Role of uterine artery Doppler indices for predicting intrauterine pathology inconclusive on 2-dimensional transvaginal imaging among infertile women undergoing frozen embryo transfer cycle

Authors

  • Lavi Sindhu Department of Reproductive Medicine and IVF, Medicover Fertility, Panchsheel Park, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20215079

Keywords:

Uterine artery Doppler, Embryo transfer, Endometrial pathology, Hysteroscopy

Abstract

Background: Objective of current study was to correlate uterine artery Doppler parameters with endometrial findings on hysteroscopy and its importance for the prediction of intrauterine pathology inconclusive on 2-dimensional transvaginal imaging prior to frozen embryo transfer.

Methods: This was a retrospective study conducted at Medicover fertility center, New Delhi, India. The study population comprised of women with infertility who have undergone hysteroscopy before frozen embryo transfer. Total 70 patients were recruited based on inclusion/exclusion criteria. Intrauterine pathology found in 57.2% (n= 40) patients and 42.8% (n=30) had normal endometrial cavity on hysteroscopy, they were categorized as group 1 and group 2 respectively based on their findings. Both the groups were compared for pre hysteroscopy uterine artery Doppler parameters, resistivity index and pulsatility index. Further clinical pregnancy rate and miscarriage rate were determined in both groups.

Results: Both the groups were comparable for age, body mass index, duration, and type of infertility. Mean RI and PI was significantly higher in group 1 as compared to group 2 (0.90±0.025, 2.89±0.291 vs. 0.76±0.043, 1.82±0.27; p value <0.001). The best cut-off value of uterine artery RI was ≥0.87 with sensitivity of 90% (95% CI=0.7634-0.9721), specificity of 100% (95% CI=0.8843-1.0000) and PI was 2.46 with sensitivity of 100% (95% CI=0.9119-1.0000), specificity of 96.7% (95% CI=0.8278-0.9992).

Conclusions: Uterine artery Doppler is a non-invasive, cost- effective useful add-on tool for routine endometrial evaluation and can be a good predictor for screening intrauterine pathology and valuable in decision making for pre-IVF hysteroscopy.

 

 

 


References

Nygren KG, Andersen AN, European IVFmp. Assisted reproductive technology in Europe, 1998. Results generated from European registers by ESHRE. European Society of Human Reproduction and Embryology. Hum Reprod. 2001;16(11):2459-71.

Noyes RW, Hertig AT, Rock J. Dating the endometrial biopsy. Am J Obstet Gynecol. 1975; 122(2):262-3.

Ledee-Bataille N, Lapree-Delage G, Taupin JL. Concentration of leukaemia inhibitory factor (LIF) in uterine flushing fluid is highly predictive of embryo implantation. Hum Reprod. 2002;17(1):213-8.

Horcajadas JA, Pellicer A, Simon C. Wide genomic analysis of human endometrial receptivity: new times, new opportunities. Hum Reprod Update. 2007;13(1):77-86.

Schiano A, Jourdain O, Papaxanthos A. The value of hysteroscopy after repeated implantation failures with in vitro fertilization. Contracept Fertil Sex. 1999;27(2):129-32.

Gavino-Gavino F, Guzman-Gonzalez E, Reyes-Munoz E. Impact of office hysteroscopy in patients with a history of two or more failed cycles of IVF-ET and pre-ICSI in assisted an reproduction center. Ginecol Obstet Mex. 2010;78(1):9-14.

Fatemi HM, Popovic-Todorovic B. Implantation in assisted reproduction: a look at endometrial receptivity. Reprod Biomed. 2013;27(5):530-8.

Shawki HE, Elmorsy M, Eissa MK. Routine office hysteroscopy prior to ICSI and its impact on assisted reproduction program outcome: A randomized controlled trial. Middle East Fertil Soc J. 2012; 17(1):14-21.

Dalal RJ. Role of hysteroscopy prior to assisted reproductive techniques in patients with previous IVF Failure. Int J Infertil Fetal Med. 2011;2(1):19-22.

Shohayeb A, El-Khayat W. Does a single endometrial biopsy regimen (S-EBR) improve ICSI outcome in patients with repeated implantation failure? A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2012;164(2):176-9.

Salle B, Bied-Damon V, Benchaib M, et al. Preliminary report of an ultrasonography and colour Doppler uterine score to predict uterine receptivity in an in-vitro fertilization programme. Hum Reprod. 1998;13(6):1669-73.

