifty-five pregnant women (normal group, n = 27; PE group, n = 28) underwent VI, FI, and VFI at four locations in the placenta during the second and third trimesters. Two hematoxylin and eosin (HE)-stained specimens of the postpartum placenta were prepared. We randomly selected two of these locations and used ImageJ, an open-source image package, to quantify intervillous blood vessels (IBV), intervillous spaces (IS), and intervillous blood vessels + intervillous spaces (IBV + IS) per unit placenta and analyzed their correlation with VI, FI, and VFI. RESULTS There was no positive correlation between VI, FI, VFI, IBV, IS, and IBV + IS. There were no significant differences in VI, FI, and VFI between the normal and PE groups; however, there were significant differences in IBV, IS, and IBV + IS in the PE group compared to those in the normal group. CONCLUSIONS Placental hemodynamics measured by VI, FI, and VFI were not positively correlated with placental morphology in the third trimester. There were no differences in the VI, FI, and VFI in the third trimester between the normal and PE groups, suggesting that these may reflect placental circulatory insufficiency.
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Affiliation(s)
- Toshihide Sakuragi
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Eiji Shibata
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Emi Kondo
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shota Higami
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shigeki Fujimoto
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shoko Amimoto
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroshi Mori
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Aramaki
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Zuo N, Dong S, Li D, Zhang N, Wang X. Inspection depth of uterine lumen measured by transvaginal ultrasound is associated with the success of IVF: a prospective longitudinal cohort study in China. J Assist Reprod Genet 2022; 39:2777-2787. [PMID: 36427172 PMCID: PMC9790830 DOI: 10.1007/s10815-022-02657-z] [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: 07/04/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure the inspection depth of uterine lumen by transvaginal ultrasound and assess the association between the inspection depth and pregnancy outcomes in IVF-ET. METHODS This prospective longitudinal cohort study was conducted from June 2018 to December 2020. We enrolled patients aged 20-45 years who underwent frozen embryo transfer cycle. We calculated the average distance from the uterine lumen to the ultrasound probe (inspection depth) using transvaginal ultrasonography and divided the entire cohort into four groups according to the quartiles of the overall inspection depth distribution. The chi-square test was used to compare the pregnancy outcomes of the four groups. Univariate and multivariate regression analyses were performed to assess the association between the inspection depth and pregnancy outcomes. RESULTS Seven hundred forty-two patients were finally enrolled, and they were grouped according to the inspection depth quartiles. There were significant decrease in the clinical pregnancy, implantation, and live birth rates among the four groups (P < 0.05); however, there was no significant difference in the miscarriage rate. Multivariable logistic regression analysis with the inspection depth as a continuous variable demonstrated that the inspection depth was associated with clinical pregnancy, implantation, and live birth rates (clinical pregnancy rate, adjusted odds ratio, 0.549; 95% confidence interval, 0.380-0.793; implantation rate, adjusted odds ratio, 0.680; 95% confidence interval, 0.496-0.931; live birth rate, adjusted odds ratio, 0.602; 95% confidence interval, 0.420-0.863), but not with the miscarriage rate. CONCLUSIONS The inspection depth of the uterine lumen measured by transvaginal ultrasound was associated with IVF success. TRIAL REGISTRATION This prospective observational study was registered at the Chinese Clinical Trial Registry ( www.chictr.org.cn ) (ChiCTR2200057977) on March 24, 2022, retrospectively registered.
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Affiliation(s)
- Na Zuo
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Sitong Dong
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Da Li
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Ningning Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Xiuxia Wang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004 China
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Zhang J, Du M, Fang JI, Lv S, Lou W, Xie Z, Chen Z, Gong X. In vivo evaluation of endometrium through dual-modality intrauterine endoscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:2554-2565. [PMID: 35774306 PMCID: PMC9203095 DOI: 10.1364/boe.453191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
Female infertilities are highly associated with poor endometrial receptivity. A receptive endometrium is generally characterized by the normal uterine cavity, intact endometrial surface, appropriate endometrial thickness, and echo pattern. Acquiring comprehensive structural information is the prerequisite of endometrium assessment, which is beyond the ability of any single-modality imaging method. In this paper, we introduce a custom-made intrauterine dual-modality (OCT/ultrasound) endoscopic imaging system and achieve in vivo imaging of rabbit uteri, for the first time to our knowledge. The endometrial features of the injured uteri in both ultrasonic and OCT images are consistent with their corresponding pathology. The quantified parameters, including uterine thickness and endometrial surface roughness, show the correlation with the endometrial injury degree but with poor performance for injury classification. The combination of these parameters was proved to assess the degrees of endometrial injury more accurately. Our work shows the potential of the dual-modality system to be translated into a clinical tool, providing multiple quantitative imaging information and helping evaluate the endometrial receptivity and diagnose infertility.
