Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People s Republic of China
|
|
- Franklin Palmer
- 6 years ago
- Views:
Transcription
1 Human Reproduction Vol.21, No.1 pp , 2006 Advance Access publication August 25, doi: /humrep/dei277 The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment Ernest Hung Yu Ng 1, Carina Chi Wai Chan, Oi Shan Tang, William Shu Biu Yeung and Pak Chung Ho Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People s Republic of China 1 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. nghye@hkucc.hku.hk BACKGROUND: A good blood supply towards the endometrium is usually considered to be an essential requirement for implantation. We aimed to evaluate the role of endometrial and subendometrial blood flows in the prediction of pregnancy during IVF treatment. METHODS: Patients undergoing the first IVF cycle were recruited. A three-dimensional (3D) ultrasound examination with power Doppler was performed on the day of oocyte retrieval to determine endometrial thickness, endometrial pattern, pulsatility index (PI) and resistance index (RI) of uterine vessels, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS: Uterine RI, endometrial VI and VFI were significantly lower in the pregnant group than the non-pregnant group. There was a non-significant trend of higher implantation and pregnancy rates in patients with absent endometrial or subendometrial blood flow. The number of embryos replaced and endometrial VI were the only two predictive factors for pregnancy. Receiver operator characteristic curve analysis revealed that the area under the curve was ~0.5 for all ultrasound parameters for endometrial receptivity. CONCLU- SION: Endometrial and subendometrial blood flows measured by 3D power Doppler ultrasound were not good predictors of pregnancy if they were measured at one time-point during IVF treatment. Key words: endometrial and subendometrial blood flows/ivf/three-dimensional power Doppler Introduction The endometrium undergoes adequate proliferation and differentiation in the follicular phase, which is followed by timely secretory changes during the luteal phase. Successful implantation is dependent on a close dialogue between the blastocyst and the receptive endometrium. Endometrial receptivity can be evaluated by histological evaluation of an endometrial biopsy (Noyes et al., 1950), endometrial proteins in uterine flushing (Li et al., 1998) or more commonly a noninvasive ultrasound examination of the endometrium. Different ultrasound parameters have been used to assess endometrial receptivity during IVF treatment and these include endometrial thickness, endometrial pattern, endometrial volume, Doppler study of uterine arteries and endometrial blood flow. Endometrial thickness and pattern have low positive predictive value and specificity in the prediction of IVF outcome (Turnbull et al., 1995; Friedler et al., 1996). Angiogenesis plays a critical role in various female reproductive processes such as development of a dominant follicle, formation of a corpus luteum, growth of endometrium and implantation (Abulafia and Sherer, 2000; Smith, 2001). A good blood supply towards the endometrium is usually considered as an essential requirement for implantation. Gannon et al. (1997) used an intrauterine laser Doppler technique to measure endometrial microvascular blood flow, which differed between phases of the menstrual cycle with significant increase in blood flow during early follicular and early luteal phases. Endometrial microvascular blood flow which is determined by an intrauterine laser Doppler technique in the early luteal phase of the cycle preceding an IVF cycle has been shown to be predictive of pregnancy and superior to other conventional parameters predicting endometrial receptivity (Jinno et al., 2001). Endometrial blood flow can be non-invasively evaluated by a colour and power Doppler ultrasound. Power Doppler imaging is more sensitive than colour Doppler imaging at detecting low velocity flow and hence improves the visualization of small vessels (Guerriero et al., 1999). In combination with a three-dimensional (3D) ultrasound, power Doppler provides a unique tool with which to examine the blood supply towards the whole endometrium and the subendometrial region (Schild et al., 2000; Kupesic et al., 2001; Wu et al., 2003; Raine-Fenning et al., 2004a; Ng et al., 2004, 2005). 164 The Author Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please journals.permissions@oupjournals.org
2 Endometrial and subendometrial blood flows in IVF The aim of this study was to evaluate the role of endometrial and subendometrial blood flows measured by 3D power Doppler ultrasound in the prediction of pregnancy during IVF treatment. We compared the endometrial and subendometrial blood flows between pregnant and non-pregnant patients in their first IVF cycle. Implantation and pregnancy rates were also compared between those with and without endometrial and subendometrial blood flows. The hypothesis was that endometrial and subendometrial blood flows were significantly higher in pregnant patients than non-pregnant patients. Materials and methods Infertile patients undergoing the first IVF cycle in the Assisted Reproduction Unit of the Department of Obstetrics and Gynaecology, The University of Hong Kong between November 2002 and December 2004 were recruited if they had normal uterine cavity detected on the day of transvaginal ultrasound-guided oocyte retrieval (TUGOR). Indications for IVF included tubal, male, endometriosis, unexplained and mixed factors. ICSI was performed for couples with severe semen abnormalities where < motile sperm were recovered after sperm preparation. In cases of obstructive or non-obstructive azoospermia, surgically retrieved sperm from epididymis or testis respectively were used for ICSI. Serum basal FSH concentration was checked on day 2 3 of the cycle within 2 3 months of commencing treatment. Every patient gave her written informed consent prior to participating in the study, which was approved by the Ethics Committee, Faculty of Medicine, University of Hong Kong. They were evaluated only once during the study period and did not receive any monetary compensation for their participation in the study. The details of the long protocol of ovarian stimulation regimen, gamete handling, standard insemination and ICSI were as previously described (Ng et al., 2000). In short, they were pre-treated with buserelin (Suprecur; Hoechst, Frankfurt, Germany) nasal spray 150 mg four times a day from the mid-luteal phase of the cycle preceding the treatment cycle and they also received HMG (Pergonal; Serono, Geneva, Switzerland) for ovarian stimulation. HCG (Profasi; Serono, Geneva, Switzerland) was given i.m. when the leading follicle reached 18 mm in diameter and there were at least three follicles of 16 mm in diameter. Serum E 2 concentration was measured on the day of hcg administration. TUGOR was scheduled 36 h after the hcg injection. All ultrasound measurements were performed by E.H.Y.N. on the day of TUGOR prior to the procedure using Voluson 730 (Kretz, Zipf, Austria) at around 08:00 10:00 after they had emptied their bladder. The details of 3D ultrasound and data analysis were as previously described (Ng et al., 2004). The results of this ultrasound assessment did not affect subsequent clinical management procedures. The maximum thickness of the endometrium on both sides of the midline was measured in a longitudinal plane. The endometrial pattern visualized was designated as a multilayered or a non-multilayered endometrium (Sher et al., 1991). A multilayered endometrium presented as a triple-line pattern in which hyperechogenic outer lines and a well-defined central echogenic line were seen with hypoechogenic or black areas between these lines. A non-multilayered endometrium consisted of homogeneous endometrial patterns characterized by either hyperechogenic or isoechogenic endometrium. Using colour Doppler in the 2D mode, flow velocity waveforms were obtained from the ascending main branch of the uterine artery on the right and left side of the cervix in a longitudinal plane before they entered the uterus. The gate of the Doppler was positioned when the vessel with good colour signals was identified on the screen. PI and RI of the uterine arteries were calculated electronically when similar consecutive waveforms of good quality were obtained (Ng and Ho, 2002). As there were no differences in uterine PI and RI between the left and the right sides, the averaged uterine PI and RI were given. The ultrasound machine was switched to the 3D mode with power Doppler. The setting condition for this study was as follows: frequency mid; dynamic set 2; balance G >140; smooth 5/5; ensemble 12; line density 7; power Doppler map 5. The setting condition for the sub-power Doppler mode was as follows: gain 6.0; balance 140; quality normal; wall