ULTRASONOGRAPHIC PREDICTORS OF IMPLANTATION AFTER ASSISTED REPRODUCTION

Objective: To assess the utility of endometrial thickness, echogenic e ndometrial pattern, and uterine artery impedance measured as pulsativi ty index in predicting implantation. Design: Prospective case-controll ed study of infertile patients undergoing assisted reproductive techno logies (ARTs). Patients: Four hundred five women undergoing ARTs were studied: 100 women after ET of thawed embryos in natural cycles (froze n ET), 107 women after standardized IVF-ET, 99 women receiving donor o ocytes after controlled endometrial development with estrogen and P, a nd 99 women undergoing IUI with various ovarian stimulation regimens ( none, 16; GnRH, 7; clomiphene citrate [CC], 29; hMG, 47). Intervention s: Transvaginal ultrasonographic examination performed on the day of h CG administration during stimulated cycles; on E(2) day 15 during cont rolled endometrial cycles; and on the day of ovulation during natural, CC, and GnRH pump cycles. Main Outcome Measure: The endometrial thick ness, echogenic pattern, and pulsativity index results in 170 concepti on cycles were compared with 235 nonconception cycles. Results: When c onception and nonconception cycles were compared, no difference in mea n endometrial thickness and significant differences in the frequency o f nonmultilayered pattern and pulsativity index > 3.3 were observed. F orty-seven percent of nonconception and 9% of conception cycles were a ssociated with at least one of these factors. Conclusion: Ultrasonic m easurements of pulsativity index, resistance index, and echogenic patt ern are useful in predicting implantation after assisted reproduction.