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Affiliation(s)
- Jinke Zhang
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Equal contribution
| | - Meng Du
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang 421001, China
- Equal contribution
| | - JInghui Fang
- Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Equal contribution
| | - Shengmiao Lv
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wenjin Lou
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhihua Xie
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhiyi Chen
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang 421001, China
- Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaojing Gong
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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Akgün Kavurmacı S, Şahin G, Akdoğan A, Yeniel AÖ, Acet F, Tavmergen E, Göker ENT. Evaluating the role of endometrial colour Doppler dynamic tissue perfusion measurements in in vitro fertilisation success. J OBSTET GYNAECOL 2021; 42:1305-1311. [PMID: 34709108 DOI: 10.1080/01443615.2021.1960292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The role of uterine receptivity and endometrial perfusion in in vitro fertilisation (IVF) remains unclear. In our prospective pilot study, we used a new dynamic tissue perfusion measurement method to evaluate this relationship in humans. A standard ovulation induction and embryo transfer method were applied to all the volunteers. On the day of embryo transfer, dynamic images of the uterus were recorded using colour Doppler ultrasound, and these images were uploaded onto PixelFlux Chameleon Software (GmbH, Münster, Germany). After determining the region of interest (ROI), the average velocity, intensity, and area values for all coloured pixels in the ROI, the tissue resistance index (RI) and the tissue pulsatility index were calculated. Endometrial thickness, morphology and dynamic endometrial perfusion parameters were compared between the clinically pregnant and non-pregnant groups. Endometrial thickness, morphology values and endometrial dynamic tissue perfusion measurements were similar between the groups. This study compared perfusion parameters between clinically pregnant and non-pregnant patients by accurately calculating endometrial tissue perfusion using standard software to establish its relationship with implantation success in IVF treatment.IMPACT STATEMENTWhat is already known about this subject? The relationship between IVF success, endometrial receptivity and perfusion is known. Clear valuations of endometrial receptivity require an endometrial biopsy which may cause endometrial damage to the actual IVF cycle. This problem has led researchers to conduct non-interventional studies. Studies have revealed the value of endometrial thickness, pattern and Doppler examination of endometrial uterine arteries in predicting the success of IVF treatment.What do the results of this study add? This prospective pilot study is the first one to use this programme in humans to evaluate uterine receptivity in IVF. Successful results can be obtained by using computer programmes in tissues where perfusion parameters cannot be measured using traditional colour Doppler ultrasonography. Revealing the relationship between tissue perfusion and IVF success will be more effective and accurate with the development of software technologies.What are the implications of these findings for clinical practice and/or further research? To increase the success of IVF treatment, current and new technological developments, as well as imaging methods should continue to be tested.
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Affiliation(s)
- Seda Akgün Kavurmacı
- Department of Gynecology and Obstetrics, Atatürk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
| | - Gülnaz Şahin
- Family Planning and Infertility Research and Treatment Center, Ege University, Izmir, Turkey
| | - Ayşin Akdoğan
- Family Planning and Infertility Research and Treatment Center, Ege University, Izmir, Turkey
| | - Ahmet Özgür Yeniel
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Ferruh Acet
- Family Planning and Infertility Research and Treatment Center, Ege University, Izmir, Turkey
| | - Erol Tavmergen
- Family Planning and Infertility Research and Treatment Center, Ege University, Izmir, Turkey.,Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Ege Nazan Tavmergen Göker
- Family Planning and Infertility Research and Treatment Center, Ege University, Izmir, Turkey.,Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
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Jin Z, Li J, Yang E, Shi H, Bu Z, Niu W, Wang F, Huo M, Song H, Zhang Y. Effect of endometrial thickness changes on clinical pregnancy rates after progesterone administration in a single frozen-thawed euploid blastocyst transfer cycle using natural cycles with luteal support for PGT-SR- and PGT-M-assisted reproduction: a retrospective cohort study. Reprod Biol Endocrinol 2021; 19:154. [PMID: 34627292 PMCID: PMC8501735 DOI: 10.1186/s12958-021-00841-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate whether the endometrial thickness change ratio from the progesterone administration day to the blastocyst transfer day is associated with pregnancy outcomes in a single frozen-thawed euploid blastocyst transfer cycle. METHODS All patients used natural cycles with luteal support for endometrial preparation and selected a single euploid blastocyst for transfer after a biopsy for preimplantation genetic testing. The endometrial thickness was measured by transvaginal ultrasound on the progesterone administration day and the transfer day, the change in endometrial thickness was measured, and the endometrial thickness change ratio was calculated. According to the change rate of endometrial thickness, the patients were divided into three groups: the endometrial thickness compaction group, endometrial thickness non-change group and endometrial thickness expansion group. Among them, the endometrial thickness non-change and expansion groups were combined into the endometrial thickness noncompaction group. RESULTS Ultrasound images of the endometrium in 219 frozen-thawed euploid blastocyst transfer cycles were evaluated. The clinical pregnancy rate increased with the increase in endometrial thickness change ratio, while the miscarriage rate and live birth rate were comparable among the groups. The multiple logistic regression results showed that in the fully adjusted model a higher endometrial thickness change ratio (per 10%) was associated with a higher clinical pregnancy rate (adjusted odds ratio [aOR] 1.29; 95% confidence interval [CI], 1.01-1.64; P = .040). Similarly, when the patients were divided into three groups according to the change rate of endometrial thickness, the endometrial thickness noncompaction group had a significant positive effect on the clinical pregnancy rate compared with the endometrial thickness compaction group after adjusting for all covariates. CONCLUSIONS In frozen-thawed euploid blastocyst transfer cycles in which the endometrium was prepared by natural cycles with luteal support, the clinical pregnancy rate was higher in cycles without endometrial compaction after progesterone administration.
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Affiliation(s)
- Ziqi Jin
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingdi Li
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - EnTong Yang
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqin Bu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenbin Niu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingzhu Huo
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Song
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - YiLe Zhang
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- , Zhengzhou, People's Republic of China.