motion filter low 1; velocity range 0.9 khz. The resulting truncated sector covering the endometrial cavity in a longitudinal plane of the uterus was adjusted and moved and the sweep angle was set to 90 to ensure that a complete uterine volume encompassing the entire subendometrium was obtained. The patient and the 3D transvaginal probe remained as still as possible during the volume acquisition. A 3D dataset was then acquired using the medium speed sweep mode. The resulting multi-planar display was examined to ensure that the area of interest was captured in its entirety. If the volume measurement was completed without a power Doppler artefact, the dataset was stored for later analysis by E.H.Y.N. The built-in VOCAL (Virtual Organ Computer-Aided Analysis) Imaging Program for the 3D power Doppler histogram analysis was used in the analysis, along with computer algorithms, to measure the endometrial volume and indices of blood flow within the endometrium. Vascularization index (VI), which measures the ratio of the number of colour voxels to the total number of voxels, is thought to represent the presence of blood vessels (vascularity) in the endometrium and is expressed as a percentage (%) of the endometrial volume. Flow index (FI), the mean power Doppler signal intensity inside the endometrium, is thought to express the average intensity of flow. Vascularization flow index (VFI) is a combination of vascularity and flow intensity (Pairleitner et al., 1999). During the analysis and calculation, the manual mode of the VOCAL Contour Editor was used to cover the whole 3D volume of the endometrium with a 15 rotation step. Hence, 12 contour planes were analysed for the endometrium of each patient to cover 180. Following the assessment of the endometrium itself, the subendometrium was examined through the application of shell-imaging, which allows the user to generate a variable contour that parallels the originally defined surface contour. In the present study, the subendometrial region was considered to be within 1 mm of the originally defined myometrial endometrial contour (Ng et al., 2004). VI, FI and VFI of the subendometrial region were obtained accordingly. Patients were advised to have two embryos replaced into the uterine cavity 48 h after the retrieval but replacing three embryos was allowed. Excess good quality embryos were frozen. All fresh embryos were cryopreserved if serum E 2 on the day of hcg injection was >20000 pmol/l in order to reduce the risks of ovarian hyperstimulation syndrome (OHSS). Luteal phase was supported by two doses of HCG or vaginal progesterone (Cyclogest; Cox Pharmaceuticals, Barnstaple, UK). A urine pregnancy test was done 16 days after embryo transfer. If it was positive, ultrasound examination was performed days later to confirm intrauterine pregnancy and to determine the number of gestational sacs present. Only clinical pregnancies defined by the presence of one or more gestational sacs or the histological confirmation of gestational product in miscarriages were considered. Ongoing pregnancies were those pregnancies beyond weeks of gestation, at which stage the patients were referred for antenatal care. Implantation rate was the proportion of embryos transferred resulting in an intrauterine gestational sac. The intra-observer reliability was expressed as the mean intra-class correlation coefficient (ICC) with 95% confidence interval (CI). The mean ICC (95% CI) was (0.920, 0.989) for endometrial thickness, (0.912, 0.992) for PI and (0.838, 0.985) for RI. The 165
3 E.H.Y.Ng et al. mean ICC for 3D scanning of endometrial volume, VI, FI and VFI were (0.8591, ), (0.9689, ), (0.7157, ) and (0.9750, ) respectively. The mean ICC for data acquisition of endometrial volume, VI, FI and VFI were (0.9746, ), (0.9437, ), (0.9619, ) and (0.9517, ) respectively. Serum FSH and E 2 concentrations were measured using commercially available kits (Automated Chemiluminescence System; Bay Corporation, NY, USA). The inter-assay and intra-assay coefficients of variation (CV) for serum FSH concentration were 2.8 and 1.7% respectively. The intra- and inter-assay CV for serum E 2 concentration were 8.1 and 8.7% respectively. Statistical analysis The primary outcome measure was a clinical pregnancy. Continuous variables were not normally distributed and were given as median (interquartile range), unless indicated. Statistical comparison was carried out by Mann Whitney, χ 2 and Fisher s exact tests, where appropriate. Multiple logistic regression analysis and the receiver operator characteristic (ROC) curve analysis were applied to determine the best predictive variables (Altman and Bland, 1994). Statistical analysis was performed using the Statistical Program for Social Sciences (SPSS Inc., Version 12.0, Chicago, USA). The two-tailed value of P < 0.05 was considered statistically significant. Results During the study period, a total of 542 patients received ovarian stimulation for their first IVF cycle but only 525 patients proceeded to TUGOR because of cycle cancellation in 17 (3.1%, 17/542) patients who had poor ovarian response. Three patients declined to participate because of personal reasons and another three patients were excluded after scanning because of distortion of uterine cavity by uterine fibroids. No oocyte was obtained in one cycle, failed fertilization was encountered in another 20 cycles and in another 18 cycles embryos failed to cleave. Embryo transfer was postponed in 29 cycles because of the risk of OHSS. Therefore, embryo transfer was performed in 451 cycles and 94 clinical pregnancies resulted. The pregnancy rate was 20.8% per transfer. Uterine fibroids were encountered in 120 transfer cycles (26.6%, 120/451). All transfer cycles Table I summarizes the demographic data and ovarian responses of non-pregnant and pregnant patients. There were no significant differences in age of women, primary/secondary infertility, duration of infertility, cause of infertility, presence of fibroids, the insemination method, body mass index (BMI), basal serum FSH concentration, HMG dosage and duration, serum E 2 concentration, number of oocytes obtained and number of embryos replaced between the non-pregnant group and the pregnant group. Patients in the pregnant group had significantly lower uterine RI, endometrial VI and VFI than those in the non-pregnant group. Endometrial thickness, endometrial volume, endometrial pattern, uterine PI, endometrial FI and subendometrial VI, FI and VFI were similar between the nonpregnant and pregnant groups (Table II). Endometrial blood flow was absent in 31 patients and subendometrial blood flow was absent in 23 patients. Twenty patients had no endometrial and subendometrial blood flows. Implantation and pregnancy rates were higher in patients without endometrial and subendometrial blood flows than those with endometrial and subendometrial blood flows, although the difference did not reach statistical significance (Table III). When age of women, type of infertility, duration of infertility, BMI, number of oocytes obtained, serum E 2 concentration, number of embryos replaced, uterine PI, uterine RI, endometrial thickness, endometrial pattern, endometrial volume, 3D Table I. Comparison of demographic data and ovarian responses between non-pregnant and pregnant patients Data are given as median (interquartile range) unless otherwise specified. No differences between groups were statistically significant. 166 Non-pregnant (n = 357) Pregnant (n = 94) Age of women (years) 35.0 ( ) 35.0 ( ) Primary infertility [n (%)] 244 (68.3) 68 (72.3) Infertility duration (years) 4.0 ( ) 4.0 ( ) Causes of infertility [n (%)] Tubal 78 (21.8) 13 (13.8) Male 185 (51.8) 49 (52.1) Endometriosis 40 (11.2) 15 (6.0) Unexplained 32 (9.0) 11 (11.7) Mixed 22 (6.2) 6 (6.4) Insemination method [n (%)] Conventional 245 (68.6) 70 (74.5) ICSI 112 (31.4) 24 (25.5) Body mass index (kg/m 2 ) 21.3 ( ) 21.6 ( ) Basal FSH concentration (IU/l) 6.5 ( ) 6.3 ( ) HMG dosage (IU) 1950 ( ) 1950 ( ) HMG duration (days) 11.0 ( ) 11.0 ( ) Serum estradiol (pmol/l) 9737 ( ) 9032 ( ) No. of oocytes obtained 8.0 ( ) 9.0 ( ) No. of embryos transferred [n (%)] 1 38 (10.6) 4 (4.3) (86.0) 83 (88.3) 3 12 (3.4) 7 (7.4)