Steer CV, Tan SL, Dillon D. Vaginal color Doppler assessment of uterine artery impedance correlates with immunohistochemical markers of endometrial receptivity required for the implantation of an embryo. Fertil Steril. 1995;63(1):101-8.

Cacciatore B, Simberg N, Fusaro P, et al. Transvaginal Doppler study of uterine artery blood flow in in vitro fertilization-embryo transfer cycles. Fertil Steril. 1996;66(1):130-4.

Goswamy RK, Steptoe PC. Doppler ultrasound studies of the uterine artery in spontaneous ovarian cycles. Hum Reprod. 1988;3(6):721-6.

Steer CV, Campbell S, Tan SL, et al. The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril. 1992;57(2):372-6.

Ali zarad C, Mohamed MH, Shanab WSA. Role of uterine artery Doppler in assessment of unexplained infertility. Egyptian J Radiol Nuclear Med. 2021; 52(1):59.

Strohmer H, Herczeg C, Plockinger B, et al. Prognostic appraisal of success and failure in an in vitro fertilization program by transvaginal Doppler ultrasound at the time of ovulation induction. Ultrasound Obstet Gynecol. 1991;1(4):272-4.

Gao M, Sun Y, Xie H. Hysteroscopy prior to repeat embryo transfer may improve pregnancy outcomes for asymptomatic women with repeated implantation failure. J Obstet Gynaecol Res. 2015;41(10):1569-76.

Oliveira FG, Abdelmassih VG, Diamond MP. Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization-embryo transfer who repeatedly cannot conceive. Fertil Steril. 2003;80(6):1371-5.

Moini A, Kiani K, Ghaffari F. Hysteroscopic findings in patients with a history of two implantation failures following in vitro fertilization. Int J Fertil Steril. 2012;6(1):27-30.

Cenksoy P, Ficicioglu C, Yildirim G. Hysteroscopic findings in women with recurrent IVF failures and the effect of correction of hysteroscopic findings on subsequent pregnancy rates. Arch Gynecol Obstet. 2013;287(2):357-60.

Elsetohy KA, Askalany AH, Hassan M. Routine office hysteroscopy prior to ICSI vs. ICSI alone in patients with normal transvaginal ultrasound: a randomized controlled trial. Arch Gynecol Obstet. 2015;291(1):193-9.

Doldi N, Persico P, Di Sebastiano F. Pathologic findings in hysteroscopy before in vitro fertilization-embryo transfer (IVF-ET). Gynecol Endocrinol. 2005;21(4):235-7.

Smit JG, Kasius JC, Eijkemans MJC. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet. 2016; 387(10038):2622-9.

El-Toukhy T, Campo R, Khalaf Y. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet. 2016;387(10038):2614-21.

Yu HT, Wang CJ, Lee CL. The role of diagnostic hysteroscopy before the first in vitro fertilization/intracytoplasmic sperm injection cycle. Arch Gynecol Obstet. 2012;286(5):1323-8.

Singla SGS, Munjal R, Chawla S, Dash BB. Role of pre IVF hysteroscopy in women with unexplained infertility for detecting unsuspected intrauterine lesions and effect on pregnancy outcome. Fertil Sci Res. 2020;7:105-10.

Ng EH, Chan CC, Tang OS. 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):1134-41.

Chien LW, Au HK, Chen PL. Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2002;78(2):245-51.

Uysal S, Ozbay EP, Ekinci T. Endometrial spiral artery Doppler parameters in unexplained infertility patients: is endometrial perfusion an important factor in the etiopathogenesis? J Turk Ger Gynecol Assoc. 2012;13(3):169-71.

Elkholy HANK, Hashad AMN-E, Ibrahim IM. A Study of Endometrial Perfusion in Unexplained Infertility. Egyptian J Hosp Med. 2018;72(6):4673-80.

Pace S, Cerekja A, Stentella P. Improvement of uterine artery Doppler velocimetry indices after metroplasty in arcuate uteri. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):81-4.

Pace S, Cerekja A, Dillon KC. Improvement in uterine artery doppler indices via hysteroscopic metroplasty. J Prenat Med. 2013;7(2):25-8.

Downloads

Published

2021-12-28

Issue

Section

Original Research Articles