On Evaluation Of Transvaginal Three-Dimensional Ultrasound In Endometrial Receptivity During Frozen Thawed Embryo Transfer Cycles

Background:The problem of population aging is becoming more and more serious in recent years.With the implementation of two-child policy,senior infertility problems become a serious social problem.With the accelerated pace of modern life,environmental pollution,the change of lifestyle in recent years,infertility patients increased significantly.With the rapid development of modern assisted reproductive technology,it is possible for more and more infertility patients to become pregnant.Good endometrial receptivity and embryo of high quality are the key factor of successful pregnancy,synergistic effect between both of them is necessary for successful implantation.With the development of embryo laboratory technology,the clinical pregnancy rate of in vitro fertilization and embryo transfer has been gradually improved.Endometrial receptivity has become the focus and difficulty in the research of reproductive medicine.The current gold standard for the evaluation of endometrial receptivity is by endometrial biopsy,However,the biopsy is invasive and can not be transplanted after biopsy,the clinical application is limited.Ultrasonography is an intuitive,simple,noninvasive and repeatable examination,with the development of three-dimensional ultrasound and energy doppler,it is possible to detect low blood flow.More and more related professionals research endometrial receptivity by three-dimensional power doppler technology.Objective:Transvaginal three-dimensional ultrasonography was used to measure the endometrial thickness,volume of endometrial,volume of endometrial and subendometrial area,blood flow parameters of endometrial and subendometrial area in frozen thawed and embryo transfer on the day of transformation with progesterone and embryo implantation,to explore the relationship between volume,blood flow parameters and pregnancy outcome,and to evaluate endometrial receptivity at different time points of frozen thawed embryo transfer cycle.Materials and methods:Select the patients who received the treatment of frozen-thawed embryo teansfer cycles in the reproductive and genetic center of Shandong University of Traditional Chinese Medicine Affiliated Hospital,the endometrial thickness,the endometrial volume,volume of endometrial and subendometrial area,the blood flow parameters of endometrium and subendometrial area include vascularization index,blood flow index and vascularization-flow index were measured by transvaginal three-dimensional ultrasonography on the day of transformation with progesterone and embryo implantation.According to the results of pregnancy,patients were divided into pregnant group and non-pregnant group,and the differences between the two groups were compared.Results:On the day of transformation with progesterone,32 cases get clinical pregnancy in 56 patients with infertility,the pregnancy rate was 57.14%.There were no significant differences between the pregnant group and non-pregnant group in endometrial thickness,volume of endometrial(VO),volume of endometrial and 1-3 mm beneath the myometrial-endometrial(Vl-V3),flow index of endometrial and 1 mm beneath the myometrial-endometrial(F1,FI1)(P>0.05).Patients in the pregnant group have lower blood flows parameters than those in the non-pregnant group(P<0.05).Blood flows parameters include vascularization index and vascularization-flow index of endometrial and 1mm beneath the myometrial-endometrial(VI,VFI,VI1,VFI1),vascularization index,blood flow index and vascularization-flow index of 2 mm and 3 mm beneath the myometrial-endometrial(VI2,FI2,VFI2,VI3,FI3,VFI3).The area under the ROC curve of VI,VFI,VII,VFI1,VI2,FI2,VFI2,VI3,FI3 and VF13 for predicting pregnancy was0.757,0.736,0.749,0.749,0.749,0.686,0.744,0.738,0.706 and 0.736.The sensitive index for predicting pregnancy in endometrial and subendometrial blood flow parameters is VI,VFI and FI3.The best critical value of VI for predicting pregnancy is less than 3.176,sensitivity was 75.00%,the specificity was 79.17%.The best critical value of VFI for predicting pregnancy is less than 0.711,sensitivity was 75.00%,the specificity was 79.17%.The best critical value of FI3 for predicting pregnancy is less than 25.814,sensitivity was75.00%,the specificity was 70.83%.On the day of embryo implantation,24 cases get clinical pregnancy in 53 patients with infertility,the pregnancy rate was 45.28%.There was no significant difference between the two groups in endometrial thickness,endometrial volume(VO),volume of endometrial and 1-3 mm beneath the myometrial-endometrial(V1-V3),blood flow parameters of endometrial(VI,FI,VFI)and blood flow parameters of 1-3 mm beneath the myometrial-endometrial(VI1-VI3,FI1-FI3,VFI1-VFI3)(P<0.05).Conclusion:Transvaginal three-dimensional ultrasound can be used to evaluate endometrial receptivity and to predict the outcome of frozen-thawed embryo transfer cycles.Blood parameters include vascularization index and vascularization-flow index of endometrial and 1 mm beneath the myometrial-endometrial(VI,VFI,VII,VFI1),vascularization index,blood flow index and vascularization-flow index of 2 mm and 3 mm beneath the myometrial-endometrial(VI2,FI2,VFI2,VI3,FI3,VFI3)have some predictive value for the outcome of pregnancy on the day of transformation with progesterone.Three dimensional blood flow parameters of endometrial and subendometrial area have no predictive value for the outcome of pregnancy on the day of embryo implantation.The subendometrial area is defined as 3 mm outside of intima,study the blood flow parameters of 3 mm outside of intima has more significant value on the evaluation of endometrial receptivity.