Ernest Hung Yu Ng, M.D., Carina Chi Wai Chan, M.B.B.S., Oi Shan Tang, M.D., and Pak Chung Ho, M.D.

Size: px
Start display at page:

Download "Ernest Hung Yu Ng, M.D., Carina Chi Wai Chan, M.B.B.S., Oi Shan Tang, M.D., and Pak Chung Ho, M.D."

Transcription

1 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, M.B.B.S., Oi Shan Tang, M.D., and Pak Chung Ho, M.D. Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People s Republic of China Objective: To compare endometrial and subendometrial blood flows among patients with and without hydrosalpinx (HSP) during in vitro fertilization treatment as measured by a three-dimensional power Doppler ultrasound. Design: A prospective observational study. Setting: A tertiary assisted-reproduction unit. Patient(s): Twenty-one patients with HSP were compared with 42 matched controls without HSP. Intervention(s): None. Main Outcome Measure(s): Endometrial thickness, endometrial pattern, endometrial volume, pulsatility index (PI) and resistance index (RI) of uterine vessels, and the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrial and subendometrial regions were measured on the day of oocyte retrieval. Result(s): The proportion of the non-multilayered endometrial pattern was significantly higher in the HSP group than in the non-hsp group. Patients in the HSP group had significantly lower endometrial and subendometrial VI and VFI. Endometrial thickness, endometrial volume, uterine PI, uterine RI, and endometrial and subendometrial FI were similar between the two groups. No significant differences were observed in endometrial and subendometrial VI, FI, and VFI among patients with unilateral and bilateral HSP. Conclusion(s): A change in endometrial pattern and a decrease in endometrial and subendometrial blood flows may be the reasons for impaired implantation in patients with HSP. (Fertil Steril 2006;85: by American Society for Reproductive Medicine.) Key Words: Endometrial and subendometrial blood flow, hydrosalpinx, three-dimensional power Doppler About 30% of infertile women seeking IVF treatment have hydrosalpinx (HSP) (1 3). Two metaanalyses (4, 5) clearly demonstrate that the presence of HSP is detrimental to the outcome of IVF treatment. Although the exact mechanisms are not fully known, there are several possibilities suggested for the implantation failure associated with HSP (6). Hydrosalpinx fluid (HF) within the uterine cavity may act as a mechanical barrier to implantation because the replaced embryos will be flushed out or because the normal apposition of the endometrial cells is disrupted (7). Hydrosalpinx fluid may contain microorganisms, debris, toxins, cytokines, or prostaglandins that can exert a direct adverse effect on the developing embryos (8, 9) or the endometrium (10). Angiogenesis plays a critical role in various female reproductive processes such as the development of a dominant follicle, formation of a corpus lutuem, growth of Received March 31, 2005; revised and accepted May 31, Supported by the Hong Kong Research Grant Council (HKU 7280/01M). Reprint requests: Ernest Hung Yu Ng, Department of Obstetrics and Gynaecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong (FAX: ; nghye@hkucc.hku.hk). endometrium, and implantation (11, 12). A good blood supply toward the endometrium is usually considered to be an essential requirement for normal implantation. Endometrial microvascular blood flow in the early luteal phase of the cycle preceding an IVF cycle, as determined by an intrauterine laser Doppler technique, has been shown to be predictive of pregnancy and to be superior to other conventional parameters predicting endometrial receptivity (13). Endometrial blood flow can be evaluated noninvasively by color and power Doppler ultrasound. Power Doppler imaging is more sensitive than color Doppler imaging at detecting low-velocity flow, hence improving the visualization of small vessels (14). In combination with a three-dimensional (3-D) ultrasound, power Doppler provides a unique tool with which to examine the blood supply in the whole endometrial and subendometrial regions (15 20). The hypothesis stated that endometrial and subendometrial blood flows were significantly different among patients with and without HSP. The aim of this study was to compare endometrial and subendometrial blood flows among patients with and without HSP during IVF treatment as measured by a 3-D power Doppler ultrasound /06/$32.00 Fertility and Sterility Vol. 85, No. 2, February 2006 doi: /j.fertnstert Copyright 2006 American Society for Reproductive Medicine, Published by Elsevier Inc. 333