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Evaluation of embryo transfer through a scoring system: ETSS (Embryo transfer scoring system). J Gynecol Obstet Hum Reprod 2021; 51:102237. [PMID: 34614436 DOI: 10.1016/j.jogoh.2021.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To create a scoring system by including all of the factors that are recommended for an ideal ET and to investigate its correlation with the Β-HCG results. MATERIALS AND METHODS This study was conducted as a retrospective trial between January 2009 and December 2018. Women who had a single ET between the specified dates were included in the study. The embryo grade, ET day, distance between the fundus to embryo transfer site measured via ultrasonography, endometrial thickness on ET day, and presence of mucus and blood in the catheter after transfer were the variables evaluated. Each one of the five variables that constituted the scoring system were rated separately. RESULTS Overall, 1652 patients participated in this research. Antral follicle count (13,3 ± 8 vs. 14,6 ± 8,2, p: 0,001), endometrial thickness on the ET day (9.9 ± 2 vs.10.3 ± 2, p = 0.006) and number of mature oocytes (8.6 ± 6 vs. 9 ± 5.1, p: 0.003) were significantly higher in patients with positive Β-HCG values. The total score in the Β-HCG positive group was 9.8 ± 1.4 versus 8.9 ± 1.4 in the Β-HCG negative group (p < 0.001). The best ETSS cut-off value for predicting Β-HCG positivity was 9.5, with 82% sensitivity and 67% specificity (AUC:0.808). CONCLUSION Our scoring system is an important step toward standardization, as it offers a new, practical, cost-free, and applicable scoring system based on pre- and post-ET measurements and laboratory data.
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Endometriumdicke in der Sonographie – ein wichtiger Parameter der endometrialen Rezeptivität? GYNAKOLOGISCHE ENDOKRINOLOGIE 2018. [DOI: 10.1007/s10304-018-0204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hsu YC, Liang IT, Huang SY, Wang HS, Soong YK, Chang CL. Transcutaneous electrical acupoint stimulation (TEAS) treatment improves pregnancy rate and implantation rate in patients with implantation failure. Taiwan J Obstet Gynecol 2018; 56:672-676. [PMID: 29037556 DOI: 10.1016/j.tjog.2017.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Although major advances have greatly improved the outcomes of assisted reproductive technology in the last two cascades, there remains significant difficulty in achieving pregnancy for many patients even after repeated attempts of IVF. Interestingly, recent studies have shown that transcutaneous electrical acupoint stimulation (TEAS) can improve the reproductive outcomes of select IVF patients. To determine the utility of TEAS in improving IVF outcomes in patients with a history of implantation failure, we conducted a retrospective study of clinical outcomes of women, who had a prior history of unsuccessful pregnancy outcome after IVF-embryo transfer (IVF-ET), following TEAS treatment. MATERIALS AND METHODS A total of 25 patients, who had failed to conceive after multiple IVF cycles in which good embryos were transferred, received noninvasive low frequency TEAS treatment prior to and during an IVF-ET cycle. The clinical outcomes, including biochemical pregnancy rate, clinical pregnancy rate and implantation rate, were compared to those of prior cycles which received only standard IVF treatment. RESULTS Analysis of reproductive outcomes showed that implantation rate and clinical pregnancy rate increased significantly in IVF cycles that included the TEAS treatment when compared to prior cycles that received only the standard IVF treatment in this cohort of patients. CONCLUSIONS This surprising finding indicated that TEAS treatment is a promising technique to improve reproductive outcomes in difficult cases of IVF-ET. Because TEAS treatment is noninvasive and has high reproducibility, and can be applied with limited training, further refinement of this procedure would not only substantiate the beneficial effects of TEAS, but also allow the technique to be more effective and reproducible.
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Affiliation(s)
- Ya-Chiung Hsu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan.
| | - I-Ting Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Shang-Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Hsin-Shih Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Yung-Kuei Soong
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Chia-Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan.
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Griesinger G, Trevisan S, Cometti B. Endometrial thickness on the day of embryo transfer is a poor predictor of IVF treatment outcome. Hum Reprod Open 2018; 2018:hox031. [PMID: 30895243 PMCID: PMC6276703 DOI: 10.1093/hropen/hox031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/12/2017] [Accepted: 12/30/2017] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the independent contribution of endometrial thickness (EMT) on day of embryo transfer to achieving an ongoing pregnancy and live birth after IVF treatment? SUMMARY ANSWER EMT is a poor predictor of IVF success and has only little independent prognostic value. WHAT IS KNOWN ALREADY In a number of previous studies, pregnancy rates have been found to be lower in patients with thin endometrium. STUDY DESIGN SIZE DUARATION This is a retrospective analysis of data from two large, randomized phase III studies (conducted in Europe and the USA) comparing s.c. progesterone with vaginal progesterone for luteal phase support. The studies were very similar in design, patient population and outcome, and the study data were combined and analysed on an individual patient level. PARTICIPANTS/MATERIALS SETTING METHOD Subjects were infertile patients with an indication for IVF/ICSI, aged between 18 and 42 years, BMI <30 kg/m2, <3 prior ART cycles and ≥ 3 oocytes after controlled ovarian stimulation with GnRH-agonist or GnRH-antagonist. EMT was assessed on day of embryo transfer (n = 1401). The association of EMT and ongoing pregnancy rate was determined by comparison of outcomes by quantiles of EMT. The predictive capacity of EMT for ongoing pregnancy achievement was assessed at each millimeter cut-off. Finally, a regression model was built to determine the contribution of EMT among other confounders, such as age and oocyte numbers, on the likelihood of ongoing pregnancy and live birth. MAIN RESULTS AND THE ROLE OF CHANCE In univariate analysis, ongoing pregnancy rates correlate to EMT. In patients above a cut-off of ≥9 mm EMT, the chance of pregnancy was higher as compared to patients with an EMT of 3-8 mm (odds ratio (OR) = 1.69, 95% CI: 1.23-2.35, P = 0.001; sensitivity 88.89%, specificity 17.52%, positive predictive value 39.02%, negative predictive value 72.64% and likelihood ratio 1.08). In multivariate regression analysis, after controlling for trial, female age and oocyte numbers, EMT was a statistically significant predictor of live birth (OR = 1.05, 95% CI: 1.00-1.10; P = 0.0351). If EMT indeed is an independent factor affecting outcome, this finding implies that at a baseline live birth rate of 20% an increase of 2 mm in EMT should result in an increase of the live birth rate of ~1.6%. LIMITATIONS REASONS FOR CAUTION The independent contribution of EMT to live birth likelihood is small and may result from (undetermined) confounding. The EMT on day of embryo transfer is usually higher as compared to the EMT on day of triggering final oocyte maturation when it is conventionally assessed during routine cycle monitoring. Furthermore, endometrial lining pattern and/or subendometrial Doppler flow have not been assessed and, accordingly, the conclusions of this work are limited to only the thickness of the endometrium. WIDER IMPLICATIONS OF THE FINDINGS EMT can be ignored during cycle monitoring of the majority of IVF patients and only the extremes of EMT deserve further diagnostic work-up. STUDY FUNDING/COMPETING INTERESTS The study was supported by IBSA. G.G. has received personal fees and non-financial support from MSD, Ferring, Merck-Serono, Finox, TEVA, IBSA, Glycotope, Abbott, Gedeon-Richter as well as personal fees from VitroLife, NMC Healthcare, ReprodWissen, BioSilu and ZIVA. S.T. and B.C. are employees of IBSA. TRIAL REGISTRATION NUMBER NCT00827983 and NCT00828191 (clinicaltrials.gov). Trial registration date 23 January 2009 (NCT00827983 and NCT00828191). DATE OF FIRST PATIENT’S ENROLMENT January 2009 (NCT00827983 and NCT00828191).
