Archives of Gynecology and Obstetrics

, Volume 297, Issue 2, pp 539–545 | Cite as

Effect of intramural fibroid on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization

  • Ahmed KamelEmail author
  • Akmal El-Mazny
  • Wafaa Ramadan
  • Suzy Abdelaziz
  • Sherine Gad-Allah
  • Hany Saad
  • Ahmed M. Hussein
  • Emad Salah
Gynecologic Endocrinology and Reproductive Medicine



To study the effect of intramural fibroids on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization (IVF).


3D power Doppler was used to measure the endometrial volume and blood flow indices in 182 women with intramural fibroids not affecting the uterine cavity and compared them to a matched control group without fibroids.


There was significantly increased vascularity in the endometrium of the fibroid group as denoted by higher endometrial VI (p = 0.018), FI (p = 0.027) and Endometrial VFI. No significant difference in mean uterine artery RI (p = 0.277) or PI (p = 0.187). Among the fibroid group 62.6% had a fibroid > 4 cm. Women with fibroids > 4 cm had a significantly higher Endometrial FI (p = 0.037), and VFI (p = 0.02). Uterine artery blood flow was not affected, as uterine RI (p = 0.369) and PI (p = 0.321) were not statistically different. Compared with the control group (non fibroid), women with fibroids > 4 cm had significantly higher endometrial VI (p = 0.013), FI (p = 0.004), and VFI (p < 0.001), whereas women with fibroid ≤ 4 cm had no statistically significant differences in VI (p = 0.292), FI (p = 0.198), and VFI (p = 0.304).


Intramural fibroids > 4 cm significantly increase endometrial vascularity. This increase in blood flow may be a factor that affects the outcome of IVF.


3D power Doppler Endometrial vascularity and blood flow Intramural fibroids IVF Uterine vascularity 



Assisted reproductive technologies


Body mass index


Confidence interval


Flow index


Intraclass correlation coefficient


In-vitro fertilization


Pulsatility index


Resistance index


Trans-vaginal ultrasound


Vascularization flow index


Virtual organ computer-aided analysis


Vascularization index


Author contributions

AK and AE-M: Protocol/project development, Data analysis, Manuscript writing/editing. WR, SA and AMH: Data collection or management, manuscript writing/editing. SG-A: Protocol/project development, Data collection or management, manuscript writing/editing. HS: Data collection or management, Data analysis. ES: Protocol/project development, Data collection or management.