4 Endometrial and subendometrial blood flows in IVF Table II. Comparison of uterine pulsatility index (PI) and uterine resistance index (RI), endometrial and subendometrial three-dimensional power Doppler indices between non-pregnant and pregnant patients Data given as median (interquartile range) unless otherwise specified. VI = vascularization index; FI = flow index; VFI = vascularization flow index; NS = not significant. Non-pregnant (n = 357) Pregnant (n = 94) P Endometrial thickness (mm) 11.8 ( ) 11.6 ( ) NS Endometrial volume (cm 3 ) 4.93 ( ) 4.73 ( ) NS Endometrial pattern [n (%)] NS Multilayered 346 (96.9) 91 (96.8) Non-multilayered 11 (3.1) 3 (3.2) Uterine PI 2.03 ( ) 2.04 ( ) NS Uterine RI 0.84 ( ) 0.82 ( ) Endometrial VI (%) ( ) ( ) Endometrial FI (0 100) ( ) ( ) NS Endometrial VFI (0 100) ( ) ( ) Subendometrial VI (%) ( ) ( ) NS Subendometrial FI (0 100) ( ) ( ) NS Subendometrial VFI (0 100) ( ) ( ) NS Table III. Comparison of implantation and pregnancy rates in patients with and without endometrial and subendometrial blood flows Implantation rate Pregnancy rate Endometrial flow Absent 13/61 (21.3) 9/31 (29.0) Present 100/818 (12.2) 85/20 (20.2) P Subendometrial flow Absent 9/43 (20.9) 7/23 (30.4) Present 104/834 (12.5) 87/428 (20.3) P Endometrial and subendometrial flows Absent 8/39 (20.5) 6/20 (30.0) Present 105/840 (12.5) 88/431 (20.4) P Table IV. Receiver operator characteristics curve analysis of ultrasound parameters of endometrial receptivity Test variables Area (95% confidence interval) All cycles (n = 451) Good prognosis cycles (n = 205) Uterine PI (0.400, 0.535) (0.373, 0.583) Uterine RI (0.373, 0.509) (0.346, 0.556) Endometrial thickness (0.433, 0.571) (0.396, 0.616) Endometrial volume (0.418, 0.559) (0.400, 0.628) Endometrial VI (0.366, 0.494) (0.362, 0.565) Endometrial FI (0.418, 0.551) (0.347, 0.552) Endometrial VFI (0.368, 0.495) (0.358, 0.560) Subendometrial VI (0.401, 0.529) (0.369, 0.580) Subendometrial FI (0.448, 0.580) (0.351, 0.576) Subendometrial VFI (0.407, 0.537) (0.370, 0.584) PI = pulsatility index; RI = resistance index; VI = vascularization index; FI = flow index; VFI = vascularization flow index. power Doppler flow indices of endometrial and subendometrial regions were entered in a conditional forward fashion in multiple logistic regression analysis, only the number of embryos replaced and endometrial VI significantly improved the chance of pregnancy with odds ratios of 2.39 [95% confidence interval (CI): , P = 0.016] and 0.87 (95% CI: , P = 0.037) respectively. Other parameters were not predictive of pregnancy. The ROC curve analysis showed that only endometrial thickness and subendometrial FI had the area under the curve slightly >0.5 (Table IV). Transfer cycles with good prognosis A total of 166 patients were included in the good prognosis group defined as patients aged 35 years with endometrial 167
5 E.H.Y.Ng et al. thickness>8 mm, transfer of two or more good quality embryos and the availability of frozen embryo(s). There were no significant differences between the non-pregnant and pregnant groups in demographic data, ovarian responses and ultrasound parameters for endometrial receptivity including 3D power Doppler flow indices of endometrial and subendometrial regions (data not shown). In the multiple logistic regression analysis, none of the above parameters was predictive of pregnancy. The ROC curve analysis showed that the area under the curve was also <0.5 for the ultrasound parameters of endometrial receptivity (Table IV). Discussion This study evaluated the role of the endometrial and subendometrial blood flows measured by 3D power Doppler ultrasound in the prediction of pregnancy during IVF treatment. In order to avoid confounding variables, our patients were in their first IVF cycle and received a standard long protocol of pituitary down-regulation. Except those with distortion of uterine cavity, patients with uterine fibroids were recruited because we could not find an adverse effect of intramural fibroids on the pregnancy rate following IVF (Ng and Ho, 2002). Moreover, endometrial and subendometrial 3D power Doppler flow indices were similar in patients with and without small intramural fibroids (Ng et al., 2005). All patients in the present study were scanned early in the morning after an overnight fasting although there was lack of control for exogenous substances such as caffeine or antihistamine, which might have had an impact on blood flow measurements. The role of the endometrial and subendometrial blood flows was examined in all transfer cycles and those with good prognosis. In all transfer cycles, the pregnant group had significantly lower uterine RI, endometrial VI and VFI than the non-pregnant group whereas the number of embryos replaced and endometrial VI were the only two predictive factors for pregnancy. In the good prognosis group, none of the parameters were predictive of pregnancy. ROC curve analysis revealed that the area under the curve was 0.5 for all ultrasound parameters for endometrial receptivity in all transfer cycles and good prognosis cycles. The endometrial volume measured by 3D ultrasound has not been shown to be predictive of pregnancy (Raga et al., 1999; Yaman et al., 2000; Schild et al., 2001). Doppler flow measurements of spiral vessels were not performed in this study because of inconsistent waveforms obtained from colour Doppler signals of these tiny spiral vessels. Doppler flow indices of spiral arteries are not predictive of pregnancy (Zaidi et al., 1995; Yuval et al., 1999; Schild et al., 2001), although Battaglia et al. (1997) and Kupesic et al. (2001) found significantly lower spiral artery PI in pregnant cycles than non-pregnant ones. Blood flow in the endometrium and the subendometrial region can be objectively measured by the use of 3D ultrasound with power Doppler (Schild et al., 2000; Kupesic et al., 2001; Wu et al., 2003; Ng et al., 2004, 2005; Raine-Fenning et al., 2004a). In 75 IVF cycles, Schild et al. (2000) showed that all 3D subendometrial power Doppler flow indices performed on the first day of ovarian stimulation were significantly lower in pregnant cycles than non-pregnant ones. Logistic regression analysis 168 found that the subendometrial FI was the strongest predictive factor for the outcome among the tested sonographic parameters. Kupesic et al. (2001) found in 89 patients that subendometrial FI on the day of embryo transfer was significantly higher in pregnant cycles whereas subendometrial VI and VFI were similar between pregnant and non-pregnant patients. Wu et al. (2003) also demonstrated in 54 patients that subendometrial VFI on the day of hcg was significantly higher in the pregnant group and was superior to endometrial volume, subendometrial VI and FI in predicting the outcome. Areas under the ROC curve for VFI, VI, FI and endometrial volume were , , and respectively. The best predictive rate was achieved by a subendometrial VFI threshold value of >0.24. This is the largest study in the literature involving 451 transfer cycles, whereas a much smaller number of subjects was studied by Kupesic et al. (2001) and Wu et al. (2003). Our results were clearly contradictory to those of Kupesic et al. (2001) and Wu et al. (2003). These studies were different in patients characteristics, the day of ultrasound examination and the selection of the subendometrial region. In the present study, all patients were in the first IVF cycle and had two to three embryos replaced at the early cleavage stage 2 days after TUGOR following a standard protocol of ovarian stimulation. Kupesic et al. (2001) recruited patients undergoing repeated IVF attempts following a long protocol of pituitary down-regulation, who had serum basal FSH concentration <10 IU/l, no uterine fibroids, ovarian cysts or ovarian endometriomas. One or two good quality blastocysts were replaced 5 days after TUGOR. Wu et al. (2003) examined patients in their first IVF cycle who were aged <38 years with basal FSH concentration <15 IU/l and had two or more good quality embryos transferred. The details of ovarian stimulation and day of embryo transfer were not described in the study. Ultrasound examination was performed on the day of hcg (Wu et al., 2003), TUGOR (the present study) and embryo transfer (Kupesic et al., 2001). In the studies of Kupesic et al. (2001) and Wu et al. (2003), 3D power Doppler indices of the endometrial region were not given and the subendometrial region included 5 mm of the myometrial endometrial interface. We reported endometrial and subendometrial blood flow separately and the subendometrial region was defined as a shell within 1 mm of the myometrial endometrial interface. We chose 1 mm as the subendometrial region because the subendometrial region may extend beyond the uterine contour especially in the corneal region if 5 mm was taken. The fibroids, if present, would not also be included when 1 mm was used. Moreover, only the myometrium immediately underlying the endometrium exhibits a cyclic pattern of steroid receptor expression like that of the endometrium (Noe et al., 1999). There is no standard definition of subendometrial region in the literature, ranging from 5 mm (Schild et al., 2001; Wu et al., 2003) to 10 mm (Chien et al., 2002). Zaidi et al. (1995), Battaglia et al. (1997) and Maugey-Laulom et al. (2002) did not specify the subendometrial region. We are still uncertain whether these differences in patients characteristics, the day of ultrasound examination and the selection of the subendometrial region could explain the contradictory findings of these studies.