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Affiliation(s)
- Georg Griesinger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Silvia Trevisan
- IBSA Institut Biochimique SA, via del Piano, 6915 Pambio-Noranco, Switzerland
| | - Barbara Cometti
- IBSA Institut Biochimique SA, via del Piano, 6915 Pambio-Noranco, Switzerland
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Zhang T, Li Z, Ren X, Huang B, Zhu G, Yang W, Jin L. Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles: A retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst. Medicine (Baltimore) 2018; 97:e9689. [PMID: 29369190 PMCID: PMC5794374 DOI: 10.1097/md.0000000000009689] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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
To evaluate the relationship between endometrial thickness during fresh in vitro fertilization (IVF) cycles and the clinical outcomes of subsequent frozen embryo transfer (FET) cycles.FET cycles using at least one morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded both on the oocyte retrieval day and on the day of progesterone supplementation in FET cycles. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were analyzed.One thousand five hundred twelve FET cycles was included. The results showed that significant difference in endometrial thickness on day of oocyte retrieval (P = .03) was observed between the live birth group (n = 844) and no live birth group (n = 668), while no significant difference in FET endometrial thickness was found (P = .261) between the live birth group and no live birth group. For endometrial thickness on oocyte retrieval day, clinical pregnancy rate ranged from 50.0% among patients with an endometrial thickness of ≤6 mm to 84.2% among patients with an endometrial thickness of >16 mm, with live birth rate from 33.3% to 63.2%. Multiple logistic regression analysis of factors related to live birth indicated endometrial thickness on oocyte retrieval day was associated with improved live birth rate (OR was 1.069, 95% CI: 1.011-1.130, P = .019), while FET endometrial thickness did not contribute significantly to pregnancy outcomes following FET cycles. The ROC curves revealed the cut-off points of endometrial thickness on oocyte retrieval day was 8.75 mm for live birth.Endometrial thickness during fresh IVF cycles was a better predictor of endometrial receptivity in subsequent FET cycles than FET cycle endometrial thickness. For those females with thin endometrium in fresh cycles, additional estradiol stimulation might be helpful for adequate endometrial development.
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Yuan X, Saravelos SH, Wang Q, Xu Y, Li TC, Zhou C. Endometrial thickness as a predictor of pregnancy outcomes in 10787 fresh IVF-ICSI cycles. Reprod Biomed Online 2016; 33:197-205. [PMID: 27238372 DOI: 10.1016/j.rbmo.2016.05.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/25/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
This retrospective study assessed the predictive value of endometrial thickness (EMT) on HCG administration day for the clinical outcome of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. A total of 8690 consecutive women undergoing 10,787 cycles over a 5-year period were included. The 5th, 50th and 95th centiles for EMT were determined as 8, 11 and 15 mm, respectively. Group analysis according to these centiles (Group 1: < 8 mm; Group 2: ≥ 8 and ≤11 mm; Group 3: > 11 and ≤15 mm; Group 4: > 15 mm) demonstrated significant differences (P < 0.001) in clinical pregnancy rates (23.0%, 37.2%, 46.2% and 53.3%, respectively), live birth rates per clinical pregnancy (63.3%, 72.0%, 78.1% and 80.3%, respectively), spontaneous abortion rates (26.7%, 23.8%, 19.9% and 17.5%, respectively), and ectopic pregnancy rates (10.0%, 4.3%, 2.1% and 2.2%, respectively). Logistic regression analyses showed EMT as one of the independent variables predictive of clinical pregnancy (OR = 1.097; P < 0.001), live birth (OR = 1.078; P < 0.001), spontaneous abortion (OR = 0.948; P < 0.001), and ectopic pregnancy (OR = 0.851; P < 0.001). Future research should aim to understand the underlying mechanisms relating EMT to conception, ectopic implantation and spontaneous abortion.
