| Objectives:In this study,the endometrial receptivity was evaluated by three-dimensional power Doppler ultrasound.The parameters including endometrial thickness,endometrial type,uterine volume,endometrial and subendometrial blood flow were measured,and the differences between pregnant group and non-pregnant group were compared.To further determine the value of three-dimensional power Doppler ultrasound in the evaluation of endometrial receptivity.At the same time,the effects of different luteal support schemes on pregnancy outcomes after frozen-thawed embryo transplantation were discussed in order to provide guidance for clinical work.Methods:The study was conducted on 237 cycles of frozen-thawed embryo transplantation in the Reproductive Medicine Center of the First Affiliated Hospital of Soochow University from October 2016 to October 2018.All subjects were excluded reproductive system diseases such as endometriosis,hydrosalpinx,pituitary adenomas,thyroid dysfunction,and other serious endocrine system diseases.The serum ?-HCG level was measured after 2 weeks of transplantation.Those with positive value and confirmed by ultrasound were identified as pregnant group,those with negative serum ?-HCG value or biochemical pregnancy were identified as non-pregnant group,so as to ensure that there is no statistical difference(P>0.05)in age,body mass index(BMI),anti-Muller factor(AMH),the number of embryos transferred between pregnant group and non-pregnant group.Endometrial receptivity was evaluated by transvaginal three-dimensional color Doppler energy ultrasound on the day before frozen embryo transplantation.The endometrial thickness,endometrial type,uterine volume,the RI,PI of uterine artery and endometrial spiral artery,subendometrial blood flow type and the VI,FI,VFI of endometriuml,were compared whether there are statistical differences between pregnant group and non-pregnant group.The day before frozen-thawed embryo transfer,123 cycles of non-trilinear endometrial types were selected.According to different luteal support schemes after transplantation,the patients were divided into two groups.The control group was treated with conventional luteal support scheme for 65 cycles,and the experimental group was treated with conventional luteal support scheme and growth hormone for 58 cycles.The general data and other parameters of three-dimensional Doppler power ultrasound except endometrial type to evaluate endometrial receptivity were compared,and the clinical pregnancy rates of the two groups were analyzed.At the same time,the above 123 cycles were further divided into two groups:ovulatory cycle group and stimulation cycle group.The ovulatory cycle of the experimental group and the control group were 18 cycles and 24 cycles respectively.The hormone replacement cycle of the experimental group and the control group were 40 cycles and 41 cycles respectively.The clinical pregnancy rates of the two groups were analyzed and compared.So as to determine whether adding growth hormone to routine luteal support schemes for non-trilinear FET cycles of endometrium can improve the clinical pregnancy rate.(Because of the small sample size,the general data of natural cycle and hormone replacement cycle,and the ultrasonographic parameters excluding endometrial morphology were not further compared.)Results:1.The day before frozen-thawed embryo transfer,the general data of pregnancy group and non-pregnancy group were compared.There was no significant difference in age,body mass index(BMI),anti-Muller factor(AMH),number of embryos transferred between the two groups(P>0.05).2.The ultrasonic parameters of pregnant and non-pregnant women were measured by transvaginal three-dimensional color Doppler energy ultrasound one day before frozen-thawed embryo transfer.The thickness of endometrium was(10.71±2.07)mm and(10.666±2.12)mm,the volume of uterine cavity was(4.89±2.06)ml and(5.03±2.15)ml,the RI of uterine artery blood flow was(0.84±0.06)and(0.84±0.06),and the PI of uterine artery blood flow was(2.33±0.50)and(2.38±0.65),respectively.There was no significant difference between the above parameters(P>0.05).The RI of endometrial spiral artery was(0.54±0.06)and(0.56±0.08),PI of endometrial spiral artery was(0.85±0.15)and(0.93±0.25),endometrial vascular index(VI)was(3.50±1.63)and(2.28±1.16),endometrial blood flow