New look at endometrial echogenicity: objective computer-assisted measurements predict endometrial receptivity in in vitro fertilization-embryo transfer

Objective: To determine whether endometrial echogenicity, assessed objectiv ely by a computer-assisted system on the day of hCG administration, predict s endometrial receptivity in controlled ovarian hyperstimulation (COH) cycl es for IVF-ET. Design: Prospective analysis. Setting: Assisted reproduction unit, Clamart, France. Patient(s): Two hundred twenty-one women (aged <38 years with a normal uter us and greater than or equal to 2 grade A or B embryos transferred) undergo ing 228 GnRH agonist and FSH/hCG cycles for IVF-ET. Intervention(s): On the day of hCG administration, uterine ultrasound scans were digitized with an image analysis system. Endometrial echogenicity was assessed as the ratio of the extent of the hyperechogenic transformation o ver the whole endometrial thickness. According to this, cycles were sorted arbitrarily into six groups: <30% (n = 34), 31%-40% (n = 37), 41%-50% (n = 37), 51%-60% (n = 55), 61%-70% (n = 37), and >70% (n = 28). Main Outcome Measure(s): Pregnancy and implantation rates. Result(s): The groups were similar in regard to population characteristics, ovarian response to COH, and embryology data. Pregnancy rates (59%, 57%, 3 5%, 20%, 16%, and 11%, respectively) and implantation rates (35%, 23%, 17%, 6%, 7%, and 3%, respectively) fell progressively and significantly from th e low-echogenicity group to the high-echogenicity group. Conclusion(s): The present results confirm and extend previous observations that advanced hyperechogenic transformation of the endometrium is associat ed with poor IVF-ET outcome. (C) 2000 by American Society for Reproductive Medicine.