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Affiliation(s)
- Xi Yuan
- Reproductive Medicine Centre, Department of Obstetric and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; MOH Holdings Pte Ltd (MOHH), Singapore
| | - Sotirios H Saravelos
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Qiong Wang
- Reproductive Medicine Centre, Department of Obstetric and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanwen Xu
- Reproductive Medicine Centre, Department of Obstetric and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Canquan Zhou
- Reproductive Medicine Centre, Department of Obstetric and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Chen M, He Y, Zhang P, Geng Q, Liu Q, Kong L, Chen Y, Wei Q, Liu J, Guo S, Liu H. Comparison of Uterine Receptivity between Fertile and Unexplained Infertile Women by Assessment of Endometrial and Subendometrial Perfusion Using Contrast-Enhanced Ultrasound: Which Index is Better--Peak Intensity or Area under the Curve? ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:654-663. [PMID: 26723901 DOI: 10.1016/j.ultrasmedbio.2015.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 06/05/2023]
Abstract
The goal of this study was to compare uterine receptivity between women with normal fertility and those with unexplained infertility during natural cycles by assessment of endometrial and subendometrial perfusion using contrast-enhanced ultrasound (CEUS). We wanted to determine the better index: peak intensity (PI) or area under the curve (AUC). Thirty women with unexplained infertility were recruited into the study group, and 30 women with normal fertility were recruited into the control group. All women underwent CEUS during the late proliferative phase, ovulation phase, and implantation window of a menstrual cycle. Endometrial PI, endometrial AUC, subendometrial PI and subendometrial AUC were analyzed. In the late proliferative phase, the control group had a significantly higher endometrial PI (p < 0.001) as well as subendometrial PI (p < 0.001) and AUC (p = 0.004) than the study group. In the ovulation phase, the control group had a significantly higher endometrial PI (p < 0.001) and AUC (p = 0.021), as well as subendometrial PI (p < 0.001) and AUC (p = 0.003). During the implantation window, there were no significant differences between the two groups. Only subendometrial PI underwent a significant periodic change during the menstrual cycle in both groups. This finding was further confirmed by evaluation of the microvessel density of endometria. In conclusion, CEUS can be used to assess endometrial and subendometrial perfusion to evaluate uterine receptivity. Subendometrial PI was the most sensitive index compared with endometrial PI, endometrial AUC and subendometrial AUC.
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Affiliation(s)
- Minxia Chen
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Yanni He
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
| | - Pengjie Zhang
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Qiang Geng
- Department of Infertility, Sun-Time Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qiuxiang Liu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Linghong Kong
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Yihan Chen
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Qingzhu Wei
- Department of Pathology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Jianghuan Liu
- Department of Pathology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China
| | - Suiqun Guo
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
| | - Hongmei Liu
- Department of Medical Ultrasound, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics in Guangdong Province, Guangzhou, Guangdong, China.
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Cheng F, Li T, Wang QL, Zhou HL, Duan L, Cai X. Effects of hydrosalpinx on ultrasonographic parameters for endometrial receptivity during the window of implantation measured by power color Doppler ultrasound. Int J Clin Exp Med 2015; 8:6103-6108. [PMID: 26131211 PMCID: PMC4483946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/26/2015] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study is to assess the effects of hydrosalpinx on ultrasonographic parameters for endometrial receptivity during the window of implantation, as measured by power color Doppler ultrasound. METHODS The women recruited to this study included sixty with unilateral or bilateral hydrosalpinx and fifty-seven prior to in vitro fertilization-embryo transfer (IVF-ET) or artificial insemination (AI) performed due to male infertility. Ultrasonographic parameters for endometrial receptivity were measured during the window of implantation by power color Doppler ultrasound. RESULTS The proportion of triple-line endometrial pattern and uterine contractions from the cervix to the fundus were significantly lower in the hydrosalpinx group than in the control group. In addition, patients in the hydrosalpinx group had a significantly lower pulsatility index (PI) of uterine spiral arteries. There were no significant differences in endometrial thickness, subendometrial blood flow distribution pattern, uterine artery PI, uterine artery resistance index (RI), or uterine spiral artery RI between the two groups. CONCLUSIONS Hydrosalpinx may be involved in the regulation of endometrial receptivity through its influence on endometrial pattern, uterine contractions, and PI of the uterine spiral arteries.
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Affiliation(s)
- Fang Cheng
- Reproductive Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
- Department of Obstetrics, Fifth Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Tao Li
- Department of Liver Transplantation and Laparoscope, Digestive-Vascular Surgical Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Qing-Li Wang
- Reproductive Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Hui-Li Zhou
- Department of Gynecology and Obstetrics Ultrasound, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, China
| | - Li Duan
- Department of Gynecology and Obstetrics Ultrasound, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, China
| | - Xia Cai
- Reproductive Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
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Abstract
OBJECTIVE To review the literature regarding inadequate growth ("thin") of the endometrium and to present the hitherto published methods aimed to improve endometrial thickness and the consequent endometrial receptivity. MATERIALS AND METHODS A literature review was conducted for all relevant articles assessing the effect of various treatment modalities on "thin" endometrium and the consequent reproductive outcome. RESULTS Several treatment modalities have been offered to patients with "thin" endometrium, including hysteroscopic adhesiolysis, hormonal manipulation by estrogen and GnRH-agonist, vasoactive measures such as aspirin, vitamin E, pentoxifylline, l-arginine or sildenafil, intra-uterine infusion of growth factor such as G-CSF and the recent application of regenerative medicine. In spite of the vast diversity of treatment, most of the options accomplish only minor change in the endometrium thickness and subsequent pregnancy rate, and when they fail, patients are usually referred to surrogacy. CONCLUSIONS "Thin" endometrium is known to adversely affect reproductive performance. Treatment of "thin endometrium" remains a challenge and future large researches are required to further elucidate and optimal management of patients with "thin" endometrium.