2 MATERIALS AND METHODS Infertile patients undergoing IVF treatment in the Assisted Reproduction Unit of the Department of Obstetrics and Gynecology at the University of Hong Kong between January 2003 and December 2004 were recruited if they had unilateral or bilateral HSP as shown during scanning on the day of hcg administration. During the infertility workup, tubal patency was checked by either a diagnostic laparoscopy or a hysterosalpingogram. The presence of HSP was confirmed if [1] on laparoscopy, the fimbrial end of the tube was occluded with abnormal distension of the ampullary portion of the tube or [2] on hysterosalpingography, there was filling and distension of the ampullary region but no spillage of dye into the peritoneal cavity through the tube on that side. Two adjacent patients to the recruited subject in IVF treatment served as controls who had no HSP during infertility workup or during scanning on the day of hcg administration. They were matched with the study s subjects with respect to age ( 2 years), type of infertility (primary or secondary), cause of infertility (tubal factors), and serum E 2 concentrations ( 2,000 pmol/l). Patients with distorted uterine cavities as detected on scanning were excluded. Every patient gave her written informed consent before participating in the study, which was approved by the Ethics Committee, Faculty of Medicine, the University of Hong Kong. Patients were evaluated only once during the study period and did not receive any monetary compensation for their participation in the study. Patients had serum basal FSH concentrations checked on day 2 3 of a spontaneous cycle within 2 to 3 months of commencing treatment. All received a long protocol of pituitary down-regulation as described elsewhere (21). In short, they were pretreated with Buserelin (Suprecur, Hoechst, Frankfurt, Germany) nasal spray (150 g, four times a day) from the midluteal phase of the cycle preceding the treatment cycle and received hmg (Pergonal; Serono, Geneva, Switzerland) for ovarian stimulation. Human chorionic gonadotropin (Profasi; Serono) was given IM when the leading follicle reached 18 mm in diameter and there were at least three follicles of 16mm in diameter. Serum E 2 concentration was measured on the day of hcg administration. Serum E 2 concentrations were measured by using commercially available kits (Automated Chemiluminescence System, Bay Corporation, Tarrytown, NY). The intra-assay and interassay coefficients of variation were 8.1% and 8.7%, respectively. Transvaginal ultrasound guided oocyte retrieval was scheduled 36 hours after the hcg injection. A maximum of three normally cleaving embryos were replaced into the uterine cavity 48 hours after transvaginal ultrasound guided oocyte retrieval. Excess good-quality embryos were frozen for subsequent transfer. All ultrasound measurements were performed by one of the authors (E.H.Y.N.) on the day of transvaginal ultrasound guided oocyte retrieval and before the procedure using with a Voluson 730 (Kretz, Zipf, Austria) at approximately 8 to 10 AM, after each patient had emptied her bladder. The results of this ultrasound examination 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 (22). 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. By using color Doppler in the two-dimensional mode, flow velocity waveforms were obtained from the ascending main branch of the uterine artery on the right and left sides of the cervix in a longitudinal plane, before they entered the uterus. The gate of the Doppler was considered positioned when the vessel with good color signals was identified on the screen. Pulsatility index and RI of the uterine arteries were calculated electronically when similar consecutive waveforms of good quality were obtained (23). Because 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 3-D mode with power Doppler. The details of 3-D ultrasound and data analysis were as described elsewhere (19, 20). 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; and 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, low1; and 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 3-D transvaginal probe remained as still as possible during the volume acquisition. A 3-D data set then was acquired by using the medium speed sweep mode. The resulting multiplanar 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 artifact, the data set was stored for later analysis by one of the authors (E.H.Y.N.). The built-in VOCAL (virtual organ computer-aided analysis) imaging program for the 3-D power Doppler histogram 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 color voxels to the number of all the voxels, is thought to represent the presence of blood vessels (vascularity) in the endometrium, and this was 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), arrived at by multiplying VI and FI, is a 334 Ng et al. Endometrial blood flow in hydrosalpinx Vol. 85, No. 2, February 2006

3 combination of vascularity and flow intensity (24). During analysis and calculation, the manual mode of the VOCAL Contour Editor was used to cover the whole 3-D volume of the endometrium with a 15 rotation step. Hence, 12 contour planes were analyzed for the endometrium of each patient, to cover 180. After 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 (19). The VI, FI, and VFI of the subendometrial region were obtained accordingly. The intraobserver reliability was expressed as the mean intraclass correlation coefficient (ICC), with 95% confidence interval (CI). The mean ICC was (95% CI: 0.920, 0.989) for endometrial thickness, (95% CI: 0.912, 0.992) for PI, and (95% CI: 0.838, 0.985) for RI. The mean ICCs for 3-D scanning of endometrial volume, VI, FI, and VFI were (95% CI: , ), (95% CI: , ), (95% CI: , ), and (95% CI: , ), respectively. The mean ICCs for data acquisition of endometrial volume, VI, FI, and VFI were (95% CI: , ), (95% CI: , ), (95% CI: , ), and (95% CI: , ), respectively. Statistical Analysis The primary outcome measures were VI, FI, and VFI of endometrial and subendometrial regions. Continuous variables were given as mean SD for normally distributed data or as median (range) for skewed data. Statistical comparison was performed by using Student s t, Mann-Whitney, 2, and Fisher s exact tests, whenever these were appropriate. Statistical analysis was performed by using the Statistical Program for Social Sciences (version 12.0; SPSS Inc., Chicago, IL). The two-tailed value of P.05 was considered statistically significant. RESULTS Sixty-three patients were recruited: 21 in the HSP group and 42 in the non-hsp group. Unilateral and bilateral HSP was found in 14 and 7 patients, respectively. Fluid in the uterine cavity was not detected in all patients in the HSP group. Table 1 summarizes the demographic data and ovarian responses. There were no differences in the age of women, percentage of primary infertility and smokers, cause of infertility, duration of infertility, body mass index, basal serum FSH concentration, hmg dosage and duration, serum E 2 concentration, number of eggs obtained, and pregnancy rate between the two groups. The proportion of the non-multilayered endometrial pattern was significantly higher in the HSP group than in the non-hsp group. Patients in the HSP group had significantly lower endometrial and subendometrial VI and VFI (Table 2). Endometrial thickness, endometrial volume, uterine PI, uterine RI, and endometrial and subendometrial FI were similar between the two groups. No significant differences were observed in endometrial and subendometrial VI, FI, and VFI among patients with unilateral and bilateral HSP (Fig. 1). TABLE 1 Comparison of demographic data, ovarian responses, and pregnancy rate between patients with and without hydrosalpinx. Hydrosalpinx group (n 21) Non-hydrosalpinx group (n 42) Age of women (y) Primary infertility a 11 (52.4%) 22 (52.4%) Smokers a 5 (23.8%) 5 (11.9%) Infertility duration (y) Body mass index (Kg/m 2 ) Basal FSH level (IU/L) HMG dosage (IU) HMG duration (days) Serum estradiol b (pmol/l) No. of eggs obtained Pregnancy rate Per cycle started 2/21 (9.5%) 10/42 (23.8%) Per transfer 2/20 (10.0%) 10/40 (25.0%) Note: Data given as mean standard deviation. a Number of patients (%). b On the day of HCG. Ng. Endometrial blood flow in hydrosalpinx. Fertil Steril Fertility and Sterility 335

