Skip to main content

The reproducibility of the novel utilization of five-dimensional ultrasound and power Doppler in the prediction of endometrial receptivity in intracytoplasmic sperm-injected women: a pilot prospective clinical study

Archives of Gynecology and Obstetrics volume 299, pages 551–558 (2019)Cite this article

Abstract

Objective

The ultimate goal of this study is to reassess the five-dimensional implantation markers and pregnancy predictors on the day of human chorionic gonadotropin injection in the intracytoplasmic sperm injection and embryo transfer programs.

Design

A pilot prospective clinical trial.

Setting

The Assisted Reproductive Technology Unit of Ain Shams Maternity Teaching Hospital during the period from April 2014 to December 2017.

Patients and methods

The study was conducted on 400 women undergoing intracytoplasmic sperm injection (ICSI). Those women were not older than 40 years, with normal uterine cavity and with no previous uterine scars.

Intervention

The ovarian stimulation protocol, used in this study for all patients, was the long protocol, before ovarian stimulation therapy, patients were instructed to use oral contraceptive pills from day 2 starting in the preceding cycle, then the standard regimen. On the day of hCG administration, 5D transvaginal ultrasound measurements were performed by the same observer after the patients had emptied their bladders. Measurements included endometrial volume and 3D power Doppler parameters, endometrial vascularization index, flow index, and vascularization flow index.

Results

The present study shows that endometrial volume ≥ 5 in the prediction of endometrial receptivity in ICSI patients had good sensitivity and low specificity in a group application; in an individual application it had good predictive negative value and bad predictive positive value. So it could be used as a good test to exclude success. Overall pregnancy rate was 40.5%; endometrial volume, flow index, vascularization index, and vascularization flow index were significantly lower in the nonpregnant group than those of the pregnant group. The area under curve in the receiver operating characteristic for three-dimensional ultrasound and power Doppler angiography parameters was statistically significant, but their values were suggestive but not conclusive in the prediction of endometrial receptivity in ICSI patients, no cutoff points with good diagnostic characteristics could be obtained.

Conclusion

Five-dimensional ultrasound and power Doppler angiography is a useful exam to assess the endometrial receptivity in IVF/ICSI and embryo transfer cycles.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Andersen AN, Gianaroli L, Felberbaum R, de Mouzon J, Nygren KG (2005) Assisted reproductive technology in Europe, 2001. Results generated from European registers by ESHRE. Hum Reprod 20:1158–1176

    Article  PubMed  Google Scholar 

  2. Achache H, Revel A (2006) Endometrial receptivity markers, the journey to successful embryo implantation. Hum Reprod 12(6):731–746

    Google Scholar 

  3. Levi Setti PE, Colombo GV, Savasi V, Bulletti C, Albani E, Ferrazzi E (2004) Implantation failure in assisted reproduction technology and a critical approach to treatment. Ann N Y Acad Sci 1034:184–199

    Article  CAS  PubMed  Google Scholar 

  4. Urman B, Yakin K, Balaban B (2005) Recurrent implantation failure in assisted reproduction: how to counsel and manage. A. General considerations and treatment options that may benefit the couple. Reprod Biomed Online 11:371–381

    Article  PubMed  Google Scholar 

  5. Li TC, MacKenna A, Roberts R (1993) The techniques and complications of out-patient uterine washing in the assessment of endometrial function. Hum Reprod 8:343–346

    Article  CAS  PubMed  Google Scholar 

  6. Friedler S, Schenker JG, Herman A, Lewin A (1996) The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproduction treatments: a critical review. Hum Reprod 2:323–335

    CAS  Google Scholar 

  7. Demir R, Kayisli UA, Cayli S, Hupperzt B (2006) Sequential steps during vasculogenesis and angiogenesis in the very early human placenta. Placenta 27:535–539

    Article  CAS  PubMed  Google Scholar 

  8. Tekay A, Martikainen H, Jouppila P (2006) Blood flow changes in uterine and ovarian vasculature, and predictive value of transvaginal pulsed colour Doppler ultrasonography in an in vitro fertilization programme. Hum Reprod 10:688–693

    Article  Google Scholar 

  9. Merce LT (2002) Ultrasound markers of implantation. Ultrasound Rev Obstet Gynecol 2:110–123

    Article  Google Scholar 

  10. Chien LW, Au HK, Chen PL, Xiao J, Tzeng CR (2002) Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer. Fertil Steril 78:245–251

    Article  PubMed  Google Scholar 

  11. Merce Luis T, Barco Maria J, Bau Santiago, Troyano Juan (2008) Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome? Fertil Steril 89:112–117

    Article  Google Scholar 

  12. Alcāzar JL (2006) Three-dimensional ultrasound in gynecology: current status and future perspectives. Curr Women’s Health Rev 1:1–14

    Google Scholar 

  13. De los Santos MJ, Mercader A, Galan A, Albert C, Romero JL, Pellicer A (2003) Implantation rates after two, three, or five days of embryo culture. Placenta 24:13–19

    Article  Google Scholar 

  14. Noyes RW, Haman JO (1953) Accuracy of endometrial dating; correlation of endometrial dating with basal body temperature and menses. Fertil Steril 4:504–517

    Article  CAS  PubMed  Google Scholar 

  15. Lédé-Bataille N, Laprée-Delage G, Taupin JL et al (2002) Concentration of leukaemia inhibitory factor (LIF) in uterine flushing fluid is highly predictive of embryo implantation. Hum Reprod 17:213–218

