Leibovitz Z, Grinin V, Rabia R, Degani S, Shapiro I, Tal J, Eibschitz I, Harari O, Paltieli Y, Aharoni A, Zeevi J, Ohel G
Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel.
Ultrasound Obstet Gynecol. 1999 Sep;14(3):194-9. doi: 10.1046/j.1469-0705.1999.14030194.x.
To evaluate the outcome of in vitro fertilization (IVF) treatment in relation to the sonographic parameters of the endometrium.
Seventy-five patients with no uterine pathology (age 31.1 +/- 5.4 years) treated in our IVF clinic for various indications were assessed during 75 cycles in which good-quality (grades 1 and 2) embryos were transferred. Controlled ovarian stimulation was achieved by the long protocol (gonadotropin releasing hormone agonist and gonadotropins). The bilayered endometrial thickness (BET), estradiol, luteinizing hormone and progesterone serum levels were measured in 272 tests. A special computer program was used to measure endometrial echogenicity relative to myometrial echogenicity. The gray-level data were analyzed on the basis of the midsagittal sonographic uterine image. Endometrium-myometrium relative echogenicity coefficient (E/M REC) values were computed and displayed graphically along the anteroposterior axis of the endometrial layers in the upper part of the uterine cavity. The area under the E/M REC curve within the BET limits was defined as the relative echogenicity area (REA) and was used as a measure of endometrial echogenicity. Each cycle was sampled in six time segments representing desensitization, follicular and luteal phases. Assigning the day of ovum pick-up as day 0, the time segments of each cycle were: first, day -20 to day -11; second, day -10 to day -6; third, day -5 to day -2; fourth, day 0; fifth, day +7 to day +14; sixth, day +15 to day +21.
A total of 276 embryos were transferred (3.68 +/- 1.01 per cycle), of which 223 were of good quality (2.97 +/- 1.51 per cycle). An intrauterine pregnancy was diagnosed in 29 patients. All patients in this study had a BET of > 5 mm in the third and the fourth time segments. There was no significant difference in BET and REA between pregnant and non-pregnant patients tested in the first to the fifth time segments of the IVF cycles. Both BET and REA measured in the sixth time segment were significantly higher in pregnant compared to non-pregnant patients.
Our results suggest that the proposed sonographic assessment of the endometrium shows no benefit in characterization of uterine receptivity in IVF patients with a reactive endometrium. High BET and REA values can indicate pregnancy during the sixth time segment, when the decidualization of the endometrium is well established.
评估体外受精（IVF）治疗结果与子宫内膜超声参数之间的关系。
在我们的IVF诊所，对75例无子宫病变（年龄31.1±5.4岁）因各种适应症接受治疗的患者，在75个周期中进行了评估，这些周期均移植了优质（1级和2级）胚胎。采用长方案（促性腺激素释放激素激动剂和促性腺激素）进行控制性卵巢刺激。在272次检测中测量了双层子宫内膜厚度（BET）、雌二醇、促黄体生成素和孕酮的血清水平。使用一个特殊的计算机程序来测量子宫内膜相对于肌层的回声强度。基于子宫矢状位超声图像分析灰度数据。计算子宫内膜-肌层相对回声系数（E/M REC）值，并沿子宫腔上部子宫内膜层的前后轴以图形方式显示。将BET范围内的E/M REC曲线下面积定义为相对回声面积（REA），并将其用作子宫内膜回声强度的度量。每个周期在代表降调节、卵泡期和黄体期的六个时间段进行采样。将取卵日定为第0天，每个周期的时间段分别为：第一个，第-20天至第-11天；第二个，第-10天至第-6天；第三个，第-5天至第-2天；第四个，第0天；第五个，第+7天至第+14天；第六个，第+15天至第+21天。
共移植了276个胚胎（每个周期3.68±1.01个），其中223个质量良好（每个周期2.97±1.51个）。29例患者被诊断为宫内妊娠。本研究中的所有患者在第三个和第四个时间段的BET均>5mm。在IVF周期的第一个至第五个时间段进行检测的妊娠患者和未妊娠患者之间，BET和REA没有显著差异。与未妊娠患者相比，在第六个时间段测量的妊娠患者的BET和REA均显著更高。
我们的结果表明，所提出的子宫内膜超声评估在反应性子宫内膜的IVF患者子宫接受性特征描述方面没有益处。高BET和REA值可在第六个时间段子宫内膜蜕膜化良好建立时提示妊娠。