6 Endometrial and subendometrial blood flows in IVF Our findings also appeared to be in great contrast to the general belief that a good blood supply towards the endometrium is essential for successful implantation. Indeed, they are in keeping with studies that specifically examined perfusion within the human endometrium during the menstrual cycle. Fraser et al. (1987) determined endometrial blood flow through the menstrual cycle in non-pregnant women with the use of the clearance of radiolabelled 133 Xe following its instillation into the uterine cavity. There was a significant elevation in the middle to late follicular phase, followed by a substantial fall and a secondary slow luteal phase rise that was maintained until the onset of menstruation. More recently, Raine-Fenning et al. (2004a) showed that endometrial and subendometrial blood flows by 3D ultrasound increased during the proliferative phase, peaking around 3 days prior to ovulation before decreasing to a nadir 5 days post-ovulation. Therefore, there is a period of relatively reduced perfusion in the immediate postovulatory period, extending to the implantation period in spontaneous cycles. It is proposed that the degree of change in endometrial perfusion from the late follicular phase through to the early luteal phase is a more important determinant of endometrial receptivity (Raine-Fenning et al., 2004b). It would not be too surprising if there were a non-significant trend of higher implantation and pregnancy rates in our patients with absent endometrial or subendometrial blood flow. On the other hand, absent endometrial or subendometrial flow detected by colour or power Doppler in two-dimensional ultrasound is associated with no pregnancy (Zaidi et al., 1995; Battaglia et al., 1997) or much reduced pregnancy rate (Chien et al., 2002; Maugey-Laulom et al., 2002). Hypoxia in the endometrium may play a beneficial role for implantation, as the expression of vascular endothelial growth factor is up-regulated by hypoxia (Sharkey et al., 2000) and relatively low oxygen tension was present around the blastocyst during the time of implantation (Graham et al., 2000). There is still no consensus when the ultrasound examination for assessing endometrial receptivity in IVF treatment should be done. It may be much better to measure endometrial and subendometrial blood flow during the follicular phase and early luteal phase to determine the changes in order to delineate the role of endometrial and subendometrial blood flows. In conclusion, endometrial and subendometrial blood flows measured by 3D power Doppler ultrasound were not good predictors of pregnancy if they were measured at one time-point during IVF treatment. Further longitudinal studies in the late follicular phase and early luteal phase should be performed. Acknowledgements This study was funded by the Hong Kong Research Grant Council (HKU 7280/01M). References Abulafia O and Sherer DM (2000) Angiogenesis of the ovary. Am J Obstet Gynecol 182, Altman DG and Bland JM (1994) Diagnostic tests 3: receiver operating characteristic plots. Br Med J 309, Battaglia C, Artini PG, Giulini S, Salvatori M, Maxia N, Petraglia F and Volpe A (1997) Colour Doppler changes and thromboxane production after ovarian stimulation with gonadotrophin-releasing hormone agonist. Hum Reprod 12, Chien LW, Au HK, Chen PL, Xiao J and Tseng 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, Fraser IS, McCarron G, Hutton B and Macey D (1987) Endometrial blood flow measured by xenon 133 clearance in women with normal menstrual cycles and dysfunctional uterine bleeding. Am J Obstet Gynecol 156, Friedler S, Schenker JG, Herman A and Lewin A (1996) The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update 2, Gannon BJ, Carati CJ and Verco CJ (1977) Endometrial perfusion across the normal human menstrual cycle assessed by laser Doppler fluxmetry. Hum Reprod 12, Graham CH, Postovit LM, Park H, Canning MT and Fitzpatrick TE (2000) Adriana and Luisa Castellucci award lecture 1999: role of oxygen in the regulation of trophoblast gene expression and invasion. Placenta 21, Guerriero S, Ajossa S, Lai MP, Risalvato A, Paoletti AM and Melis GB (1999) Clinical applications of colour Doppler energy imaging in the female reproductive tract and pregnancy. Hum Reprod Update 5, Jinno M, Ozaki T, Iwashita M, Nakamura Y, Kudo A and Hirano H (2001) Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation. Fertil Steril 76, Kupesic S, Bekavac I, Bjelos D and Kurjak A (2001) Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med 20, Li TC, Okon MA, Dalton CF, Heatley M and Laird SM (1998) Is the measurement of placental protein-14 and CA-125 in plasma and uterine flushings useful in the evaluation of peri-menopausal and post-menopausal bleeding? Hum Reprod 13, Maugey-Laulon B, Commenges-Ducos M, Jullien V, Papaxanthos-Roche A, Scotet V and Commenges D (2002) Endometrial vascularity and ongoing pregnancy after IVF. Eur J Obstet Gynecol Reprod Biol 104, Ng EHY and Ho PC (2002) Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing in vitro fertilization treatment. Hum Reprod 17, Ng EHY, Yeung WSB, Lau EYL, So WWK and Ho PC (2000) High serum oestradiol levels in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent FET cycles. Hum Reprod, 15, Ng EHY, Chan CCW, Tang OS, Yeung WSB and Ho PC (2004) Endometrial and subendometrial blood flow measured during early luteal phase by threedimensional Power Doppler ultrasound in excessive ovarian responders. Hum Reprod 19, Ng EHY, Chan CCW, Tang OS, Yeung WSB and Ho PC (2005) Endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound in patients with small intramural fibroids during in vitro fertilization treatment. Hum Reprod 20, Noe M, Kunz G, Herbertz M, Mall G and Leyendecker G (1999) The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: characterization of the endometrial subendometrial unit. Hum Reprod 14, Noyes RW, Hertig AT and Rock J (1950) Dating the endometrial biopsy. Fertil Steril 1,3 25. Pairleitner H, Steiner H, Hasenoehrl G and Staudach A (1999) Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet Gynecol 4, Raga R, Bonilla-Musoles F, Casan EM, Klein O and Bonilla F (1999) Assessment of endometrial volume by three-dimensional ultrasound prior to embryo transfer: clues to endometrial receptivity. Hum Reprod 14, Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS and Johnson IR (2004a) Quantifying the changes in endometrial vascularity throughout the normal menstrual cycle with three-dimensional power Doppler angiography. Hum Reprod 19, Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS and Johnson IR (2004b) Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility. Hum Reprod 19, Schild RL, Holthanus S, Alquen JD, Fimmers R, Dorn C, van der Ven H and Hansmann M (2000) Quantitative assessment of subendometrial blood flow by three-dimensional-ultrasound is an important predictive factor of implantation in an in-vitro fertilization programme. Hum Reprod 15,