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  17. Abulafia O, Sherer DM (2000) Angiogenesis of the ovary. Am J Obstet Gynecol 182:240–246

    Article  CAS  PubMed  Google Scholar 

  18. Smith SK (2001) Angiogenesis and reproduction. Br J Obstet Gynaecol 108:777–783

    CAS  Google Scholar 

  19. Gannon BJ, Carati CJ, Verco CJ (1997) Endometrial perfusion across the normal human menstrual cycle assessed by laser Doppler fluxmetry. Hum Reprod 12:132–139

    Article  CAS  PubMed  Google Scholar 

  20. Jinno M, Ozaki T, Iwashita M et al (2001) Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation. Fertil Steril 76:1168–1174

    Article  CAS  PubMed  Google Scholar 

  21. Guerriero S, Ajossa S, Lai MP et al (1999) Clinical applications of colour Doppler energy imaging in the female reproductive tract and pregnancy. Hum Reprod Update 5:515–529

    Article  CAS  PubMed  Google Scholar 

  22. Kupesic S, Kurjak A (1993) Uterine and ovarian perfusion during periovulatory period assessed by transvaginal color Doppler. Fertil Steril 60:439–443

    Article  CAS  PubMed  Google Scholar 

  23. Zaidi J, Campbell S, Pittrof FR et al (1995) Endometrial thickness morphology, vascular penetration and velocimetry in predicting implantation in an IVF program. Ultrasound Obstet Gynecol 6:191–198

    Article  CAS  PubMed  Google Scholar 

  24. Battaglia C, Artini PG, Giulini S et al (1997) Colour Doppler changes and thromboxane production after ovarian stimulation with gonadotrophin- releasing hormone agonist. Hum Reprod 12:2477–2482

    Article  CAS  PubMed  Google Scholar 

  25. Kupesic S, Bekavac I, Bjelos D, Kurjak A (2001) Assessment of endometrial receptivity by transvaginal color Doppler and threedimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med 20:125–134

    Article  CAS  PubMed  Google Scholar 

  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. Hum Reprod 21:164–170

    Article  PubMed  Google Scholar 

  27. Wu HM, Chiang CH, Huang HY, Chao AS, Wang HS, Soong YK (2003) 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 79:507–511

    Article  PubMed  Google Scholar 

  28. Jarvela IY, Sladkevicius P, Kelly S, Ojha K, Campbell S, Nargund G (2005) Evaluation of endometrial receptivity during in vitro fertilization using three-dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol 26:765–769

    Article  CAS  PubMed  Google Scholar 

  29. Raine-Fenning NJ, Campbell BK, Clewes JS, Kendall NR, Johnson IR (2004) Defining endometrial growth during the menstrual cycle with three-dimensional ultrasound. BJOG 111:944–949

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Special thanks go to the patients and their families for the great support of our work. Also, the authors highly appreciate the support from fetology unit of Ain Shams University Maternity Hospital for the outstanding support during the entire experiment.

Funding

No available funding.

Author information

Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasyia, Cairo, Egypt

    M. Elsokkary, A. Bahaa Eldin, M. Abdelhafez, A. Rateb, M. Samy, B. A. Islam, T. A. Raafat, I. A. Gomaa, M. Taema, R. Mohamed, M. Elshourbagy, M. Mostafa, A. Abbas & H. Hemeda

  2. Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt

    A. Eldorf

  3. Department of Obstetrics and Gynecology, Banha University, Banha, Egypt

    W. Tawfik, A. Morad & T. Assar

Authors
  1. M. Elsokkary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bahaa Eldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Abdelhafez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Rateb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Samy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Eldorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. A. Islam
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. A. Raafat
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I. A. Gomaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Taema
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. R. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Elshourbagy
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. W. Tawfik
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A. Morad
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. M. Mostafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. A. Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. T. Assar
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. H. Hemeda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors had put the plan, collected the data, participated in the surgical procedure and follow-up of the patients.

Corresponding author

Correspondence to M. Elsokkary.

Ethics declarations

Ethical consideration

Institutional review board (IRB) approval: the protocol was discussed by the ethical scientific committee and informed consent was taken before the participation.

Subject confidentiality

All evaluation forms, reports, laboratory specimens, and other records that leave the site would not comprise unique personal data to maintain subject confidentiality.

Consent procedure

The investigator made a great concern that a correct informed consent process was in place to make sure that potential research subjects were fully addressed about the nature and objectives of this clinical trial, the potential hazards and gains of study participation, and also their rights as research subjects. The investigator took the written, signed informed consent of each participant before performing any study-specific technique on the participant. The investigator retained the forms of original signed informed consents. All data and materials are available on request with an agreement for publication.

Conflict of interest

All the authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Elsokkary, M., Eldin, A.B., Abdelhafez, M. et al. The reproducibility of the novel utilization of five-dimensional ultrasound and power Doppler in the prediction of endometrial receptivity in intracytoplasmic sperm-injected women: a pilot prospective clinical study. Arch Gynecol Obstet 299, 551–558 (2019). https://doi.org/10.1007/s00404-018-5001-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-5001-4

Keywords

  • Five-dimensional ultrasound
  • Doppler
  • Receptivity
  • ICSI