Kim Ari, Jung Hyuk, Choi Won June, Hong Sung Nam, Kim Heung Yeol
Department of Obstetrics and Gynecology, Institute of Wonkwang Medical Science, College of Medicine, Wonkwang University, Iksan, Republic of Korea.
Department of Obstetrics and Gynecology, College of Medicine Chosun University, Kwangju, Republic of Korea.
Taiwan J Obstet Gynecol. 2014 Sep;53(3):360-5. doi: 10.1016/j.tjog.2013.05.007.
Successful implantation depends on interaction between a blastocyst and a receptive endometrium. Endometrial vasculature is important in the early endometrial response to blastocyst implantation, and vascular changes can affect uterine receptivity. This study aims to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) could predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF-ET) using a gonadotropin releasing hormone (GnRH) agonist long protocol.
This prospective observational study enrolled 236 nulliparous women who underwent a first IVF-ET using a GnRH long protocol with stimulation by recombinant FSH (rFSH) from May 2009 to April 2012. After excluding two cases of tubal pregnancy, 234 women were in either a pregnant group (n = 113) or a nonpregnant group (n = 121). Color Doppler ultrasound and 3D PD-US examinations were performed on the day of embryo transfer. Main outcomes were pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) of the uterine artery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of the endometrium and subendometrial region. Measurements were analyzed relative to IVF-ET outcome (pregnant vs. nonpregnant).
No significant differences were observed in patient age, infertility duration, body mass index (BMI), basal FSH levels, number of retrieved oocytes or good quality embryos, or endometrial thickness or volume between the two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, p = 0.000, p = 0.021, respectively). By contrast, neither subendometrial region VI, FI, and VFI scores (p = 0.770, p = 0.252, p = 0.451), nor uterine artery PI, RI, or S/D scores (p = 0.256, p = 0.527, p = 0.365) differed between groups. Cut-off values of endometrial VI, FI, and VFI scores were 0.95, 12.94, and 0.15 for pregnancy achievement.
Three dimensional PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of embryo transfer might be associated with high pregnancy success with a GnRH long protocol, because this is indicative of endometrial receptivity in fresh IVF cycles.
成功着床取决于囊胚与容受性子宫内膜之间的相互作用。子宫内膜血管系统在子宫内膜对囊胚着床的早期反应中起重要作用，血管变化会影响子宫容受性。本研究旨在探讨使用三维能量多普勒超声（3D PD-US）测量的血管参数能否预测采用促性腺激素释放激素（GnRH）激动剂长方案进行新鲜体外受精-胚胎移植（IVF-ET）后的妊娠情况。
这项前瞻性观察性研究纳入了236例未生育女性，她们于2009年5月至2012年4月采用GnRH长方案联合重组促卵泡素（rFSH）刺激进行首次IVF-ET。排除2例输卵管妊娠病例后，234名女性分为妊娠组（n = 113）和非妊娠组（n = 121）。在胚胎移植当天进行彩色多普勒超声和3D PD-US检查。主要观察指标为子宫动脉的搏动指数（PI）、阻力指数（RI）、收缩/舒张比（S/D），子宫内膜及内膜下区域的血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI）。根据IVF-ET结局（妊娠与未妊娠）对测量结果进行分析。
两组患者在年龄、不孕时间、体重指数（BMI）、基础促卵泡素水平、获卵数或优质胚胎数、子宫内膜厚度或体积方面均未观察到显著差异。妊娠组的子宫内膜VI、FI和VFI评分高于非妊娠组（分别为p = 0.001、p = 0.000、p = 0.021）。相比之下，两组内膜下区域的VI、FI和VFI评分（p = 0.770、p = 0.252、p = 0.451）以及子宫动脉的PI、RI或S/D评分（p = 0.256、p = 0.527、p = 0.365）均无差异。子宫内膜VI、FI和VFI评分预测妊娠成功的截断值分别为0.95、12.94和0.15。
三维PD-US是评估IVF周期中子宫内膜血流的一种有用且有效的方法。胚胎移植当天良好的子宫内膜血流可能与GnRH长方案的高妊娠成功率相关，因为这表明新鲜IVF周期中的子宫内膜容受性良好。
