Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 15 , ISSUE 4 ( October-December, 2021 ) > List of Articles

Original Scientific Paper

Impact of Intraendometrial Vascularity on Implantation Rates in Frozen Blastocyst Transfer

Jalpa Shah, Chaitanya Nagori, Sonal Panchal, Manish Thaker

Keywords : Blastocyst, Conception rates, Endometrial vascularity, Frozen embryo transfer, Miscarriage rates

Citation Information : Shah J, Nagori C, Panchal S, Thaker M. Impact of Intraendometrial Vascularity on Implantation Rates in Frozen Blastocyst Transfer. Donald School J Ultrasound Obstet Gynecol 2021; 15 (4):393-400.

DOI: 10.5005/jp-journals-10009-1823

License: CC BY-NC 4.0

Published Online: 31-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Implantation remains the main limiting factor in the success of in vitro fertilization treatment, despite major advances made in this field. This study was done to evaluate whether intraendometrial vascularity affects the outcome in cases of Frozen embryo transfer (FET). Materials and methods: In total, 226 patients undergoing frozen embryo transfer out of the total 233 patients were recruited for the study. Endometrial preparation was done by artificial cycle protocol in all the patients with estradiol valerate. Endometrium is evaluated for its thickness and its morphology as seen on B-mode ultrasound. Endometrial vascularity is evaluated by power Doppler (PD) and pulse-wave Doppler. Post-embryo transfer of two Grade 1 frozen-thawed blastocyst, judicial luteal support was given. Beta human chorionic gonadotropin (β-hCG) was checked after 14 days for confirmation of pregnancy in all the patients. In all β-hCG positive cases, ultrasound was done after 10 days. All the patients with pregnancy were followed up by ultrasound for the entire first trimester and miscarriages were documented. Results: Patients showed higher positive pregnancy rate and lesser miscarriage rate with vascular penetration in zone 3 and zone 4 of the endometrium. Conception rate and miscarriage rate did not vary significantly with change in endometrial thickness beyond 7 mm in Frozen embryo transfer cycles.