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Affiliation(s)
- Oshrit Lebovitz
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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von Grothusen C, Lalitkumar S, Boggavarapu NR, Gemzell-Danielsson K, Lalitkumar PG. Recent advances in understanding endometrial receptivity: molecular basis and clinical applications. Am J Reprod Immunol 2014; 72:148-57. [PMID: 24635108 DOI: 10.1111/aji.12226] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/13/2014] [Indexed: 12/12/2022] Open
Abstract
Advancement in the field of ART has lead to the possibility of achieving good quality embryos. However, the success rate in ART needs further improvement. This is largely dependent on identifying the receptive endometrium for the successful implantation of embryos as well as modulating the endometrium to the receptive stage. In the last half-a-decade, focus has been shifting toward identifying the receptive endometrium. Here, we summarize different tools explored to identify receptive endometrium from the literature, mainly focusing on the past decade, with the help of PubMed. The quest to identify endometrial receptivity markers has lead to the exploration of morphological features at micro and macro scale levels. A large number of studies at molecular levels have focused on genomic, proteomic and lipidomic targets. Recent development of endometrial receptivity array is a promising diagnostic instrument. However, a noninvasive possibility for the diagnosis of endometrial receptivity would be an ideal tool, which could be used in the clinic to improve the success rate of ART. Improved knowledge on endometrial receptivity will not only help to improve the diagnosis and treatment of infertility but will also give possibilities to develop new contraceptive methods targeting the endometrium.
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Affiliation(s)
- Carolina von Grothusen
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Papoutsis D, Georgantzis D, Daccò MD, Halmos G, Moustafa M, Mesquita Pinto AR, Magos A. A Rare Case of Asherman's Syndrome after Open Myomectomy: Sonographic Investigations and Possible Underlying Mechanisms. Gynecol Obstet Invest 2014; 77:194-200. [DOI: 10.1159/000357489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 11/20/2013] [Indexed: 11/19/2022]
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19
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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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Revel A. Defective endometrial receptivity. Fertil Steril 2012; 97:1028-32. [PMID: 22542142 DOI: 10.1016/j.fertnstert.2012.03.039] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/26/2012] [Accepted: 03/26/2012] [Indexed: 12/20/2022]
Abstract
The endometrium is one of the most fascinating tissues in the human body. Its sole purpose is to enable implantation of an embryo during a relatively short window of opportunity in the menstrual cycle. It is becoming clear that overcoming the current bottleneck in improvements to assisted reproductive techniques will require a closer look at the interface between uterus and embryo. Indeed, embryo implantation requires a cross talk with a receptive endometrium. Using sonography, hysteroscopy and endometrial biopsy we can learn about anatomical and functional markers of endometrial receptivity. This article reviews the factors which might cause defective endometrial receptivity. These include uterine polyps, septa, leiomyomata and adhesions. The effect of thin endometrium, endometriosis and hydrosalpinx is also described. Finally contemporary investigation of molecular markers of endometrial receptivity is described. Improving embryo implantation by a closer look inside the uterus is the key to increasing pregnancy rates in IVF.
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Affiliation(s)
- Ariel Revel
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel.
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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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Junovich G, Mayer Y, Azpiroz A, Daher S, Iglesias A, Zylverstein C, Gentile T, Pasqualini S, Markert UR, Gutiérrez G. Ovarian stimulation affects the levels of regulatory endometrial NK cells and angiogenic cytokine VEGF. Am J Reprod Immunol 2011; 65:146-53. [PMID: 20618181 DOI: 10.1111/j.1600-0897.2010.00892.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PROBLEM Endometrial NK cells play a critical role in uterine vascularization producing angiogenic factors. Impact of ovarian stimulation on endometrial expression of NK cells and VEGF in normal fertile oocyte donors and the effect of endometrial injury treatment on these parameters have been investigated. METHOD OF STUDY Endometrial tissue was obtained from oocyte donors during natural and stimulated cycles. NK cell subsets were measured by flow cytometry. VEGF was determined by ELISA and flow cytometry. Endometrial angiogenic parameters were determined by ultrasound Doppler. Local injury was induced by scratching endometrial tissue previous to implantation window. RESULTS Ovarian stimulation decreased endometrial levels of NK cells and vascularization index but increased VEGF levels. Local injury normalized only the CD56(+) NK cell count. CONCLUSION Hormonal therapy for ovarian stimulation may be associated with poor endometrial vascularization. Local injury before the implantation window seems not to influence endometrial angiogenic parameters altered by ovarian stimulation.
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Affiliation(s)
- Gisela Junovich
- IDEHU (CONICET)/Department of Immunology, School of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
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Kim A, Han JE, Yoon TK, Lyu SW, Seok HH, Won HJ. Relationship between endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound and pregnancy after intrauterine insemination. Fertil Steril 2010; 94:747-52. [DOI: 10.1016/j.fertnstert.2009.03.084] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 03/20/2009] [Accepted: 03/20/2009] [Indexed: 11/25/2022]
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Germeyer A, von Wolff M, Jauckus J, Strowitzki T, Sharma T, Grazul-Bilska AT. Changes in cell proliferation, but not in vascularisation are characteristic for human endometrium in different reproductive failures--a pilot study. Reprod Biol Endocrinol 2010; 8:67. [PMID: 20565916 PMCID: PMC2904337 DOI: 10.1186/1477-7827-8-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 06/21/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Reproductive failure, determined as recurrent spontaneous abortions (RSA) or recurrent implantation failure (RIF) in women is not well understood. Several factors, including embryo quality, and cellular and molecular changes in endometrium may contribute to the insufficient feto-maternal interaction resulting in reproductive failure. Prior clinical studies suggest an inadequate endometrial growth and development of the endometrium, leading to a lesser endometrial thickness. METHODS We therefore aimed to determine the cellular proliferation using Ki67, and the expression of markers of vascularisation, such as factor VIII (a marker of endothelial cells) and smooth muscle cell actin (SMCA; a marker of pericytes and smooth muscle cells) in endometrium of healthy women and women with RSA or RIF. LH-dated mid-secretory endometrial biopsies of seven healthy women and twenty women with reproductive failure were examined via immunohistochemistry followed by image analysis. RESULTS Cellular proliferation but not expression of factor VIII or SMCA was decreased (P < 0.0004) in endometrium of women with RSA and RIF compared to healthy controls. CONCLUSION Our data indicate that reproductive failure is due to insufficient cell proliferation/tissue growth rather than inadequate vascularisation in the endometrium.
