The Relationship Between Uterine And Endometrial Blood Flow Using Three-dimensional Power Doppler Ultrasound And Pregnancy Outcome Of Frozen-thawed Embryo Transfer Cycles

BackgroundIn conventional in vitro fertilization-embryo transfer (IVF) treatment,ultrasound examination of the endometrium is a common noninvasive method toassess endometrial receptivity. Endometrial good blood supply is usually consideredas a necessary condition for implantation, therefore, in recent years, during IVFtreatment, assessmenting of the endometrial blood flow is more widespreadconcerned. Some scholars believe that endometrial Doppler study does not reflect theactual situation of endometrial blood flow, but subendometrium and endometrialparameters of blood flow by the three-dimensional power Doppler ultrasound can bemore objective and more reliable evaluation of endometrial blood flow. Nevertheless,when applied as IVF outcome predictors, their results are controversial. Differentchoices of the individual patient, the date and the subendometrium area will enable make the results different. Three-dimensional power Doppler ultrasound to is a newway of imaging which is introduced into clinical practice. Although this techniquemay not replace two-dimensional ultrasound, it is more widely used, and itsrepeatability is very good. Three-dimensional (3D) power Doppler ultrasonographycan assess the vascularization in the whole volume of an organ, for example theuterus or the ovary. The analysis of3D-power Doppler signals can better reflects theoverall vascularization in a volume than analysis of a twodimensional (2D)ultrasound image. Using3D power Doppler ultrasonography we can assess eitherarterial or venous circulation, and computer technology can make this assessmentobjective. Therefore,3D power Doppler ultrasonography should be a good tool toassess physiological and pathological changes in blood circulation. Therefore, thethree-dimensional power Doppler ultrasound is a good tool of evaluation bloodcirculation.More and more studies have shown that it is not comprehensive only usingendometrial thickness and type to evaluate endometrial receptivity, uterine blood flowparameters is the importance factor of endometrial receptivity which related toIVF-ET outcome.The main purpose of this paper is to understand the applications ofthree-dimensional power Doppler ultrasound in assisted reproductive technology, andevaluate its role in assessmenting endometrial function.ObjectiveBy pulse wave (PW) and power Doppler imaging (PDI), monitoring uterine andendometrial blood flow changes from a radiological point of view, to investigate theimpact on pregnancy outcomes of FET cycle.MethodsThe study included three hundred and eleven women who had undergone FETin the reproductive medicine center of the first affiliated hospital of Zhengzhouuniversity from Dec2013to Fer2014, for these patients on the endometrialtransformation days and before transplantation day, using GE produced GEVOLUSON E8color Doppler ultrasonography monitoring endometrial thickness,endometrial volume(V), endometrial vascular index (VI), flow index (FI), vascular flow index (VFI), uterine artery peak systolic flow velocity (PSV), end-diastolic flowvelocity (EDV), peak systolic velocity/diastolic velocity (S/D), pulsatility index(PI), resistance index (RI),and then compared and analyzed statistically.Results1.The relationshio between3D-power Doppler ultrasound index of uterine arteryand endometrial indicators and pregnancy outcomes: Uterine artery pulsatility index(PI) of pregnant group was significantly lower than non-pregnant group on theendometrial transformation days, there was significant difference between the twogroups（P＜0.05）; Uterine artery pulsatility index (PI), resistance index (RI) ofpregnant group was significantly lower than non-pregnant group beforetransplantation day, there was significant difference between the two groups（P＜0.05）; endometrial volume of (V), endometrial vascular index (VI), flow index (FI),vascular flow index (VFI) of pregnant group was significantly higher thannon-pregnant group before transplantation day, no significant difference was detectedbetween the two groups（P＜0.05）; Endometrial volume (V) and endometrialvascularization flow index (VFI) have value on predictiving pregnancy outcome; areaunder the ROC curve of them are0.637,0.620respectively.2. Comparing3D-power Doppler indicators on the day of conversion to the daybefore the transplantation: From comparison all patients data with data, we can seealthough uterine artery pulsatility index (PI) of the day before transplant, lower thanthe day conversion, no significant difference between the two groups (P>0.05).Uterine artery resistance index (RI)、peak systolic flow velocity (PSV)、end-diastolicflow velocity (EDV) of the day before transplant was significantly lower than the dayconversion, there was significant difference between the two groups(P＜0.05).Endometrial volume (V)、Uterine artery flow index (FI) of the day before transplantwas significantly higher than the day conversion, there was significant difference(P＜0.05).3. Comparing3D-power Doppler indicators of different endometrial preparingmeasurement: The uterine artery and endometrial blood flow parameters of naturalcycle group and hormone replacement cycles (E-P cycle) group have no significant difference (P>0.05).4. Comparison3D-power Doppler indicators of different endometrial thickness:uterine artery PI, RI of endometrial thickness≥15mm and8-14mm were lower thenthose≤7mm,and the differences were statistically significant (P <0.05), endometrialvolume(V)≤7mm were significantly lower than8-14mm,≥15mm, and thedifference was statistically significant (P <0.05).5. Correlation between different3D-power Doppler indicators and endometrialthickness: the correlation coefficient between uterine artery RI, PI, endometrialvolume (V) and endometrial thickness were-0.431,-0.775and0.796(P <0.01).6. Pregnancy rateof different uterine artery resistance index (RI): When uterineartery resistance index (RI) were0.70-0.85and0.86-0.95, the two grounp pregnancyrates were53.18%,40.00%, and there was significant difference (P <0.05).Conclusions1. When Uterine artery resistance index (RI) is lower,it is more likely to getpregnancy. Uterine artery resistance index (RI), endometrial volume (V) andendometrial vascularization flow index (VFI) are better indicator to predictoroutcome of thaw frozen embryo transfer cycles (FET).3D-power Doppler ultrasoundmonitoring has advantage of simple, accurate and quick.2. Thicker endometrium has lower uterine artery pulsatility index (PI), uterineartery resistance index (RI).3. Uterine artery and endometrial blood flow parameters have no significantdifference between different ways to prepare endometrium.