4 TABLE 2 Comparison of uterine PI and RI and endometrial and subendometrial three-dimensional power Doppler indices between patients with and without hydrosalpinx. Hydrosalpinx group (n 21) Non-hydrosalpinx group (n 42) Endometrial thickness (mm) Endometrial volume (cm 3 ) Endometrial pattern a Multilayered c Non-multilayered 3 0 c Averaged uterine PI Averaged uterine RI Endometrial VI b (%) ( ) d ( ) Endometrial FI b (0 100) ( ) ( ) Endometrial VFI b (0 100) ( ) e ( ) Subendometrial VI b (%) ( ) c ( ) Subendometrial FI b (0 100) ( ) ( ) Subendometrial VFI b (0 100) ( ) c ( ) Note: Data as mean standard deviation. a Data given in number. b Data given in median (range). c P.03. d P.01. e P.04. Ng. Endometrial blood flow in hydrosalpinx. Fertil Steril DISCUSSION One of the proposed mechanisms leading to impaired implantation in patients with HSP is that the endometrium is also damaged when the tubes are acutely inflamed and damaged. This may result in a persistent negative effect on implantation in the endometrium. Endometrial biopsies obtained from asymptomatic women at risk for chlamydial infection showed evidence of chronic endometritis and were positive for chlamydia trachomatis (25). Sharara et al. (26) suggested that chronic endometritis caused by chlamydia or the effect of protein expression might directly affect endometrial receptivity. Meyer et al. (10) demonstrated that integrins associated with the window of implantation v 3 are found to be decreased in women with HSP as compared with in controls. These women s endometria were described as out of phase because of the presence of gland or stromal dyssynchrony. However, 70% (14/20) of these women showed increased integrin expression after surgical correction of their HSP. Bildirici et al. (27) also reported that surgical removal of communicating HSP increased the expression of v 3 and may, therefore, improve endometrial receptivity. To the best of our knowledge, this is the first study examining endometrial and subendometrial blood flows in patients with HSP as shown on scanning during IVF treatment. To avoid the possible impact of other clinical factors on endometrial and subendometrial blood flows, patients with HSP and controls without HSP were matched with respect to their age, type of infertility, cause of infertility, and serum E 2 on the day of hcg. Fluid accumulation in the uterine cavity was not observed in all patients with HSP, although fluid in the uterine cavity caused by back-passage of fluid can occasionally be observed in patients with HSP (28, 29). Only patients with HSP that was detected on scanning during IVF treatment were recruited in this study. This is because a randomized multicenter study in Scandinavia showed a statistically significant benefit of salpingectomy for HSP before IVF only in a subset of women who had HSP that was large enough to be visible by ultrasound (30, 31). There was lack of control for exogenous substances such as caffeine or antihistamine, which might have had an impact on blood flow measurements. We demonstrated that patients with HSP had significantly lower endometrial and subendometrial VI and VFI than those without HSP but that endometrial and subendometrial FI was comparable for the two groups. It appears logical to infer that only the vascularity of the endometrial and endometrial regions is adversely affected in patients with HSP. The pregnancy rate of the HSP group also was lower than that of the non-hsp group despite the similar number of embryos replaced in both groups. Such difference did not reach statistical significance, probably because of the small sample size of this study. Reduced pregnancy rate in the HSP group may be related to a higher proportion of non-multilayer endometrial pattern and lower endometrial and subendometrial blood flows. A multilayered endometrial pattern was associated more frequently with conception cycles (32). A 336 Ng et al. Endometrial blood flow in hydrosalpinx Vol. 85, No. 2, February 2006

5 FIGURE 1 Boxplot of endometrial and subendometrial VI, FI, and VFI in patients with unilateral (n 14) and bilateral (n 7) hydrosalpinx. Ng. Endometrial blood flow in hydrosalpinx. Fertil Steril higher endometrial FI on the day of ET was shown in pregnancy cycles (16). Subendometrial VFI on the day of hcg was superior to endometrial volume and subendometrial VI and FI in predicting the IVF outcome (17). The changes in endometrial pattern and the decrease in endometrial and subendometrial blood flows in patients with HSP may be related to the presence of chronic endometritis in these patients. The effect of the size of HSP on endometrial and subendoendometral blood flows could not be examined because the HSP size was not documented in this study. There was no significant difference in endometrial and subendometrial 3-D power Doppler flow indices among patients with unilateral and bilateral HSP. However, the sample size (n 21) of this study is too small to draw a firm conclusion, and a much larger sample size would be required to detect a small difference in endometrial Fertility and Sterility 337

