Assessment of endometrial receptivity for gestation in patients undergoingin vitro fertilization, using endometrial thickness and the endometrium-myometrium relative echogenicity coefficient
Z. Leibovitz et al., Assessment of endometrial receptivity for gestation in patients undergoingin vitro fertilization, using endometrial thickness and the endometrium-myometrium relative echogenicity coefficient, ULTRASOUN O, 14(3), 1999, pp. 194-199
Objective To evaluate the outcome of in vitro fertilization (IVF) treatment
in relation to the sonographic parameters of the endometrium.
Design and methods Seventy-five patients with no uterine pathology (age 31.
1 +/- 5.4 years) treated in our IVF clinic for various indications were ass
essed during 75 cycles in which good-quality (grades 1 and 2) embryos were
transferred. Controlled ovarian stimulation was achieved by the long protoc
ol (gonadotropin releasing hormone agonist and gonadotropins). The bilayere
d endometrial thickness (BET), estradiol, luteinizing hormone and progester
one serum levels were measured in 272 tests. A special computer program was
used to measure endometrial echogenicity relative to myometrial echogenici
ty. The gray-level data were analyzed on the basis of the midsagittal sonog
raphic uterine image. Endometrium-myometrium relative echogenicity coeffici
ent (E/M REC) values were computed and displayed graphically along the ante
roposterior axis of the endometrial layers in the upper part the uterine ca
vity. The area under the E/M REC curve within the BET limits was defined as
the relative echogenicity area (REA) and was used as a measure of endometr
ial echogenicity. Each cycle was sampled in six time segments representing
desensitization, follicular and luteal phases. Assigning the day of oz,ram
pick-up as day 0, the time segments of each cycle were: first, day -20 to d
ay -11; second, day -10 to day -6; third day -5 to day -2; fourth, day 0; f
ifth, day +7 to day +14; sixth, day +15 to day +21.
Results A total of 276 embryos were transferred (3.68 +/- 1.02 per cycle),
of which 223 were of good quality (2.97 +/- 1.51 per cycle). An intrauterin
e pregnancy was diagnosed in 29 patients. All patients in this study had a
BET of >5 mm in the third and the fourth time segments. There was no signif
icant difference in BET and REA between pregnant and non-pregnant patients
tested in the first to the fifth time segments of the IVF cycles. Both BET
and REA measured in the sixth time segment were significantly higher in pre
gnant compared to non-pregnant patients.
Conclusions Our results suggest that the proposed sonographic assessment of
the endometrium shows no benefit in characterization of uterine receptivit
y in IVF patients with a reactive endometrium. High BET and REA values can
indicate pregnancy during the sixth time segment when the decidualization o
f the endometrium is well established.