7 E.H.Y.Ng et al. Schild RL, Knoblock C, Dorn C, Fimmers R, van der Ven H and Hansmann M (2001) Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and uterine artery blood flow. Fertil Steril 75, Sharkey AM, Day K, McPherson A, Malik S, Licence D, Smith SK and Charnock- Jones DS (2000) Vascular endothelial growth factor expression in human endometrium is regulated by hypoxia. J Clin Endocrinol Metab 85, Sher G, Herbert C, Maassarani G and Jacobs MH (1991) Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET). Hum Reprod 6, Smith SK (2001) Regulation of angiogenesis in the endometrium. Trends Endocrinol Metab 12, Turnbull LW, Lesny P and Killick SR (1995) Assessment of uterine receptivity prior to embryo transfer: a review of currently available imaging modalities. Hum Reprod Update 1, Wu HM, Chiang CH, Huang HY, Chao AS, Wang HS and Soong YK (2003) Detection of the subendometrial vascularization flow index by threedimensional ultrasound may be useful for predicting the pregnancy rate for patients undergoing in vitro fertilization embryo transfer. Fertil Steril 79, Yaman C, Ebner T, Sommergruber M, Polz W and Tews G (2000) Role of three-dimensional ultrasonographic measurement of endometrium volume as a predictor of pregnancy outcome in an IVF ET program. A preliminary study. Fertil Steril 74, Yuval Y, Lipitz S, Dor J and Achiron R (1999) The relationship between endometrial thickness, and blood flow and pregnancy rates in in-vitro fertilization. Hum Reprod 14, Zaidi J, Campbell S, Pittrof FR and Tan SL (1995) Endometrial thickness morphology, vascular penetration and velocimetry in predicting implantation in an IVF program. Ultrasound Obstet Gynecol 6, Submitted on June 16, 2005; resubmitted on July 20, 2005; accepted on July 25,
Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
Human Reproduction Vol.21, No.6 pp. 1612 1617, 2006 Advance Access publication January 31, 2006. doi:10.1093/humrep/dei502 The role of endometrial and subendometrial vascularity measured by three-dimensional
More informationErnest Hung Yu Ng, M.D., Carina Chi Wai Chan, M.B.B.S., Oi Shan Tang, M.D., and Pak Chung Ho, M.D.
Comparison of endometrial and subendometrial blood flows among patients with and without hydrosalpinx shown on scanning during in vitro fertilization treatment Ernest Hung Yu Ng, M.D., Carina Chi Wai Chan,
More informationAri Kim, M.D., Ji Eun Han, M.D., Tae Ki Yoon, M.D., Sang Woo Lyu, M.D., Hyun Ha Seok, M.D., and Hyung Jae Won, M.D.
Relationship between endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound and pregnancy after intrauterine insemination Ari Kim, M.D., Ji Eun Han, M.D., Tae
More informationResearch Article. Manisha Choudhary 1 *, Jai Chowdhary 2, Mohan Lal Swarankar 1, Shiv Lal Bharadwaj 3
International Journal of Research in Medical Sciences Choudhary M et al. Int J Res Med Sci. 2015 Nov;3(11):3114-3118 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151146
More informationArticle Ovarian stromal vascularity is not predictive of ovarian response and pregnancy
RBMOnline - Vol 12. No 1. 2006 43-49 Reproductive BioMedicine Online; www.rbmonline.com/article/2032 on web 24 November 2005 Article Ovarian stromal vascularity is not predictive of ovarian response and
More informationASSESSMENT OF ENDOMETRIAL-SUBENDOMETRIAL BLOOD FLOW DETECTED BY COLOR DOPPLER SONOGRAPHY AND UTERINE RECEPTIVITY IN INFERTILE WOMEN
ORIGINAL REPORT ASSESSMENT OF ENDOMETRIAL-SUBENDOMETRIAL BLOOD FLOW DETECTED BY COLOR DOPPLER SONOGRAPHY AND UTERINE RECEPTIVITY IN INFERTILE WOMEN M. Aghahoseini *, K. Tuba, V. Marsousi and A. Aleyasin
More informationAssessment of Uterine Receptivity by the Subendometrial- Endometrial Blood Flow Distribution Pattern in Frozenthawed Embryo Transfer Cycles
Assessment of Uterine Receptivity by the Subendometrial-Endometrial 10.5005/jp-journals-10016-1099 Blood Flow Distribution Pattern original article Assessment of Uterine Receptivity by the Subendometrial-
More informationDSJUOG ABSTRACT INTRODUCTION /jp-journals
Firoozeh Ahmadi et al ORIGINAL ARTICLE 10.5005/jp-journals-10009-1491 A Two-year Cross-sectional Prospective Study for Assessment of Endometrial Thickness and Volume using Three-dimensional Transvaginal
More informationThree-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters
Human Reproduction Vol.22, No.12 pp. 3116 3123, 2007 Advance Access publication on October 18, 2007 doi:10.1093/humrep/dem218 Three-dimensional ultrasound features of the polycystic ovary and the effect
More informationOriginal Article. KEY WORDS: Doppler, endometrial thickness, in-vitro fertilization
Original Article Predictive value of endometrial thickness, pattern and sub-endometrial blood flows on the day of hcg by 2D Doppler in in-vitro fertilization cycles: A prospective clinical study from a
More informationEvaluation of cycle-to-cycle variation of endometrial. responsiveness using transvaginal sonography in women undergoing assisted reproduction
Ultrasound Obstet Gynecol 2002; 19: 484 489 Evaluation of cycle-to-cycle variation of endometrial Blackwell Science, Ltd responsiveness using transvaginal sonography in women undergoing assisted reproduction
More informationMenstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
Human Reproduction Vol.21, No.4 pp. 1012 1017, 2006 Advance Access publication December 8, 2005. doi:10.1093/humrep/dei415 Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
More informationThree-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age
FERTILITY AND STERILITY VOL. 79, NO. 1, JANUARY 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Three-dimensional
More informationObjective: To study the role of sildenafil on the echogenic pattern of endometrium in infertile patients with bad endometrium.