6 and subendometrial blood flows. The recruitment of suitable subjects is getting more difficult, because patients who are found to have HSP during the infertility workup would be counseled to undergo laparoscopic salpingotomy to increase the chance of spontaneous conceptions or to undergo laparoscopic salpingectomy to improve IVF success. It would be interesting to examine any increase in endometrial and subendometrial blood flows in patients with HSP after the surgical removal of HSP. In conclusion, patients with HSP had a significantly higher proportion of the non-multilayered endometrial pattern and significantly lower endometrial and subendometrial blood flows measured on the day of oocyte retrieval, when compared with those without HSP. Change in endometrial pattern and decrease in endometrial and subendometrial blood flows may be the reasons for impaired implantation in patients with HSP. REFERENCES 1. Strandell A, Waldenstrom U, Nilsson L, Hamberger L. Hydrosalpinx reduces in-vitro fertilization/embryo transfer pregnancy rates. Hum Reprod 1994;9: Blazar AS, Hogan JW, Seifer DB, Frishman GN, Wheeler CA, Haning RV. The impact of hydrosalpinx on successful pregnancy in tubal factor infertility treated by in vitro fertilization. Fertil Steril 1997;67: Ng EHY, Yeung WSB, Ho PC. The presence of hydrosalpinx may not adversely affect the implantation and pregnancy rates in in vitro fertilization treatment. J Assist Reprod Genet 1997;14: Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization embryo transfer. Fertil Steril 1998;70: Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod 1999;14: Ajonuma LC, Ng EHY, Chan HC. New insights into the mechanisms underlying hydrosalpinx fluid formation and its adverse effects on IVF outcome. Hum Reprod Update 2002;8: Edwards RG. Why are agonadal and post-amenorrhoeic women so fertile after oocyte donation? Hum Reprod 1992;7: Sachdev R, Kemmann E, Bohrer MK, el-danasouri I. Detrimental effect of hydrosalpinx fluid on the development and blastulation of mouse embryos in vitro. Fertil Steril 1997;68: Koong MK, Jun JH, Song SJ, Lee HJ, Song IO, Kang IS. A second look at the embryotoxicity of hydrosalpingeal fluid: an in-vitro assessment in a murine model. Hum Reprod 1998;13: Meyer WR, Castelbaum AJ, Somkuti S, Sagoskin AW, Doyle M, Harris JE, et al. Hydrosalpinges adversely affects markers of endometrial receptivity. Hum Reprod 1997;12: Abulafia O, Sherer DM. Angiogenesis of the ovary. Am J Obstet Gynecol 2000;182: Smith SK. Regulation of angiogenesis in the endometrium. Trends Endocrinol Metab 2001;12: Jinno M, Ozaki T, Iwashita M, Nakamura Y, Kudo A, Hirano H. Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation. Fertil Steril 2001;76: Guerriero S, Ajossa S, Lai MP, Risalvato A, Paoletti AM, Melis GB. Clinical applications of color Doppler energy imaging in the female reproductive tract and pregnancy. Hum Reprod Update 1999;5: Schild RL, Holthanus S, Alquen J, Fimmers R, Dorn C, van Der Ven H, et al. 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 2000;15: Kupesic S, Bekavac I, Bjelos D, Kurjak A. Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med 2001;20: Wu HM, Chiang CH, Huang HY, Chao AS, Wang HS, Soong YK. 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 2003;79: Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS, Johnson IR. Quantifying the changes in endometrial vascularity throughout the normal menstrual cycle with three-dimensional power Doppler angiography. Hum Reprod 2004;19: Ng EHY, Chan CCW, Tang OS, Yeung WSB, Ho PC. Endometrial and subendometrial blood flow measured during early luteal phase by three-dimensional power Doppler ultrasound in excessive ovarian responders. Hum Reprod 2004;19: Ng EHY, Chan CCW, Tang OS, Yeung WSB, Ho PC. 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 2005;20: Ng EHY, Yeung WSB, Lau EYL, So WWK, Ho PC. High serum oestradiol levels in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent FET cycles. Hum Reprod 2000;15: Sher G, Herbert C, Maassarani G, Jacobs MH. Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET). Hum Reprod 1991;6: Ng EHY, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing in vitro fertilization treatment. Hum Reprod 2002;17: Pairleitner H, Steiner H, Hasenoehrl G, Staudach A. Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet Gynecol 1999;14: Jones RB, Mammel JB, Shepard MK. Recovery of Chlamydia trachomatis from the endometrium of women at risk for chlamydial infection. Am J Obstet Gynecol 1986;155: Sharara FI, Scott RT Jr, Marut EL, Queenan JT Jr. In-vitro fertilization outcome in women with hydrosalpinx. Hum Reprod 1996;11: Bildirici I, Bukulmez O, Ensari A, Yarali H, Gurgan T. A prospective evaluation of the effect of salpingectomy on endometrial receptivity in cases of women with communicating hydrosalpinges. Hum Reprod 2001;16: Mansour R, Aboulghar M, Serour G, Riad R. Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance for implantation. J In Vitro Fert Embryo Transfer 1991;8: Andersen AN, Yue Z, Meng FJ, Petersen K. Low implantation rate after in vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography. Hum Reprod 1994;9: Strandell A, Lindhard A, Waldenstrom U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicenter trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod 1999;14: Strandell A, Lindhard A, Waldenstrom U, Thorburn J. Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial. Hum Reprod 2001;16: Friedler S, Schenker JG, Herman A, Lewin A. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update 1996;2: Ng et al. Endometrial blood flow in hydrosalpinx Vol. 85, No. 2, February 2006