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Affiliation(s)
- Ariane Germeyer
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Berne, Berne, Switzerland
| | - Julia Jauckus
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Tanuj Sharma
- Department of Animal Sciences and Cell Biology Center, North Dakota State University, Fargo, North Dakota, USA
| | - Anna T Grazul-Bilska
- Department of Animal Sciences and Cell Biology Center, North Dakota State University, Fargo, North Dakota, USA
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Guimarães Filho HA, Mattar R, Araujo Júnior E, da Costa LLD, de Mello Junior CF, Nardozza LMM, Nowak PM, Moron AF. Reproducibility of three-dimensional power Doppler placental vascular indices in pregnancies between 26 and 35 weeks. Arch Gynecol Obstet 2010; 283:213-7. [DOI: 10.1007/s00404-009-1341-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 12/15/2009] [Indexed: 11/28/2022]
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Žáčková T, Järvelä IY, Tapanainen JS, Feyereisl J. Assessment of endometrial and ovarian characteristics using three dimensional power Doppler ultrasound to predict response in frozen embryo transfer cycles. Reprod Biol Endocrinol 2009; 7:151. [PMID: 20035622 PMCID: PMC2804609 DOI: 10.1186/1477-7827-7-151] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 12/25/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate whether endometrial or ovarian parameters as measured using 3D power Doppler ultrasound would predict the outcome in frozen embryo transfer (FET) cycles. METHODS Thirty women with no known gynecological pathology undergoing FET were recruited. The FET was carried out in the natural menstrual cycle 3-4 days after the first positive LH test result. Blood samples for hormonal analysis were collected, and three-dimensional (3D) ultrasonographic examination was performed on the day of the FET and repeated with analysis of the total hCG one week later. RESULTS The demographic, clinical, and embryological characteristics were similar between the pregnant (15/30) and nonpregnant groups (15/30). There were no differences between the groups in endometrial/subendometrial thickness, volume, or vascularization index (VI). The endometrial triple-line pattern was more often present in the pregnant group on the day of the FET (93.3% vs. 40.0%, 95% CI 25.5-81.2%). No differences in the ovaries were observed on the day of the FET. At the second visit, the triple-line pattern was still more often present in those patients who had conceived (91.7% vs. 42.9%, 95% CI 18.5-79.1%), and their corpus luteum was more active as judged by the rise in 17-hydroxyprogesterone and estradiol levels. No differences were observed in the dominant ovarian vasculature. CONCLUSIONS According to our results, measurement of power Doppler indices using 3D ultrasound on the day of the FET does not provide any additional information concerning the outcome of the cycle. The existence of the triple-line pattern on the day of the FET seems to be a prognostic sign of a prosperous outcome after FET. The dominant ovary in the pregnant group seems to be already activated one week after the FET.
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Affiliation(s)
- Tamara Žáčková
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Institute for the Care of Mother and Child (UPMD), Department of IVF, Charles University, Prague, Czech Republic
| | - Ilkka Y Järvelä
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Jaroslav Feyereisl
- Institute for the Care of Mother and Child (UPMD), Department of IVF, Charles University, Prague, Czech Republic
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Filho HAG, Júnior EA, Mattar R, Da Costa LLD, Júnior CFDM, Nardozza LMM, Moron AF. Placental blood flow measured by three-dimensional power Doppler ultrasound at 26 to 35 weeks gestation in normal pregnancies. J Matern Fetal Neonatal Med 2009; 23:69-73. [DOI: 10.3109/14767050903121431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vignal P. Angiographie par couplage de l’écho 3D au Doppler puissance : 3D-power Doppler angiography (3D-PDA). Application clinique en gynécologie. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sifer C, Cédrin-Durnerin I, Hugues JN, Poncelet C. [Views of each member of an Assisted Reproductive Technologies centre on the embryo transfer procedure]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2009; 37:645-652. [PMID: 19589713 DOI: 10.1016/j.gyobfe.2009.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/27/2009] [Indexed: 05/28/2023]
Abstract
The embryo transfer (ET) is probably the key step of Assisted Reproductive Technologies (ART), end point of the collaboration of a multidisciplinary clinical team and an infertile couple. Thus, a perfect knowledge of available data regarding ET is required to optimize the results of ART. Indeed, numerous published studies demonstrate the impact of defined parameters onto the effectiveness of ET procedure. The aim of this study is to provide views of physicians dealing with ART, i.e. endocrinologist, ultrasound scan specialist, surgeon and biologist to put in perspective questions and answers about ET.
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Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy, France.