The effect of Sildenafil on endometrial characters in patients with infertility Ali F. Al-Assadi, F.I.C.O.G.,C.A.B.O.G.1. Sajeda A. Al-Rubaye, F.I.C.O.G.1 Zainab Laaiby, M.B.Ch.B.2 (1- Assist. Prof./Basra
More informationA Tale of Three Hormones: hcg, Progesterone and AMH
A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,
More informationMedicine. Wei Yang, MMed, Tao Zhang, MMed, Zhou Li, PhD, Xinling Ren, PhD, Bo Huang, PhD, Guijin Zhu, MMed, Lei Jin, PhD. Observational Study
Observational Study Medicine Combined analysis of endometrial thickness and pattern in predicting clinical outcomes of frozen embryo transfer cycles with morphological good-quality blastocyst A retrospective
More informationThe outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology
Human Reproduction vol.14 no.1 pp.167 171, 1999 The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology Lawrence Engmann 1,2,5, Noreen Maconochie
More informationTHREE-DIMENSIONAL ULTRASOUND MORPHOMETRIC ANALYSIS OF THE UTERINE JUNCTIONAL ZONE IN PATIENTS WITH UNEXPLAINED INFERTILITY
THREE-DIMENSIONAL ULTRASOUND MORPHOMETRIC ANALYSIS OF THE UTERINE JUNCTIONAL ZONE IN PATIENTS WITH UNEXPLAINED INFERTILITY Abdel-Elah Al-Farraj MD* ABSTRACT Objective: To use three-dimensional ultrasound
More informationEndometrial blood flow response to hormone replacement therapy in women with premature ovarian failure: a transvaginal Doppler study
. M.,nopause FERTILITY AND STERILITY Vol. 63, No.3, March 1995 Copyright 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. Endometrial blood flow response to hormone
More informationArticle Role of utero ovarian vascular impedance: predictor of ongoing pregnancy in an IVF embryo transfer programme
RBMOnline - Vol 9. No 3. 2004 299-305 Reproductive BioMedicine Online; www.rbmonline.com/article/1383 on web 12 July 2004 Article Role of utero ovarian vascular impedance: predictor of ongoing pregnancy
More informationInterpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used
Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara
More informationEHY Ng, WSB Yeung, PC Ho. Introduction
Comparison of two dosages of recombinant human follicle-stimulating hormone in Chinese women undergoing controlled ovarian stimulation: prospective randomised double-blind study EHY Ng, WSB Yeung, PC Ho
More informationORIGINAL ARTICLE ENDOMETRIAL THICKNESS AND PREGNANCY OUTCOME IN IUI CYCLES
ENDOMETRIAL THICKNESS AND PREGNANCY OUTCOME IN IUI CYCLES Asha Verma 1, Rekha Mulchandani 2, Nupur Lauria 3, Kusum Verma 4, Sunita Himani 5 HOW TO CITE THIS ARTICLE: Asha Verma, Rekha Mulchandani, Nupur
More informationNeil Goodman, MD, FACE
Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects
More informationSerial uterine artery Doppler velocity parameters and human uterine receptivity in IVF/ICSI cycles
Ultrasound Obstet Gynecol 2008; 31: 432 438 Published online 4 February 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5179 Serial uterine artery Doppler velocity parameters
More informationInfertility treatment
In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation
More informationOutlook Ultrasound and the receptivity of the endometrium
RBMOnline - Vol 15 No 1. 2007 63-67 Reproductive BioMedicine Online; www.rbmonline.com/article/2859 on web 16 May 2007 Outlook Ultrasound and the receptivity of the endometrium Stephen Killick has worked
More informationThe reproductive lifespan
The reproductive lifespan Reproductive potential Ovarian cycles Pregnancy Lactation Male Female Puberty Menopause Age Menstruation is an external indicator of ovarian events controlled by the hypothalamicpituitary
More informationFixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol
Yamanashi Med. J. 14(3), 77 ~ 82, 1999 Original Article Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol Tsuyoshi KASAI and Kazuhiko
More informationAssisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi
Assisted Reproduction By Dr. Afraa Mahjoob Al-Naddawi Learning Objectives: By the end of this lecture, you will be able to: 1) Define assisted reproductive techniques (ART). 2) List indications for various
More informationFemale Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF
Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve
More informationOvarian response in three consecutive in vitro fertilization cycles
FERTILITY AND STERILITY VOL. 77, NO. 4, APRIL 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Ovarian response in
More informationKisspeptin: A Potential Factor for Unexplained Infertility and Impaired Embryo Implantation
Original Article Kisspeptin: A Potential Factor for Unexplained Infertility and Impaired Embryo Implantation Aaida Mumtaz, MBBS. 1#, Aqsa Khalid, MBBS. 1#, Zehra Jamil, M.Phil. 2, Syeda Sadia Fatima, Ph.D.
More informationPOST - DOCTORAL FELLOWSHIP PROGRAMME IN REPRODUCTIVE MEDICINE. Anatomy : Male and Female genital tract
POST - DOCTORAL FELLOWSHIP PROGRAMME IN REPRODUCTIVE MEDICINE DURATION OF THE COURSE : TWO YEARS Detailed syllabus: Part 1 Basic Sciences: Anatomy : Male and Female genital tract Physiology Endocrinology
More informationRelation between the Number and Size of Follicles in Ovulation Induction and the Rate of Pregnancy
Relation between the Number and Size of Follicles in Ovulation Induction and the Rate of Pregnancy Aseel Mosa Jabber M.SC.G.O. The department of Obstetrics and Gynecology, Faculty of Medicine Thi-qar university
More informationThe effect of adding oral oestradiol to progesterone as luteal phase support in ART cycles a randomized controlled study
Clinical research The effect of adding oral oestradiol to progesterone as luteal phase support in ART cycles a randomized controlled study Ashraf Moini 1,2, Shahrzad Zadeh Modarress 3, Elham Amirchaghmaghi
More informationLOW RESPONDERS. Poor Ovarian Response, Por
LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients
More informationUnderstanding Infertility, Evaluations, and Treatment Options
Understanding Infertility, Evaluations, and Treatment Options Arlene J. Morales, M.D., F.A.C.O.G. Fertility Specialists Medical Group, Inc. What We Will Cover Introduction What is infertility? Briefly
More informationThe Presence of Hydrosalpinx May Not Adversely Affect the Implantation and Pregnancy Rates in In Vitro Fertilization Treatment1
CLINICAL ASSISTED REPRODUCTION The Presence of Hydrosalpinx May Not Adversely Affect the Implantation and Pregnancy Rates in In Vitro Fertilization Treatment1 ERNEST HUNG-YU NG,2,3 WILLIAM SHU-BIU YEUNG,2
More informationEmbryo Selection after IVF
Embryo Selection after IVF Embryo Selection after IVF Many of human embryos produced after in vitro fertilization carry abnormal chromosomes. Placing a chromosomally normal embryo (s) into a normal uterus
More informationUtility of color Doppler indices of dominant follicular
Ultrasound Obstet Gynecol 2002; 20: 592 596 Utility of color Doppler indices of dominant follicular Blackwell Science, Ltd blood flow for prediction of clinical factors in in vitro fertilization-embryo
More informationThe association between anti-müllerian hormone and IVF pregnancy outcomes is influenced by age
Reproductive BioMedicine Online (2010) 21, 757 761 www.sciencedirect.com www.rbmonline.com ARTICLE The association between anti-müllerian hormone and IVF pregnancy outcomes is influenced by age Jeff G
More informationArticle Prediction of pituitary down-regulation by evaluation of endometrial thickness in an IVF programme
RBMOnline - Vol 8. No 5. 2004 595-599 Reproductive BioMedicine Online; www.rbmonline.com/article/1065 on web 17 March 2004 Article Prediction of pituitary down-regulation by evaluation of endometrial thickness
More informationTimur Giirgan, M.D.* Bulent Urman, M.D. Hakan Yarali, M.D. Hakan E. Duran, M.D.