The Presence of Hydrosalpinx May Not Adversely Affect the Implantation and Pregnancy Rates in In Vitro Fertilization Treatment1

The 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 information

Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.

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 information

Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People s Republic of China

Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People s Republic of China Human Reproduction Vol.21, No.1 pp. 164 170, 2006 Advance Access publication August 25, 2005. doi:10.1093/humrep/dei277 The role of endometrial and subendometrial blood flows measured by three-dimensional

More information

Article Ovarian stromal vascularity is not predictive of ovarian response and pregnancy

Article 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 information

Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization embryo transfer

Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization embryo transfer FERTILITY AND STERILITY VOL. 70, NO. 3, SEPTEMBER 1998 Copyright 1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Adverse effects

More information

Ari 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.

Ari 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 information

ASSESSMENT OF ENDOMETRIAL-SUBENDOMETRIAL BLOOD FLOW DETECTED BY COLOR DOPPLER SONOGRAPHY AND UTERINE RECEPTIVITY IN INFERTILE WOMEN

ASSESSMENT 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 information

- (IVF-ET), IVF : ; ; IVF ; : ; - (IVF-ET); ; ; : R711.6 : A : X(2014)

- (IVF-ET), IVF : ; ; IVF ; : ; - (IVF-ET); ; ; : R711.6 : A : X(2014) 34 7 Vol.34 No.7 2014 7 Jul. 2014 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2014.07.0584 E-mail: randc_journal@163.com ( 430060) - (-ET) : Essure : - (-ET) : R711.6 : A : 0253-357X(2014)07-0584-06

More information

Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF

Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF Human Reproduction Vol.17, No.2 pp. 351 356, 2002 Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF Li-Wei Chien, Heng-Kien Au, Jean Xiao and Chii-Ruey Tzeng

More information

Evaluation of cycle-to-cycle variation of endometrial. responsiveness using transvaginal sonography in women undergoing assisted reproduction

Evaluation 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 information

THE POSSIBLE EFFECT OF HYDROSALPINX FLUID HUMAN EMBRYOS

THE POSSIBLE EFFECT OF HYDROSALPINX FLUID HUMAN EMBRYOS Prof D. Loutradis 1 st Obstetrics and Gynecology Department of University of Athens Alexandra Maternity Hospital THE POSSIBLE EFFECT OF HYDROSALPINX FLUID HUMAN EMBRYOS Tubal factor Infertility IVF was

More information

Usama M Fouda *, Ahmed M Sayed, Hatem I Abdelmoty and Khaled A Elsetohy

Usama M Fouda *, Ahmed M Sayed, Hatem I Abdelmoty and Khaled A Elsetohy Fouda et al. BMC Women's Health (2015) 15:21 DOI 10.1186/s12905-015-0177-2 RESEARCH ARTICLE Open Access Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients

More information

Expression of alpha 1 and beta 3 integrins subunits in the endometrium of patients with tubal phimosis or hydrosalpinx

Expression of alpha 1 and beta 3 integrins subunits in the endometrium of patients with tubal phimosis or hydrosalpinx REPRODUCTIVE BIOLOGY Expression of alpha 1 and beta 3 integrins subunits in the endometrium of patients with tubal phimosis or hydrosalpinx Ricardo Francalacci Savaris, Ph.D., a José Luiz Pedrini, M.Sc.,

More information

An Overview of Uterine Factors That Influence Implantation

An Overview of Uterine Factors That Influence Implantation An Overview of Uterine Factors That Influence Implantation Bulent Urman, M.D. Dept. of Obstetrics and Gynecology Koc University School of Medicine Assisted Reproduction Unit, American Hospital, ISTANBUL

More information

DSJUOG ABSTRACT INTRODUCTION /jp-journals

DSJUOG 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 information

Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters

Three-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 information

Research Article. Manisha Choudhary 1 *, Jai Chowdhary 2, Mohan Lal Swarankar 1, Shiv Lal Bharadwaj 3

Research 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 information

Prospective 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 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 information

One-Stop fertility assessment using advanced ultrasound technology

One-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 information

Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx

Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx Antonios Kontoravdis, M.D., a Evangelos Makrakis, M.D., a Konstantinos

More information

Cost effectiveness analysis of salpingectomy prior to IVF, based on a randomized controlled trial

Cost effectiveness analysis of salpingectomy prior to IVF, based on a randomized controlled trial Human Reproduction Vol.20, No.12 pp. 3284 3292, 2005 Advance Access publication August 11, 2005. doi:10.1093/humrep/dei244 Cost effectiveness analysis of salpingectomy prior to IVF, based on a randomized

More information

Neil Goodman, MD, FACE

Neil 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 information

Utility of color Doppler indices of dominant follicular

Utility 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 information

Original Article. KEY WORDS: Doppler, endometrial thickness, in-vitro fertilization

Original 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 information

Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx

Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx Gaurang S. Daftary, M.D., Umit Kayisli, Ph.D., Emre Seli, M.D., Orhan Bukulmez, M.D., Aydin Arici, M.D.,

More information

Adverse effects of hydrosalpinx fluid on sperm motility and survival

Adverse effects of hydrosalpinx fluid on sperm motility and survival Human Reproduction vol.15 no.4 pp.772 777, 2000 Adverse effects of hydrosalpinx fluid on sperm motility and survival Ernest Hung Yu Ng 1, Louis C.Ajonuma, Estella Yee to demonstrate any adverse effect.