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Ghosh D, Sharkey AM, Charnock-Jones DS, Smith SK, Sengupta J. Effect of low-dose mifepristone administration on day 2 after ovulation on transcript profiles in implantation-stage endometrium of rhesus monkeys. Reproduction 2009; 138:357-70. [PMID: 19439560 DOI: 10.1530/rep-08-0442] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Progesterone is essential for endometrial receptivity in primates. In studies previously performed using global gene profiling based on microarray technology, attempts have been made to identify changes in gene expression between early luteal-phase and mid-luteal-phase endometria. However, the issue of the putative impact of preimplantation embryo-derived signal in the process of endometrial receptivity was missing in the previous studies. In the present study, an attempt has been made to delineate the transcripts profile in implantation-stage endometrium under combinatorial regulation of progesterone and embryo-derived signal in the rhesus monkey. To this effect, we have compared transcript profiles for 409 known genes between control receptive stage (n=13), and mifepristone-induced desynchronized and non-receptive stage (n=12) monkey endometrial samples collected on days 4 (n=12) and 6 (n=13) after ovulation from mated, potential conception cycles, using cDNA arrays containing sequence-verified clones. Statistical analysis of correlation of estimated transcript abundance between arrays and qRT-PCR for nine selected gene products yielded significant (P<0.05) concordance. Of 409 genes, a total of 40 gene transcripts were seen to be affected, nine gene transcripts in endometrial samples were found to progressively increase between days 4 and 6 following mifepristone treatment, while an additional five genes showed differential expression profile depending on the day after treatment. Additionally, different sets of 12 and 14 gene products showed changes in days 4 and 6 post-ovulation samples respectively. A new cohort of 28 gene products in implantation-stage endometrium was seen to be affected by luteal-phase mifepristone.
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Affiliation(s)
- D Ghosh
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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Haouzi D, Assou S, Mahmoud K, Tondeur S, Rème T, Hedon B, De Vos J, Hamamah S. Gene expression profile of human endometrial receptivity: comparison between natural and stimulated cycles for the same patients. Hum Reprod 2009; 24:1436-45. [PMID: 19246470 DOI: 10.1093/humrep/dep039] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The adjunction of exogenous hormones for controlled ovarian stimulation (COS) may alter endometrial receptiveness. In order to identify the genes misregulated under COS, we compared the endometrium gene expression profiles, from the same patients, in a natural cycle and in a subsequent COS cycle. METHODS For the same normal-responder patients (n = 21), endometrial biopsies (n = 84) were collected during the pre-receptive (LH + 2) and receptive stages (LH + 7) of a natural cycle and, subsequently, on oocyte retrieval day (hCG + 2) and on transfer day (hCG + 5) of a stimulated cycle. Samples were analyzed using DNA microarrays. Gene expression profiles and biological pathways involved in endometrial receptivity were analyzed. RESULTS Although endometrium transition profiles from pre-receptive to receptive phases are similar between patients, COS regimens alter endometrial receptivity in comparison with natural cycle. Under COS conditions, two endometrial profiles were identified and were associated either with a moderately altered receptivity profile for the majority of the patients or a strongly altered profile for a sub-category of patients. The receptive endometrium transcription profile under COS was defective for biological functions such as TGFbeta signaling, leukocyte transendothelial migration and the cell cycle. CONCLUSIONS Gonadotrophin treatments in COS cycles led to disruptions of the transcriptional activation of genes involved in normal endometrial receptivity. We propose that when the receptiveness of the endometrium is seriously compromised by the COS protocol, fresh embryo replacement should be cancelled, the embryo frozen and thawed embryo replacement should be performed under natural cycles.
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Affiliation(s)
- D Haouzi
- CHU Montpellier, Institut de Recherche en Biothérapie, Hôpital Saint-Eloi, Montpellier F-34000, France
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Hamamah S, Dechaud H. Newly identified genes linked to endometrial receptiveness: lessons from IVF. Biomark Med 2009; 3:9-12. [DOI: 10.2217/17520363.3.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Samir Hamamah
- ART/PGD Division, Arnaud de Villeneuve hospital, 34295-Montpellier, France
| | - Hervé Dechaud
- ART/PGD Division, Arnaud de Villeneuve hospital, 34295-Montpellier, France
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Schulten-Wijman MJNC, Struijk PC, Brezinka C, De Jong N, Steegers EAP. Evaluation of volume vascularization index and flow index: a phantom study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:560-564. [PMID: 18726935 DOI: 10.1002/uog.6112] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Three-dimensional (3D) power Doppler ultrasonography provides indices to quantify moving blood within a volume of interest (e.g. ovary, endometrium, tumor or placenta). The purpose of this study was to determine the influence of ultrasound instrument settings on vascularization index (VI) and flow index (FI) at different flow velocities, using a specially built flow phantom with a small tube diameter. METHODS Blood-mimicking fluid was pumped at 10-100 mL/h through a plastic tube with a diameter of 0.65 mm within a virtual spherical volume (content 137.12 cm(3)) of a Voluson 730 Expert 3D power Doppler ultrasound instrument. VI and FI were determined at different pulse repetition frequency (PRF) settings, with minimal and maximal wall motion filter (WMF) settings. The measured VI was compared with the actual VI. RESULTS The ability to measure VI and FI at different flow velocities was highly dependent on the PRF and WMF settings. In our experimental set-up, using a PRF of 0.3 kHz, flow velocities of about 2 cm/s and higher could be registered. Measured VI was overestimated up to 44 times relative to actual VI. CONCLUSIONS Our main finding in a laboratory set-up was a considerable overestimation of moving blood volume using 3D power Doppler ultrasound in a single small tube. The degree of overestimation depends on the spatial resolution and on the settings of the ultrasound instrument. When small vessels are involved in a clinical setting, interpretation of VI should take this overestimation of moving blood volume into account.
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Affiliation(s)
- M J N C Schulten-Wijman
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Zuid-holland, The Netherlands.
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Lédée N, Chaouat G, Serazin V, Lombroso R, Dubanchet S, Oger P, Louafi N, Ville Y. Endometrial vascularity by three-dimensional power Doppler ultrasound and cytokines: a complementary approach to assess uterine receptivity. J Reprod Immunol 2008; 77:57-62. [DOI: 10.1016/j.jri.2007.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 05/28/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
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Chen CK, Wu HM, Soong YK. Clinical Application of Ultrasound in Infertility: From Two-dimensional to Three-dimensional. J Med Ultrasound 2007. [DOI: 10.1016/s0929-6441(08)60030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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