FERTILITY AND STEFULI~ Vol. 68, No. 3, September 1997 Copyright 1997 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Published by Elsevier Science Inc. Follicle-stimulating
More informationA Prospective Observational Study to Evaluate the Efficacy and Safety Profiles of Leuprorelin 3 Month Depot for the Treatment of Pelvic Endometriosis
SH SUEN & SCS CHAN A Prospective Observational Study to Evaluate the Efficacy and Safety Profiles of Leuprorelin 3 Month Depot for the Treatment of Pelvic Endometriosis Sik Hung SUEN MBChB, MRCOG Resident
More informationLUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi
LUTEAL PHASE SUPPORT Doç. Dr. Nafiye Yılmaz Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi TAJEV, 2014 1 ART & success *Live birth rate 2 Optimal luteal phase Etiology of luteal phase deficiency
More informationN.A.Bersinger 1, A.Brandenberger, E.Berger, C.K.Baumann and M.H.Birkhäuser
Human Reproduction vol.13 no.7 pp.1962 1967, 1998 Serum pregnancy-specific β 1 -glycoprotein before embryo transfer is related to endometrial thickness and to outcome prognosis in women undergoing in-vitro
More informationSample size a Main finding b Main limitations
1 Table 1. Available studies on the relation between endometriosis and miscarriage (1995-2015). Study (citation) Country Study period Study design Sample size a Main finding b Main limitations Matoras
More informationDoes previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?
J Assist Reprod Genet (26) 23:427 431 DOI 1.17/s1815-6-965-x ASSISTED REPRODUCTION Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,350 108,000 1.7 M Open access books available International authors and editors Downloads Our
More informationManaging infertility when adenomyosis and endometriosis co-exist
Managing infertility when adenomyosis and endometriosis co-exist Jinhua Leng Beijing,China Endometriosis Endometriosis (EM) is a common, benign, ovary hormone-dependent gynecologic disorder which affects
More informationHow to make the best use of the natural cycle for frozen-thawed embryo transfer?
How to make the best use of the natural cycle for frozen-thawed embryo transfer? Ariel Weissman, MD IVF Unit, Dep. Ob/Gyn Wolfson Medical Center, Holon Sackler Faculty of Medicine, Tel Aviv University
More informationOriginal Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and embryo transfer
Int J Clin Exp Med 2015;8(7):11327-11331 www.ijcem.com /ISSN:1940-5901/IJCEM0008838 Original Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and
More informationProspective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a new indicator of oocyte maturity
Prospective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a new indicator of oocyte maturity Adela Rodrıguez-Fuentes, M.D., a Jairo Hernandez, Ph.D.,
More informationAgonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M
Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Record Status This is a critical abstract of an economic
More information3-D Ultrasound and Dopplers in Reproductive Medicine
3-D Ultrasound and Dopplers in Reproductive Medicine Laurel Stadtmauer,M.D. PhD Professor, Department of OB/GYN EVMS Director of REI Division and REI Fellowship Jones institute Norfolk VA, U.S.A. Dr Howard
More informationPredictive factors of successful pregnancy after assisted reproductive technology in women aged 40 years and older
Reprod Med Biol (2009) 8:145 149 DOI 10.1007/s12522-009-0023-z ORIGINAL ARTICLE Predictive factors of successful pregnancy after assisted reproductive technology in women aged 40 years and older Akihisa
More informationIncreased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization embryo transfer
Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization embryo transfer Xingqi Zhang, Ph.D., a Chi-Huang Chen, M.D., b Edmond
More informationInformation Booklet. Exploring the causes of infertility and treatment options.
Information Booklet Exploring the causes of infertility and treatment options www.ptafertility.co.za info@ptafertility.co.za +27 12 998 8854 Faith is taking the first step even if you don t see the whole
More informationSonographic determination of a possible adverse effect of domiphene citrate on endometrial growth
Human Reproduction vol.5 no.6 pp.670-674, 1990 Sonographic determination of a possible adverse effect of domiphene citrate on endometrial growth Yael Gonen 1 and Robert F.Casper Division of Reproductive
More informationPhases of the Ovarian Cycle
OVARIAN CYCLE An ovary contains many follicles, and each one contains an immature egg called an oocyte. A female is born with as many as 2 million follicles, but the number is reduced to 300,000 to 400,000
More informationOutline. Male Reproductive System Testes and Sperm Hormonal Regulation
Outline Male Reproductive System Testes and Sperm Hormonal Regulation Female Reproductive System Genital Tract Hormonal Levels Uterine Cycle Fertilization and Pregnancy Control of Reproduction Infertility
More informationThe effect of endometrial thickness on IVF/ICSI outcome
Human Reproduction Vol.18, No.11 pp. 2337±2341, 2003 DOI: 10.1093/humrep/deg461 The effect of endometrial thickness on IVF/ICSI outcome P.Kovacs 1,3, Sz.Matyas 1, K.Boda 2 and S.G.Kaali 1 1 Kaali Institute
More informationThe diagnosis of endometriomas using colour Doppler energy imaging
Human Reproduction vol.13 no.6 pp.1691 1695, 1998 The diagnosis of endometriomas using colour Doppler energy imaging Stefano Guerriero, Silvia Ajossa, Valerio Mais, Andrea Risalvato, Maria Paola Lai and
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationEffect of pituitary down-regulation on the ovary before in vitro fertilization as measured using three-dimensional power Doppler ultrasound
FERTILITY AND STERILITY VOL. 79, NO. 5, MAY 2003 Copyright 2003 American Society for Reproductive Medicine ublished by Elsevier Inc. rinted on acid-free paper in U.S.A. Effect of pituitary down-regulation
More informationWhich is the Best Protocol of Ovarian Stimulation Prior to Artificial Insemination by Donor
Journal of Reproduction & Contraception doi: 10.7669j.issn.1001-7844.2014.01.0041 2014 Mar.; 25(1):41-48 E-mail: randc_journal@163.com Which is the Best Protocol of Ovarian Stimulation Prior to Artificial
More informationSupraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles
Human Reproduction Vol.17, No.1 pp. 83 87, 2002 Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles Joseph E.Peña, Peter L.Chang 1, Lai-King Chan, Khaled
More informationDoes triggering ovulation by 5000 IU of uhcg affect ICSI outcome? *
Middle East Fertility Society Journal Vol. 11, No. 2, 2006 Copyright Middle East Fertility Society Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? * Amany A.M. Shaltout, M.D. Mohamed
More informationIn Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome
Original Article Effect of Laparoscopic Ovarian Drilling on Outcomes of In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Maryam Eftekhar, M.D. 1, Razieh Deghani Firoozabadi,
More informationNICE fertility guidelines. Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic
NICE fertility guidelines Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic About the LWC 4 centres around the UK London Cardiff Swansea Darlington The largest sperm bank in
More informationINDICATIONS OF IVF/ICSI
PROCESS OF IVF/ICSI INDICATIONS OF IVF/ICSI IVF is most clearly indicated when infertility results from one or more causes having no other effective treatment; Tubal disease. In women with blocked fallopian
More informationin vitro fertilization
FERTILITY AND STERILITY VOL 69, NO. 6, JUNE 1998 Copyright (#1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Elevated levels of basal
More informationlbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour
lbt lab tests t and Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour Research Instituteof Avicenna 4/23/2012 Why good prediction of poor response good prediction i of OHSS application appropriate
More informationNitasha Garg 1 Harkiran Kaur Khaira. About the Author
https://doi.org/10.1007/s13224-017-1082-4 ORIGINAL ARTICLE A Comparative Study on Quantitative Assessment of Blood Flow and Vascularization in Polycystic Ovary Syndrome Patients and Normal Women Using
More informationOriginal Article. Fauzia HaqNawaz 1*, Saadia Virk 2, Tasleem Qadir 3, Saadia Imam 3, Javed Rizvi 2
Original Article Comparison of Letrozole and Clomiphene Citrate Efficacy along with Gonadotrophins in Controlled Ovarian Hyperstimulation for Intrauterine Insemination Cycles Fauzia HaqNawaz 1*, Saadia
More informationLuteal phase rescue after GnRHa triggering Progesterone and Estradiol
Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective
More informationFertility 101. About SCRC. A Primary Care Approach to Diagnosing and Treating Infertility. Definition of Infertility. Dr.
