Assessment of endometrial receptivity during implantation window in women with unexplained infertility

Wang, Li; Lv, Shulan; Mao, Wenjun; Pei, Meili; Yang, Xiaofeng

doi:10.1080/09513590.2020.1727433

Cited by 24 publications

(22 citation statements)

References 14 publications

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“…In addition, intrauterine fluid aspiration also had no effect on pregnancy in infertile patients with endometriosis, or patients with idiopathic infertility or luteal phase deficiency ( 32 ). Similar to previous studies, the safety of this method has been proven in our previous studies, which selected fertile women and patients with unexplained infertility as subjects ( 33 ). Data in our study revealed that integrin αvβ3 and VEGF concentrations in uterine fluid were significantly higher in the LE group compared with the CC group and natural cycle group.…”

Section: Discussionsupporting

confidence: 63%

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome

Wang

et al. 2021

Front. Endocrinol.

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ObjectiveNumerous studies have reported on ovulation and pregnancy rates in patients with polycystic ovary syndrome (PCOS). However, relevant data on endometrial receptivity are limited. This study was conducted to compare endometrial receptivity during implantation windows among letrozole (LE), clomiphene citrate (CC), and natural cycle, and to assess the predictive value for pregnancy of observed indicators.MethodsThis randomized controlled trial study enrolled 270 patients with PCOS. Patients were given LE (n=90) at a dose of 2.5mg/day or CC (n=90) at a dose of 50 mg/day on cycle days 5–9 for ovulation induction. Patients in the natural cycle group (n=90) did not receive any drug for ovulation induction. Endometrial ultrasonic parameters, integrin αvβ3, and vascular endothelial growth factor (VEGF) concentrations in uterine secretion were detected during the implantation window. The endometrial receptivity, ovulation rate, pregnancy rates, and predictive value of observed indicators for pregnancy were analyzed.ResultsThe successful ovulation rate did not differ between the LE group and CC group (P>0.05). Endometrial ultrasonic parameters [endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), vascularization flow index (VFI)], integrin αvβ3, and VEGF concentrations in uterine fluid were significantly higher in the LE group compared with the CC group and natural cycle group (P<0.05). The clinical pregnancy and ongoing pregnancy rates of the LE group were significantly higher than in the CC group (P<0.05). Endometrial ultrasonic parameters (VI, FI, and VFI), integrin αvβ3, and VEGF concentrations in uterine fluid of all pregnancy groups were significantly higher compared with the no pregnancy group (P<0.05), and the above parameters in ongoing pregnancy were significantly higher than in biochemical pregnancy (P<0.05). The endometrial FI during the implantation window had the highest predictive value for pregnancy (AUC=0.889). The integrin αvβ3 in uterine fluid had better predictive value (AUC=0.876) than VEGF.ConclusionsEndometrial receptivity during the implantation window of LE is superior to CC in PCOS women, which may be related to higher clinical pregnancy and ongoing pregnancy rates. Endometrial FI examined by 3-D power Doppler, and integrin αvβ3 in uterine secretion during the implantation window, could be preferable non-invasive predictor markers for pregnancy.Clinical Trial Registrationwww.chictr.org.cn, ChiCTR1900023423.

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Section: Discussionsupporting

confidence: 63%

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome

Wang

et al. 2021

Front. Endocrinol.

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“…8 In this study, we found that unexplained infertility was associated with a significantly impaired uterine as well as sub-endometrial perfusion which was in agreement with previous reports. 6,16,17 Schild et al suggested that sub-endometrial perfusion relates to fertility outcome more than uterine perfusion with the hypothesis that sub-endometrial blood flow may be masked by the larger proportion of uterine blood distributed to myometrium. 22 This suggestion provided a possible explanation for the heterogenous evidence regarding the correlation between uterine artery Doppler flow values and pregnancy rate and suggesting a possible beneficial role of endometrial blood flow enhancement in the management of unexplained infertility.…”

Section: Discussionmentioning

confidence: 99%

“…For the fertile group a sample size of 16 cases was required to detect an effect size of 0.91 with an α error=0.05 and the power=0.8 for a difference in the mean flow index between unexplained infertility and fertile cases based on results of a previous study. 6 As control group was predetermined to include 30 women, the same size was planned for fertile group.…”

