Ultrasound markers of implantation

Rational Use of TVS/Color and 3D in Evaluating Subfertile Women

Infertility is defined as the failure to conceive a desired pregnancy after 12 months of unprotected intercourse and affects approximately 10% of married couples. With recent technological development and proper use of medically assisted reproduction techniques, one half of these couples will become pregnant.

More than any other new method, ultrasound has made significant improvements in the modern management of female infertility. Transvaginal sonography provides the reproductive endocrinologists with a tool that cannot only evaluate normal and stimulated cycles but also assist in follicle aspiration and subsequent transfer of the embryo. The addition of color Doppler capabilities to transvaginal probes permits visualization of small intraovarian and endometrial vessels, allowing depiction of normal and abnormal physiologic changes in the ovary and uterus. This article reviews on the assessment of ovarian, uterine and tubal causes of infertility and on the current and future role of color Doppler and three-dimensional ultrasound in the field of reproductive endocrinology.

Relationship between the length of the uterine cavity and clinical pregnancy rates after in vitro fertilization or intracytoplasmic sperm injection

In this prospective clinical study involving 354 IVF-intracytoplasmic sperm injection cycles, we determined the influence of the length of the uterine cavity on clinical pregnancy rates. Our data showed that clinical pregnancy and implantation rates are associated positively with an increased length of the uterine cavity.

Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome?

OBJECTIVE

To evaluate whether endometrial parameters by three-dimensional ultrasonography and power Doppler angiography (3D US-PDA) can predict in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcome.

DESIGN

Prospective clinical study.

SETTING

Assisted reproduction unit in a referral hospital.

PATIENT(S)

Eighty women who underwent IVF cycles.

INTERVENTION(S)

Endometrial 3D US-PDA evaluated by VOCAL software (plane C and 9 degrees of rotational steps).

MAIN OUTCOME MEASURE(S)

Endometrial pattern, endometrial thickness (ET), endometrial volume (EV), and PDA indexes of vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured on the day of human chorionic gonadotropin (hCG) administration. These measurements were related to IVF/ICSI and embryo transfer outcome.

RESULT(S)

In the pregnant group, EV, VI, FI, and FVI but not triple-line pattern and ET were statistically significantly higher. The area under receiver operating characteristic (ROC) curve was statistically significant for EV (0.746), VI (0.724), FI (0.828), and VFI (0.800) when no grade 1 embryos or only one were transferred (43 cycles, 14 pregnancies) but not when two or three grade 1 embryos were transferred. Moreover, these parameters were statistically significant in predicting a normal pregnancy outcome (no early pregnancy loss) but were not related to multiple pregnancies.

CONCLUSION(S)

In IVF/ICSI cycles, 3D US-PDA is useful for evaluating endometrial receptivity. Endometrial volume and 3D power Doppler indexes are statistically significant in predicting the cycle outcome when one grade 1 or no grade 1 embryos are transferred, which could be helpful data in a single-embryo transfer policy.