Dr. Shahin Ghadir A Primary Care Approach to Diagnosing and Treating Infertility St. Charles Bend Grand Rounds November 30, 2018 I have no conflicts of interest to disclose. + About SCRC State-of-the-art
More informationOne-Stop fertility assessment using advanced ultrasound technology
F, V & V IN OBGYN, 2011, 3 (1): 8-12 New perspective One-Stop fertility assessment using advanced ultrasound technology M. HREHORCAK, G. NARGUND The Centre for Reproduction and Advanced Technology (CREATE),
More informationIVF Protocols: Hyper & Hypo-Responders, Implantation
IVF Protocols: Hyper & Hypo-Responders, Implantation Midwest Reproductive Symposium June 4-5, 4 2010 Subset : Hyper-Responders Mark R. Bush, MD, FACOG, FACS OBJECTIVE: Important goals for the PCOS patient
More informationEndometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY
Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Natural Cycle FET Protocol for endometrial preparation N FET, including modified N FET HRT FET:
More informationChanges in measured endometrial thickness predict in vitro fertilization success
Changes in measured endometrial thickness predict in vitro fertilization success Grant D. E. McWilliams, D.O., a and John L. Frattarelli, M.D. b a Tripler Army Medical Center, Honolulu, Hawaii; and b Reproductive
More informationAdvanced Assisted Reproductive Technologies
Advanced Assisted Reproductive Technologies 體外受孕中心 IVF Centre IVF CENTRE at Hong Kong Sanatorium & Hospital The IVF Centre at Hong Kong Sanatorium & Hospital has been offering excellent patient care and
More informationFertility assessment and assisted conception
Fertility assessment and assisted conception Dr Geetha Venkat MD FRCOG Director Pulse Learning Women s health 14 September 2016 Disclosure statement Dr Venkat is a director of Harley Street Fertility Clinic.
More informationIndian Journal of Basic and Applied Medical Research; September 2015: Vol.-4, Issue- 4, P
Original article: To study post intrauterine insemination conception rate among infertile women with polyp and women with normal uterine endometrium cavity 1Dr. Archana Meena, 2 Dr. Renu Meena, 3 Dr. Kusum
More informationCY Tse, AMK Chow, SCS Chan. Introduction
Effects of an extended-interval dosing regimen of triptorelin depot on the hormonal profile of patients with endometriosis: prospective observational study CY Tse, AMK Chow, SCS Chan Objective. To evaluate
More informationThe effect of luteal phase progesterone supplementation on natural frozen-thawed embryo transfer cycles
Original Article Obstet Gynecol Sci 2014;57(4):291-296 http://dx.doi.org/10.5468/ogs.2014.57.4.291 pissn 2287-8572 eissn 2287-8580 The effect of luteal phase progesterone supplementation on natural frozen-thawed
More informationJinan Bekir, M.D. Amma Kyei-Mensah, M.D. Seang-Lin Tan, M.D.
FERTILITY AND STERILITY Copyright ~ 1995 American Society for Reproductive Mediciue Vol. 64, No.4, October 1995 Printed on acid-free paper in U. S. A. Administration of progestogens to hasten pituitary
More informationConsultations and Assessment Fertility Specialist consultation 180 Ultrasound scan of uterus and ovaries 100 AMH measurement 80 Semen analysis 100
We hope this price list will help you assess the cost of your consultations, investigations and treatment. It provides information about what is included in the cost and how we make a refund if your treatment
More informationThe relationship between ovarian vascularity and the duration of stimulation in in-vitro fertilization
Human Reproduction vol.12 no.6 pp.1240 1245, 1997 The relationship between ovarian vascularity and the duration of stimulation in in-vitro fertilization S.Bassil 1, C.Wyns, D.Toussaint-Demylle, M.Nisolle,
More informationCorrespondence: Tel: ; Fax: ;
RBMOnline - Vol 16. No 3. 2008 368-375 Reproductive BioMedicine Online; www.rbmonline.com/article/3055 on web 21 January 2008 Article Optimal timing of ultrasonographic and Doppler evaluation of uterine
More information2013 Sep.; 24(3):
Journal of Reproduction & Contraception doi: 10.7669/j.issn.1001-7844.2013.03.0151 2013 Sep.; 24(3):151-158 E-mail: randc_journal@163.com Reducing the Trigger Dose of Human Chorionic Gonadotrophin Does
More informationEndometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH antagonist administration
Wu et al. Reproductive Biology and Endocrinology 2014, 12:96 RESEARCH Open Access Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH
More informationI. ART PROCEDURES. A. In Vitro Fertilization (IVF)
DFW Fertility Associates ASSISTED REPRODUCTIVE TECHNOLOGY (ART) Welcome to DFW Fertility Associates/ Presbyterian-Harris Methodist Hospital ARTS program. This document provides an overview of treatment
More informationClinical Study Clinical Effects of a Natural Extract of Urinary Human Menopausal Gonadotrophin in Normogonadotropic Infertile Patients
International Reproductive Medicine Volume 2013, Article ID 135258, 4 pages http://dx.doi.org/10.1155/2013/135258 Clinical Study Clinical Effects of a Natural Extract of Urinary Human Menopausal Gonadotrophin
More informationInfertility F REQUENTLY A SKED Q UESTIONS. Q: Is infertility a common problem?
Infertility (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.
More informationIVF (,, ) : (HP-hMG) - (IVF- ET) : GnRH, HP-hMG (HP-hMG )57, (rfsh )140, (Gn)
34 11 Vol.34 No.11 2014 11 Nov. 2014 Reproduction & Contraception doi: 10.7669/j.issn.0253-3X.2014.11.0892 E-mail: randc_journal@163.com IVF ( 710003) : (H-hMG) - (IVF- ET) : GnRH H-hMG (H-hMG ) (rfsh
More informationStudy on Several Factors Involved in IVF-ET of Human Beings
Study on Several Factors Involved in IVF-ET of Human Beings Lei X 1, Zhuoran W 1, Bin L 1, Huiming L 1, Hongxiu Z 1, Yajuan Z 1, Yingbo Q 1, Guixue Z 2 1 The First Clinical College of Harbin Medical University,
More information