Section: Sample Size Justificationmentioning

confidence: 99%

“…4 The current evaluation is based on several sonographic parameters 5 with endometrial thickness being the most commonly studied parameter as a predictor for good endometrial receptivity. 6 three dimensional power Doppler has been implicated in the workup for unexplained infertility as a tool for assessment of endometrial blood flow with a hypothesis that impaired sub-endometrial perfusion might reduce endometrial receptivity and possibly contribute to unexplained infertility. [6][7][8] Nitric oxide has been demonstrated to play an essential role in reproduction and various adverse reproductive outcomes have been reported with defective nitric oxide synthesis.…”

Section: Introductionmentioning

confidence: 99%

“…6 three dimensional power Doppler has been implicated in the workup for unexplained infertility as a tool for assessment of endometrial blood flow with a hypothesis that impaired sub-endometrial perfusion might reduce endometrial receptivity and possibly contribute to unexplained infertility. [6][7][8] Nitric oxide has been demonstrated to play an essential role in reproduction and various adverse reproductive outcomes have been reported with defective nitric oxide synthesis. [9][10][11][12] Previous studies have confirmed the role of nitric oxide in adjustment of uterine blood flow.…”

Section: Introductionmentioning

confidence: 99%

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Effect of nitric oxide donors on uterine and sub-endometrial blood flow in patients with unexplained infertility: a randomized controlled trial

Hafeez

Kortam

Youssef

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Background: Impaired sub-endometrial perfusion might reduce endometrial receptivity and possibly contribute to unexplained infertility. A favorable effect on sub-endometrial blood flow has been demonstrated with nitric oxide.Methods: This randomized controlled trial evaluated the effect of nitroglycerine on uterine and sub-endometrial blood flow in women with unexplained infertility. Sixty women were randomized into 2 equal groups. The study group received 5mg nitroglycerine patch daily from day 2 of the cycle till the evaluation day and the control group received no treatment. Independent of the study arms, 30 parous women were included as the fertile group. Six to eight days after detecting luteinizing hormone surge, women were assessed for endometrial thickness, uterine artery blood flow with color Doppler and sub-endometrial blood flow with three-dimensional power Doppler.Results: Compared to fertile women, cases with unexplained infertility (control group) had a significantly thinner endometrium, higher uterine artery Doppler indices and lower sub-endometrial blood flow. Women who received nitroglycerin showed a significant improvement in sub-endometrial blood flow while uterine artery blood flow did not show a significant difference; however, the values were also comparable to fertile women. In addition, no effect on endometrial thickness was found with nitroglycerin treatment. Nitroglycerin treatment side effects were headache, blurring of vision and hypotension. These adverse effects were not significant compared to controls.Conclusions: In women with unexplained infertility, nitroglycerin significantly improved the sub-endometrial blood flow but did not affect the endometrial thickness.

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Artificial Intelligence in the Assessment of Female Reproductive Function Using Ultrasound: A Review

Chen

Wang

et al. 2021

J of Ultrasound Medicine

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The incidence of infertility is continuously increasing nearly all over the world in recent years, and novel methods for accurate assessment are of great need. Artificial Intelligence (AI) has gradually become an effective supplementary method for the assessment of female reproductive function. It has been used in clinical follicular monitoring, optimum timing for transplantation, and prediction of pregnancy outcome. Some literatures summarize the use of AI in this field, but few of them focus on the assessment of female reproductive function by AI‐aided ultrasound. In this review, we mainly discussed the applicability, feasibility, and value of clinical application of AI in ultrasound to monitor follicles, assess endometrial receptivity, and predict the pregnancy outcome of in vitro fertilization and embryo transfer (IVF‐ET). The limitations, challenges, and future trends of ultrasound combined with AI in providing efficient and individualized evaluation of female reproductive function had also been mentioned.

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Assessment of endometrial receptivity during implantation window in women with unexplained infertility

Cited by 24 publications

References 14 publications

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome

Effect of nitric oxide donors on uterine and sub-endometrial blood flow in patients with unexplained infertility: a randomized controlled trial

Artificial Intelligence in the Assessment of Female Reproductive Function Using Ultrasound: A Review

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