Junctional Zone in Infertile Women: A Three-dimensional Ultrasound Study

Abstract

Objective To analyze the interobserver and intraobserver reproducibility of the visualization and continuity of the juncional zone (JZ) by three-dimensional (3D) ultrasound in infertile women, and to evaluate the sociodemographic, hormonal, and structural factors that influence these assessments. Methods A prospective study conducted at the Assisted Reproductive Technology Unit of Hospital Senhora da Oliveira, in the city of Guimarães, Portugal. Transvaginal 3D ultrasonography was performed, and 2 volumes were generated per case. Two observers who were blinded to each other's work analyzed these volumes, choosing the best coronal section. Four months later, one of the observers performed the same methodology. The JZ visualization was classified as optimal, satisfactory, and unsatisfactory, and the JZ continuity, as continuous and discontinuous. The interobserver and intraobserver agreements were analyzed. The influence of hormonal, structural, and sociodemographic factors on the JZ was evaluated. Results In total, 65 women were included in the present study. The interobserver reproducibility was substantial for JZ visualization and continuity (k = 0.635 and 0.753 respectively), and the intraobserver reproducibility was very good for JZ visualization and continuity (k = 0.884 and 0.816 respectively). Trilaminar endometrial pattern was associated with optimal JZ visualization (p = 0.012). The increase of 1 unit in the level of serum estradiol represents a 9.9% decrease in the odds of unsatisfactory visualization of the JZ (odds ratio [OR] = 0.9; 95% confidence interval [95%CI] = 0.814–0.996; p = 0.042). Endometriosis increases the odds of unsatisfactory visualization by 24 times (OR = 23.7; 95%CI = 1.262–437.057; p = 0.034). The prevalence of discontinuous JZs was of 60%. Myomas and endometriosis were associated with discontinuous JZs (p = 0.034 and 0.016 respectively). Conclusion The assessment of JZ visualization and continuity by 3D ultrasound is reproducible enough to be used in the clinical practice.

Clinical Value of Three-Dimensional Transvaginal Ultrasound in Diagnosis of Endometrial Receptivity and Ovarian Function in Patients with Infertility

“…The monitoring began on the 3rd day of the menstrual cycle and was checked regularly every day until the follicle matured or ovulated. Ovulation standard [ 5 ]: follicles disappear or significantly decrease, follicular wall thickens and collapses, showing irregular shape, there are high-density light spots in the follicles, and the edges are serrated. Continuous monitoring can find corpus luteum images with dense light spots and thick edges.…”

“…Ultrasound has the advantages of nonradiation, nontrauma, and high repeatability. The routine examination can only detect whether the woman is pregnant but cannot accurately detect whether the reproductive system is pathological changes, and three-dimensional ultrasound can directly reflect the location of the lesions, so as to judge and diagnose [ 4 , 5 ]. The three-dimensional ultrasound automatic volume measurement (SonoAVC) software of transvaginal three-dimensional ultrasound can automatically obtain the number, size, and volume of antral follicles.…”

“…Every follicle is marked with the different colors and will not be measured repeatedly. Compared with two-dimensional ultrasound, it takes less time and is more effective [ 5 ].…”

A Study on the Prediction of Reproductive Outcomes in Frozen Embryo Transfer Cycles by Calculating the Volume of Uterine Junctional Zone with Three-Dimensional Ultrasound

“…We then established a 3 D multi-plane and TUI method and used five transverse sections to evaluate the display of the JZ. This overcame the shortcomings of the single coronal plane display in previous studies [6]. In the subsequent volume calculation, we chose the B-plane for tracing and calculation, which was concordant with the consistency study, to reduce the errors in the analysis.…”

“…The JZ is also a source of uterine contractions in non-pregnant women, causing peristalsis of the endometrium, which is associated with low pregnancy rates in natural and assisted reproductive technology cycles when uterine contractions are excessive and uncoordinated 5 . Hence, it plays an important role in reproduction and pregnancy 6 .…”