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  1. Coulam CB, Bustillo M, Soenksen DM, et al. Ultrasonographic predictors of implantation after assisted reproduction. Fertil Steril 1994;62:1004–1010. DOI: 10.1016/s0015-0282(16)57065-4
  2. Domínguez F, Remohí J, Pellicer A, et al. Human endometrialreceptivity: a genomic approach. Reprod Biomed Online 2003;6:332–338. DOI: 10.1016/s1472-6483(10)61853-6
  3. Turnbull LW, Lesny P, Killick SR. Assessment of uterine receptivity prior to embryo transfer: a review of currently available imaging modalities. Hum Reprod Update 1995;1:505–514. DOI: 10.1093/humupd/1.5.505
  4. Wang L, Qiao J, Li R, et al. Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles. Reprod Biol Endocrinol 2010;8:122–128. DOI: 10.1186/1477-7827-8-122
  5. Singh N, Bahadur A, Mittal S, et al. Predictive value of endometrial thickness, pattern and sub-endonetrial blood flows on the day of hCG by 2D Doppler in in-vitro fertilization cycles: a prospective clinical study from a tertiary care unit. J Hum Reprod Sci 2011;4:29–33. DOI: 10.4103/0974-1208.82357
  6. Horcajadas JA, Pellicer A, Simon C. Wide genomic analysis of human endometrial receptivity: new times, new opportunities. Hum Reprod Update 2007;13:77–86. DOI: 10.1093/humupd/dml046
  7. Ng EH, Chan CC, Tang OS, et al. The role of endometrial and subendometrial blood flows measured by three dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment. Hum Reprod 2006;21:164–170. DOI: 10.1093/humrep/dei277
  8. Bakos O, Lundkvist O, Bergh T. Transvaginal sonographic evaluation of endometrial growth and texture in spontaneous ovulatory cycles—a descriptive study. Hum Reprod 1993;8:799–806. DOI: 10.1093/oxfordjournals.humrep.a138145
  9. Smith B, Porter R, Ahuja K, et al. Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program. J In Vitro Fert Embryo Transf 1984;1:233–238. DOI: 10.1007/BF01131622
  10. Applebaum M. The steel or teflon endometrium-ultrasound visualization of endometrial vascularity in IVF patients and outcome. Presented at the third World Congress of ultrasound inobstetricsand gyneacology. Ultrasound Obstet Gynecol 1993;3(Suppl. 2):10.
  11. Yang JH, Wu MY, Chen CD, et al. Association of endometrial blood flow as determined by a modified color Doppler technique with subsequent outcome of in-vitro fertilization. Hum Reprod 1999;14:1606–1610. DOI: 10.1093/humrep/14.6.1606
  12. Zaidi J, Pittrof R, Shaker A, et al. Assessment of uterine artery blood flow on the day of human chorionic gonadotrophin administration by transvaginal color Doppler ultrasound in an in vitro fertilization program. Fertil Steril 1996;65(2):377–381. DOI: 10.1016/s0015-0282(16)58103-5
  13. Ng EHY, Wai Chan CC, Tang OS, et al. Endometrial and subendometrial vascularity is higher in pregnant patients with livebirth following ART than in those who suffer a miscarriage. Hum Reprod 2007;22(4):1134–1141. DOI: 10.1093/humrep/del458
  14. Kupesic S, Bekavac I, Bjelos D, et al. Assessment of endometrial receptivity by transvaginal color Doppler and 3D power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med 2001;20:125–134. DOI: 10.7863/jum.2001.20.2.125
  15. Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013;369(15):1443–1451. DOI: 10.1056/NEJMra1302417
  16. Nyberg DA, Mack LA, Laing FC, et al. Distinguishing normal from abnormal gestational sac growth in early pregnancy. J Ultrasound Med 1987;6(1):23–27. DOI: 10.7863/jum.1987.6.1.23
  17. Demir R, Kayisli UA, Cayli S, et al. Sequential steps during vasculogenesis and angiogenesis in the very early human placenta. Placenta 2006;27:535–539. DOI: 10.1016/j.placenta.2005.05.011
  18. Nardo LG. Vascular endothelial growth factor expression in the endometrium during the menstrual cycle, implantation window and early pregnancy. Curr Opin ObstetrGynecol 2005;17:419–423. DOI: 10.1097/01.gco.0000175362.12470.e0
  19. Sherer DM, Abulafia O. Angiogenesis during implantation, and placental and early embryonic development. Placenta 2001;22:1–13. DOI: 10.1053/plac.2000.0588
  20. Sharkey AM, Day K, McPherson A, et al. Vascular endothelial growth factor expression in human endometrium is regulated by hypoxia. J Clin Endocrinol Metab 2000;85:402–409. DOI: 10.1210/jcem.85.1.6229
  21. Gardner DK. The impact ofphysiological oxygen during culture, and vitrification for cryopreservation, on the outcome of extended culture in human IVF. Reprod Biomed Online 2016;32:137–141. DOI: 10.1016/j.rbmo.2015.11.008
  22. Yaman C, Ebner T, Jesacher K, et al. Sonographic measurement of endometrium thickness as a predictive value for pregnancy through IVF. Ultraschall Med 2002;23:256–259. DOI: 10.1055/s-2002-34053
  23. Friedler S, Schenker JG, Herman A, et al. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update 1996;2(4):323-335. DOI: 10.1093/humupd/2.4.323