This research did not receive any specific Grant from any funding agency in the public, commercial or not-for-profit sector.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Muniz CJ, Fleischer AC, Donnelly EF, Mazer MJ (2002) Three-dimensional color doppler sonography and uterine artery arteriography of fibroids. J Ultrasound Med 21(2):129–133CrossRefPubMedGoogle Scholar
  2. 2.
    Tsiligiannis SE, Zaitseva M, Coombs PR, Shekleton P, Olshansky M, Hickey M, Vollenhoven B, Rogers PA (2013) Fibroid-associated heavy menstrual bleeding: correlation between clinical features, Doppler ultrasound assessment of vasculature, and tissue gene expression profiles. Reprod Sci 20(4):361–370. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Guven S, Kart C, Unsal MA, Odaci E (2013) Intramural leoimyoma without endometrial cavity distortion may negatively affect the ICSI - ET outcome. Reprod Biol Endocrinol 11:102. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Vimercati A, Scioscia M, Lorusso F, Laera AF, Lamanna G, Coluccia A, Bettocchi S, Selvaggi L, Depalo R (2007) Do uterine fibroids affect IVF outcomes? Reprod Biomed Online 15(6):686–691CrossRefPubMedGoogle Scholar
  5. 5.
    Khaund A, Lumsden MA (2008) Impact of fibroids on reproductive function. Best Pract Res Clin Obstet Gynaecol 22(4):749–760. CrossRefPubMedGoogle Scholar
  6. 6.
    Chang WC, Huang SC, Sheu BC, Shih JC, Hsu WC, Chen SY, Chang DY (2009) Changes in uterine blood flow following laparoscopic myomectomy with or without uterine artery ligation on two- and three-dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol 33(2):221–227. CrossRefPubMedGoogle Scholar
  7. 7.
    Ng EH, Yeung WS, Ho PC (2009) Endometrial and subendometrial vascularity are significantly lower in patients with endometrial volume 2.5 ml or less. Reprod Biomed Online 18(2):262–268CrossRefPubMedGoogle Scholar
  8. 8.
    El-Mazny A, Ramadan W, Kamel A, Gad-Allah S (2016) Effect of hydrosalpinx on uterine and ovarian hemodynamics in women with tubal factor infertility. Eur J Obstet Gynecol Reprod Biol 199:55–59. CrossRefPubMedGoogle Scholar
  9. 9.
    Jarvela IY, Sladkevicius P, Tekay AH, Campbell S, Nargund G (2003) Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography. Ultrasound Obstet Gynecol 21(3):277–282. CrossRefPubMedGoogle Scholar
  10. 10.
    Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R (2004) Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril 81(3):582–587. CrossRefPubMedGoogle Scholar
  11. 11.
    Benecke C, Kruger TF, Siebert TI, Van der Merwe JP, Steyn DW (2005) Effect of fibroids on fertility in patients undergoing assisted reproduction. A structured literature review. Gynecol Obstet Invest 59(4):225–230. CrossRefPubMedGoogle Scholar
  12. 12.
    Bernard G, Darai E, Poncelet C, Benifla JL, Madelenat P (2000) Fertility after hysteroscopic myomectomy: effect of intramural myomas associated. Eur J Obstet Gynecol Reprod Biol 88(1):85–90CrossRefPubMedGoogle Scholar
  13. 13.
    Khalaf Y, Ross C, El-Toukhy T, Hart R, Seed P, Braude P (2006) The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception. Human Reprod 21(10):2640–2644. CrossRefGoogle Scholar
  14. 14.
    Stovall DW, Parrish SB, Van Voorhis BJ, Hahn SJ, Sparks AE, Syrop CH (1998) Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study. Human Reprod 13(1):192–197CrossRefGoogle Scholar
  15. 15.
    Sunkara SK, Khairy M, El-Toukhy T, Khalaf Y, Coomarasamy A (2010) The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Human Reprod 25(2):418–429. CrossRefGoogle Scholar
  16. 16.
    Surrey ES, Lietz AK, Schoolcraft WB (2001) Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo transfer cycle outcome. Fertil Steril 75(2):405–410CrossRefPubMedGoogle Scholar
  17. 17.
    Dietterich C, Check JH, Choe JK, Nazari A, Fox F (2000) The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients. Clin Exp Obstet Gynecol 27(3–4):168–170PubMedGoogle Scholar
  18. 18.
    Jun SH, Ginsburg ES, Racowsky C, Wise LA, Hornstein MD (2001) Uterine leiomyomas and their effect on in vitro fertilization outcome: a retrospective study. J Assist Reprod Genet 18(3):139–143CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ng EH, Ho PC (2002) Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Human Reprod 17(3):765–770CrossRefGoogle Scholar
  20. 20.
    Ramzy AM, Sattar M, Amin Y, Mansour RT, Serour GI, Aboulghar MA (1998) Uterine myomata and outcome of assisted reproduction. Human Reprod 13(1):198–202CrossRefGoogle Scholar
  21. 21.
    Yarali H, Bukulmez O (2002) The effect of intramural and subserous uterine fibroids on implantation and clinical pregnancy rates in patients having intracytoplasmic sperm injection. Arch Gynecol Obstet 266(1):30–33CrossRefPubMedGoogle Scholar
  22. 22.
    Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC (2005) Endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound in patients with small intramural uterine fibroids during IVF treatment. Human Reprod 20(2):501–506. CrossRefGoogle Scholar
  23. 23.
    Gianaroli L, Gordts S, D’Angelo A, Magli MC, Brosens I, Cetera C, Campo R, Ferraretti AP (2005) Effect of inner myometrium fibroid on reproductive outcome after IVF. Reprod Biomed Online 10(4):473–477CrossRefPubMedGoogle Scholar
  24. 24.
    Kurjak A, Kupesic-Urek S, Miric D (1992) The assessment of benign uterine tumor vascularization by transvaginal color Doppler. Ultrasound Med Biol 18(6–7):645–649CrossRefPubMedGoogle Scholar
  25. 25.
    Abdallah Y, Naji O, Saso S, Pexsters A, Stalder C, Sur S, Raine-Fenning N, Timmerman D, Brosens JJ, Bourne T (2012) Ultrasound assessment of the peri-implantation uterus: a review. Ultrasound Obstet Gynecol 39(6):612–619. CrossRefPubMedGoogle Scholar
  26. 26.
    Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC (2006) The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment. Human Reprod 21(1):164–170. CrossRefGoogle Scholar
  27. 27.
    Merce LT, Barco MJ, Bau S, Troyano J (2008) Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome? Fertil Steril 89(1):111–117. CrossRefPubMedGoogle Scholar
  28. 28.
    Wang L, Qiao J, Li R, Zhen X, Liu Z (2010) Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles. Reprod Biol Endocrinol 8:122. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS, Johnson IR (2004) Quantifying the changes in endometrial vascularity throughout the normal menstrual cycle with three-dimensional power Doppler angiography. Human Reprod 19(2):330–338CrossRefGoogle Scholar
  30. 30.
    Smith SK (2001) Angiogenesis and reproduction. BJOG 108(8):777–783. PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Faculty of MedicineCairo UniversityCairoEgypt

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