index(FI)was(23.69±1.71)and(21.45±1.29),endometrial vascularized blood flow index(VFI)was(1.22±0.96)and(0.82±0.96),respectively.The above parameters,endometrial morphological types and subendometrial blood flow patterns of the two groups were significantly different(P<0.05).3.The area under the ROC curve of endometrial indicators on the day before frozen-thawed embryo transfer was as follows:endometrial blood flow index(FI)>endometrial vascular index(VI)>endometrial vascularization blood flow index(VFI)>endometrial and subendometrial blood flow type>the PI of spiral artery>the RI of spiral artery>endometrial type.The table 3 shows that the area under ROC curve of FI is the largest.When FI is 23.405 as the cut-off point,the sensitivity and specificity of FI are 62.7%and 96.9%,respectively.4.There was no significant difference in age,body mass index(BMI),anti-Muller's factor(AMH),number of embryos transferred between the control group(n=65)using conventional luteal support and the experimental group(n=58)using growth hormone(GH)after frozen-thawed embryo transfer(P>0.05).5.On the day before frozen-thawed embryo transfer,the endometrial thickness measured by transvaginal three-dimensional color Doppler energy ultrasound was(10.92±2.12)mm and(11.12±2.02)mm,the volume of uterine cavity was(5.06±2.10)ml and(4.98±1.61)ml,the RI of uterine artery blood flow was(0.84±0.07)and(0.83±0.05),and the PI of uterine artery blood flow was(2.38±0.59)respectively.The RI of endometrial spiral artery was(0.55±0.09)and(0.54±0.07),PI of endometrial spiral artery was(0.90±0.20)and(0.91±0.24),VI was(2.28±2.16)and(3.22±4.35),FI was(22.74±2.25)and(23.60±2.66),VFI was(1.07±0.75)and(0.82±1.34),respectively,and there was no significant difference in endometrial and subendometrial blood flow patterns between the two groups(P>0.05).6.After frozen-thawed embryo transfer,the clinical pregnancy rate of the control group with routine luteal support program was 38.5%,and that of the experimental group with routine luteal support program and growth hormone was 48.3%.The clinical pregnancy rate of the experimental group was higher than that of the control group.The clinical pregnancy rate was 55.6%in the experimental group and 45.8%in the control group of natural period.The clinical pregnancy rate in the experimental group was higher than that in the control group of natural period.The clinical pregnancy rate was 45.0%in the experimental group and 34.1%in the control group of hormone replacement cycle.The clinical pregnancy rate in the experimental group was higher than that in the control group of hormone replacement cycle.There was no significant difference in the general data of the experimental group and the control group,as well as other parameters of endometrial receptivity assessed by three-dimensional Doppler energy ultrasound except endometrial type(P>0.05).(Because of the small sample size,the general data of natural cycle and hormone replacement cycle,and the ultrasonographic parameters excluding endometrial morphology were not further compared.)Conclusions:1.On the day before frozen-thawed embryo transfer,RI and PI of endometrial spiral artery in pregnant group were significantly lower than those in non-pregnant group,while VI,FI and VFI were significantly higher.In pregnant group,the endometrial type of trilinear was significantly more than that in non-pregnant group,and the endometrial and subendometrial blood flow types in pregnant group were significantly better than those in non-pregnant group,and the above-mentioned finger groups were significantly higher than those in non-pregnant group.The area under the ROC curve was larger than 0.5,which indicated that the above indexes of endometrial blood perfusion were closely related to pregnancy outcomes and could be used as routine ultrasound indicators to evaluate endometrial receptivity.2.On the day before frozen-thawed embryo transfer,the area under the ROC curve of FI,which is one of the sensitive indicators for evaluating endometrial receptivity,is the largest,and its sensitivity and specificity are higher than other indicators.3.The clinical pregnancy rate of infertile women with non-trilinear endometrium type can be significantly improved by adding growth hormone to the routine luteal support program after frozen-thawed embryo transfer. |
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