More information

in vitro fertilization

in 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 information

Effect of pituitary down-regulation on the ovary before in vitro fertilization as measured using three-dimensional power Doppler ultrasound

Effect 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 information

Ovarian response in three consecutive in vitro fertilization cycles

Ovarian 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 information

Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age

Three-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 information

Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial*

Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial* Human Reproduction Vol.16, No.11 pp. 2403 2410, 2001 Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial* A.Strandell 1,4, A.Lindhard 2, U.Waldenström

More information

V. Mijatovic S. Veersema M.H. Emanuel R. Schats P.G. Hompes. Fertil Steril. 2010;93:

V. Mijatovic S. Veersema M.H. Emanuel R. Schats P.G. Hompes. Fertil Steril. 2010;93: Essure hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization-embryo transfer in patients with a contraindication for laparoscopy. V. Mijatovic S. Veersema

More information

Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary

Infertility: 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 information

Clinical aspect of endometrial injury!

Clinical aspect of endometrial injury! Clinical aspect of endometrial injury! Zeev Shoham, M.D. Department of Obstetrics and Gynecology Kaplan Hospital, Rehovot, Israel Implantation Process Good morphology embryo Normal uterus & receptive endometrium

More information

3-D Ultrasound and Dopplers in Reproductive Medicine

3-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 information

Paracervical block with and without conscious sedation: a comparison of the pain levels during egg collection and the postoperative side effects

Paracervical block with and without conscious sedation: a comparison of the pain levels during egg collection and the postoperative side effects FERTILITY AND STERILITY VOL. 75, NO. 4, APRIL 2001 Copyright 2001 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Paracervical block with

More information

Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF*

Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF* Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on prior to IVF* A.Strandell, A.Lindhard, U.Waldenstrom, J.Thorburn, P.O.Janson, L.Hamberger 1,4 1 3 1 1 Department

More information

Increased 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 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 information

Original Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and embryo transfer

Original 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 information

In-vitro fertilization outcome in women with hydrosalpinx*

In-vitro fertilization outcome in women with hydrosalpinx* Human Reproduction vol.11 no.3 pp.526-530, 1996 In-vitro fertilization outcome in women with hydrosalpinx* Fady LSharara 1 * 3, Richard TScott Jr 2, Edward L-Marut 1 and John T.Queenan Jr 1 'Division of

More information

Objective: To study the role of sildenafil on the echogenic pattern of endometrium in infertile patients with bad endometrium.

Objective: 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 information

EHY Ng, WSB Yeung, PC Ho. Introduction

EHY 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 information

Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial

Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial Human Reproduction Vol.23, No.5 pp. 1113 1117, 2008 Advance Access publication on March 13, 2008 doi:10.1093/humrep/den071 Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy

More information

Clinical Application of Ultrasound in Infertility: From Two-dimensional to Three-dimensional

Clinical Application of Ultrasound in Infertility: From Two-dimensional to Three-dimensional R E V I E W A R T I C L E Clinical Application of Ultrasound in Infertility: From Two-dimensional to Three-dimensional Chun-Kai Chen*, Hsien-Ming Wu, Yung-Kuei Soong Transvaginal probes have enhanced sonographic

More information

Medicine. Wei Yang, MMed, Tao Zhang, MMed, Zhou Li, PhD, Xinling Ren, PhD, Bo Huang, PhD, Guijin Zhu, MMed, Lei Jin, PhD. Observational Study

Medicine. 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 information

Assessment of Uterine Receptivity by the Subendometrial- Endometrial Blood Flow Distribution Pattern in Frozenthawed Embryo Transfer Cycles

Assessment 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 information

Is hydrosalpinx fluid cytotoxic?

Is hydrosalpinx fluid cytotoxic? Human Reproduction vol.13 no.6 pp.1620 1624, 1998 Is hydrosalpinx fluid cytotoxic? I.Granot 1,3, N.Dekel 2, I.Segal 1, S.Fieldust 1, Z.Shoham 1 and A.Barash 1 1 IVF Unit, Department of Obstetrics and Gynaecology,

More information

Endometrial blood flow response to hormone replacement therapy in women with premature ovarian failure: a transvaginal Doppler study

Endometrial 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 information

Risk factors for ectopic pregnancy in assisted reproduction

Risk factors for ectopic pregnancy in assisted reproduction FERTILITY AND STERILITY VOL. 71, NO. 2, FEBRUARY 1999 Copyright 1999 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Risk factors for