  24. Remohí J, Ardiles G, García-Velasco JA, et al. Endometrial thickness and serum oestradiol concentrations as predictors of outcome in oocyte donation. Hum Reprod 1997;12(10):2271–2276. DOI: 10.1093/humrep/12.10.2271
  25. Sundström P. Establishment of a successful pregnancy following in-vitro fertilization with an endometrial thickness of no more than 4 mm. Hum Reprod 1998;13(6):1550–1552. DOI: 10.1093/humrep/13.6.1550
  26. Weissman A, Gotlieb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. Fertil Steril 1999;71:147–149. DOI: 10.1016/s0015-0282(98)00413-0
  27. Zhao J, Zhang Q, Li Y. The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reprod Biol Endocrinol 2012;10:100. DOI: 10.1186/1477-7827-10-100
  28. Rieger L, Honig A, Sutterlin M, et al. Antigen-presenting cells in human endometrium during the menstrual cycle compared to early pregnancy. J Soc Gynecol Investig 2004;11:488–493. DOI: 10.1016/j.jsgi.2004.05.007
  29. Kolibianakis EM, Zikopoulos KA, Fatemi HM, et al. Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for intrauterine insemination. Reprod Biomed Online 2004;8:115–118. DOI: 10.1016/s1472-6483(10)60505-6
  30. Vlaisavljevic V, Reljic M, Gavric-Lovrec V, et al. Subendometrial contractility is not predictive for in vitro fertilization (IVF) outcome. Ultrasound Obstet Gynecol 2001;17:239–244. DOI: 10.1046/j.1469-0705.2001.00316.x
  31. Dietterich C, Check JH, Choe JK, et al. Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer. Fertil Steril 2002;77:781–786. DOI: 10.1016/S0015-0282(01)01727-7
  32. Nagori C, Panchal S. Endometrial vascularity: its relation to implantation rates. Int J Infertility Fetal Med 2012;3(2):48–50. DOI: 10.5005/jp-journals-10016-1040
  33. Masrour MJ, Shafaie A, Yoonesi L, et al. Evaluating endometrial thickness and vascular ultrasound pattern and pregnancy outcomes in intrauterine insemination cycle. Asian J Pharm Res Health Care 2016;8(S1):24–29. DOI: 10.18311/ajprhc/2016/7718
  34. Riad ON, Hak AA. Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination. Gynecol Endocrinol 2014;30:70–73. DOI: 10.3109/09513590.2013.859668
  35. Wu HM, Chiang CH, Huang HY, et al. Detection of the subendometrial vascularization flow index by three-dimensional ultrasound may be useful for predicting the pregnancy rate for patients undergoing in vitro fertilization-embryo transfer. Fertil Steril 2003;79:507–511. DOI: 10.1016/s0015-0282(02)04698-8
  36. Nygren KG, Sullivan E, Zegers-Hochschild F, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) world report: assisted reproductive technology. Fertil Steril 2011;95:2209–2222. DOI: 10.1016/j.fertnstert.2011.03.058
  37. Ng EH, Yeung WS, Ho PC. Endometrial and subendometrial vascularity are significantly lower in patients with endometrial volume 2.5 ml or less. Reprod Biomed Online 2009;18:262–268. DOI: 10.1016/s1472-6483(10)60264-7
  38. Casper RF. It's time to pay attention to the endometrium. Fertil Steril 2011;96(3):519–521. DOI: 10.1016/j.fertnstert.2011.07.1096
  39. Dechaud H, Bessueille E, Bousquet PJ, et al. Optimal timing of ultrasonographic and Doppler evaluation of uterine receptivity to implantation. Reprod Biomed Online 2008;16:368–375. DOI: 10.1016/s1472-6483(10)60598-6
  40. Sardana D, Upadhyay AJ, K Deepika, et al. 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(2):130–135. DOI: 10.4103/0974-1208.138872
  41. Ng EHY, Chan CCW, Tang OS, et al. The role of endometrial and subendometrial vascularity measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during frozen thawed embryo transfer cycles. Hum Reprod 2006;21:1612–1617. DOI: 10.1093/humrep/dei502
  42. Raine-Fenning NJ, Campbell BK, Kendall NR, et al. Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility. Hum Reprod 2004;19:2605–2614. DOI: 10.1093/humrep/deh459
  43. Hassold TJ. Chromosome abnormalities in human reproductive wastage. Trends Genet 1986;2:105-110. DOI: 10.1016/0168-9525(86)90194-0
  44. Aleman A, Althabe F, Belizan J, et al. Bed rest during pregnancy for preventing miscarriage, Cochrane Database Syst Rev 2005;2: CD003576. DOI: 10.1002/14651858.CD003576.pub2
  45. Panchal S, Nagori C. Endometrial vascularity: its relation to implantation rates. Int J Infertil Fetal Med 2012;3(2):48–50. DOI: 10.5005/jp-journals-10016-1040.
  46. Chien LW, Au HK, Chen PL, et al. Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization embryo transfer. FertilSteril 2002;78(2):245–251. DOI: 10.1016/s0015- 0282(02)03223-5
  47. Panchal S, Nagori C, Thaker M. Doppler and 3D power Doppler assessment of the endometrium and its correlation to abortion rates. Donald School J Ultrasound Obstet Gynecol 2020;14(2):150–156. DOI: 10.5005/jp-journals-10009-1638
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