More information

HIGH SERUM ESTRADIOL LEVELS ARE FERTILIZATION OUTCOME NOT DETRIMENTAL TO IN VITRO. Introduction SUMMARY

HIGH SERUM ESTRADIOL LEVELS ARE FERTILIZATION OUTCOME NOT DETRIMENTAL TO IN VITRO. Introduction SUMMARY ORIGINAL ARTICLE HIGH SERUM ESTRADIOL LEVELS ARE NOT DETRIMENTAL TO IN VITRO FERTILIZATION OUTCOME Cheng-Hsuan Wu 1,2, Tsung-Cheng Kuo 3, Hsin-Hung Wu 1,2, Guang-Peng Yeh 1, Horng-Der Tsai 1 * 1 Division

More information

PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018

PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018 PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018 Clinical Assessment A thorough clinical evaluation is a prerequisite for ART A thorough clinical evaluation as detailed in the female and male

More information

Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH antagonist administration

Endometrial 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 information

Recent Developments in Infertility Treatment

Recent 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 information

Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy

Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy M.E. Coccia, F. Cammilli, L. Ginocchini, F. Borruto* and F. Rizzello Dept Gynaecology Perinatology and Human

More information

A Tale of Three Hormones: hcg, Progesterone and AMH

A 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 information

Hydrosalpinges adversely affect markers of endometrial receptivity

Hydrosalpinges adversely affect markers of endometrial receptivity Human Reproduction vol.12 no.7 pp.1393 1398, 1997 OUTSTANDING CONTRIBUTION Hydrosalpinges adversely affect markers of endometrial receptivity W.R.Meyer 1, A.J.Castelbaum 2, S.Somkuti 3, fertilization (IVF)

More information

Three-dimensional Ultrasound in the Fertility Clinic

Three-dimensional Ultrasound in the Fertility Clinic Donald School Journal of Ultrasound Three-dimensional in Obstetrics Ultrasound and Gynecology, in the Fertility October-December Clinic 2008;2(4):65-74 Three-dimensional Ultrasound in the Fertility Clinic

More information

A prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery

A prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery FERTILITY AND STERILITY Vol. 58, No.2, August 1992 Copyright e 1992 The American Fertility Society Printed on acid-free paper in U.S.A. A prospective randomized study comparing aspiration only with aspiration

More information

Effect of age on ovarian stromal flow measured by three-dimensional ultrasound with power Doppler in Chinese women with proven fertility

Effect of age on ovarian stromal flow measured by three-dimensional ultrasound with power Doppler in Chinese women with proven fertility Human Reproduction Vol.19, No.9 pp. 2132 2137, 2004 Advance Access publication July 8, 2004 DOI: 10.1093/humrep/deh387 Effect of age on ovarian stromal flow measured by three-dimensional ultrasound with

More information

Relationship between cytokines and the embryotoxicity of hydrosalpingeal fluid

Relationship between cytokines and the embryotoxicity of hydrosalpingeal fluid ( C 2005) DOI: 10.1007/s10815-005-4913-7 Assisted Reproduction Relationship between cytokines and the embryotoxicity of hydrosalpingeal fluid Mohamed A. Bedaiwy, 1,4 Tommaso Falcone, 1 Jeffrey M. Goldberg,

More information

Sonographic determination of a possible adverse effect of domiphene citrate on endometrial growth

Sonographic 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 information

THREE-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 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 information

Increased cystic fibrosis transmembrane conductance regulator (CFTR) expression in the human hydrosalpinx

Increased cystic fibrosis transmembrane conductance regulator (CFTR) expression in the human hydrosalpinx Human Reproduction Vol.20, No.5 pp. 1228 1234, 2005 Advance Access publication February 10, 2005 doi:10.1093/humrep/deh773 Increased cystic fibrosis transmembrane conductance regulator (CFTR) expression

More information

Sample size a Main finding b Main limitations

Sample 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 information

Endometrial 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 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 information

Correspondence: Tel: ; Fax: ;

Correspondence:   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 information

Nitasha Garg 1 Harkiran Kaur Khaira. About the Author

Nitasha 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 information

Evaluation of the Infertile Couple

Evaluation of the Infertile Couple Overview and Definition Infertility is defined as the inability of a couple to fall pregnant after one year of unprotected intercourse. Infertility is a very common condition as in any given year about

More information

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation International Journal of Reproduction, Contraception, Obstetrics and Gynecology Tiwary B et al. Int J Reprod Contracept Obstet Gynecol. 2015 Feb;4(1):157-163 www.ijrcog.org pissn 2320-1770 eissn 2320-1789

More information

A Prospective Observational Study to Evaluate the Efficacy and Safety Profiles of Leuprorelin 3 Month Depot for the Treatment of Pelvic Endometriosis

A 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 information

Article Role of utero ovarian vascular impedance: predictor of ongoing pregnancy in an IVF embryo transfer programme

Article 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 information

Timur Giirgan, M.D.* Bulent Urman, M.D. Hakan Yarali, M.D. Hakan E. Duran, M.D.

Timur 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 information

Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window

Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window Human Reproduction Vol.20, No.11 pp. 3012 3017, 2005 Advance Access publication July 15, 2005. doi:10.1093/humrep/dei188 Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF)

More information

Dr. P. M. Gopinath. Director & Senior Consultant Institute of OBG & IVF SRM Institute for Medical Sciences Chennai

Dr. P. M. Gopinath. Director & Senior Consultant Institute of OBG & IVF SRM Institute for Medical Sciences Chennai Dr. P. M. Gopinath PRESENT DESIGNATI ON: PRESENT AFFILIATIO NS: MAJOR ACHIEVEM ENTS: Director & Senior Consultant Institute of OBG & IVF SRM Institute for Medical Sciences Chennai Vice President of FERTILITY

More information

Interpreting 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 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 information

Predictive factors of successful pregnancy after assisted reproductive technology in women aged 40 years and older

Predictive 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 information

Fertility Assessment and Treatment Pathway

Fertility Assessment and Treatment Pathway Rejected referrals sent back to GP Fertility Assessment and Treatment Pathway Patients with fertility problems go to the GP GP Advice and Assessment GP to inform patient of access criteria for NHS-funded

More information

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should

More information

Superovulation with human menopausal gonadotropins is associated with endometrial gland-stroma dyssynchrony*

Superovulation with human menopausal gonadotropins is associated with endometrial gland-stroma dyssynchrony* aes FERTILITY AND STERILITY Vol. 61, No.4, April 1994 Copyright ee) 1994 The American Fertility Society Printed on acid-free paper in U. S. A. r I Superovulation with human menopausal gonadotropins is

More information

The diagnosis of endometriomas using colour Doppler energy imaging

The 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 information

SonoAVC WHITE PAPER. Introduction. gehealthcare.com

SonoAVC WHITE PAPER. Introduction. gehealthcare.com SonoAVC Adela Rodriguez-Fuentes, MD; Jairo Hernandez, PhD; Angela Palumbo, PhD Centro de Asistencia a la Reproducción Humana de Canarias (FIVAP) WHITE PAPER Introduction Imaging methods are constantly

More information

Prognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK

Prognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK Prognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK Obstetrics Gynecology and Reproductive Medicine Department Bichat

More information

Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol

Fixed 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 information

(BMI)=18.0~24.9 kg/m 2 ;

(BMI)=18.0~24.9 kg/m 2 ; 33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV

More information

Female 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 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 information

IVF treatment should not be postponed for patients with high basal FSH concentrations

IVF treatment should not be postponed for patients with high basal FSH concentrations Reproductive BioMedicine Online (2010) 21, 631 635 www.sciencedirect.com www.rbmonline.com SHORT COMMUNICATION IVF treatment should not be postponed for patients with high basal FSH concentrations Ettie

More information

Infertility F REQUENTLY A SKED Q UESTIONS. Q: Is infertility a common problem?

Infertility 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 information

Changes in measured endometrial thickness predict in vitro fertilization success

Changes 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 information

I. ART PROCEDURES. A. In Vitro Fertilization (IVF)

I. 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 information

We 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. 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 information

Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?

Does 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 information

Female Reproductive System. Lesson 10

Female Reproductive System. Lesson 10 Female Reproductive System Lesson 10 Learning Goals 1. What are the five hormones involved in the female reproductive system? 2. Understand the four phases of the menstrual cycle. Human Reproductive System

More information

Relationship between resistin and IL-23 levels in follicular fluid in infertile patients with endometriosis undergoing IVF-ET

Relationship between resistin and IL-23 levels in follicular fluid in infertile patients with endometriosis undergoing IVF-ET Original papers Relationship between resistin and IL-23 levels in follicular fluid in infertile patients with endometriosis undergoing IVF-ET Qun-Fang Zhang 1, A, C, D, Guo-Yong Chen 2, B, Yun Liu 2, B,

More information

CY Tse, AMK Chow, SCS Chan. Introduction

CY 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 information

Sonography-based Automated Volume Count (SonoAVC): an efficient and reproducible method of follicular assessment

Sonography-based Automated Volume Count (SonoAVC): an efficient and reproducible method of follicular assessment GE Healthcare Sonography-based Automated Volume Count (SonoAVC): an efficient and reproducible method of follicular assessment Todd D. Deutch, MD Clinical Reproductive Endocrinology and Infertility Fellow

More information

Serial uterine artery Doppler velocity parameters and human uterine receptivity in IVF/ICSI cycles

Serial 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 information

Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome

Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome Arch Gynecol Obstet (2006) 274:160 164 DOI 10.1007/s00404-006-0174-7 ORIGINAL ARTICLE Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome

More information

Fertility assessment and assisted conception

Fertility 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 information

Risk factors for spontaneous abortion in menotropintreated

Risk factors for spontaneous abortion in menotropintreated FERTILITY AND STERILITY Copyright ~ 1987 The American Fertility Society Vol. 48, No. 4, October 1987 Printed in U.S.A. Risk factors for spontaneous abortion in menotropintreated women Michael Bohrer, M.D.*

More information

Characterization of Normal and Polycystic Ovaries Using Three-Dimensional Power Doppler Ultrasonography

Characterization of Normal and Polycystic Ovaries Using Three-Dimensional Power Doppler Ultrasonography ( C 2002) Physiology Characterization of Normal and Polycystic Ovaries Using Three-Dimensional Power Doppler Ultrasonography I. Y. Järvelä, 1,2,5 H. D. Mason, 3 P. Sladkevicius, 4 S. Kelly, 2 K. Ojha,

More information