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

Abstract

Objective. A case-control study was conducted to explore the clinical value of three-dimensional transvaginal ultrasound in the diagnosis of endometrial receptivity (ER) and ovarian function in patients with infertility. Methods. A total of 308 infertile women treated in our hospital from March 2020 to June 2021 were enrolled as the observation group, and another 300 women of childbearing age who underwent physical examination in the same period were enrolled as the control group. The clinical value of three-dimensional transvaginal ultrasound in ER in patients with infertility was analyzed by comparing the classification of endometrial and subendometrial blood perfusion, endometrial AUC value and Pi value, and subendometrial AUC value and Pi value. According to the number of oocytes obtained, the patients were assigned into the normal response group (182 cases, ≥5 oocytes) and the low response group (126 cases, <5 oocytes). The levels of some hormones, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and FSH/LH, were measured. Transvaginal ultrasonography was performed to detect ovarian volume (OV), antral follicle count (AFC), and peak flow rate of the ovarian interstitial artery (PSV). The peak of end-diastolic flow velocity (EDV) and other indexes were analyzed. The correlation between FSH level, FSH/LH, and ultrasound indexes was analyzed, and the ROC curve was established to analyze the value of transvaginal Doppler ultrasound in evaluating ovarian reserve function and predicting ovulation. Results. There were significant differences in late proliferation type I and type III, ovulatory type II and type III ( P < 0.05 ). There exhibited no significant difference in late proliferation type II, ovulation stage type I, and implantation window stage type I, type II, and type III ( P > 0.05 ). Regarding the endometrial AUC and Pi values, the endometrial AUC and Pi values in the observation group were lower compared to the control group during late proliferation and ovulation ( P < 0.05 ). There exhibited no significant difference in AUC and Pi ( P > 0.05 ). Regarding the subintimal AUC and Pi values, the subintimal AUC and Pi values in the observation group were higher compared to the control group during late proliferation and ovulation ( P < 0.05 ). There exhibited no significant difference in AUC and Pi during the implantation window ( P > 0.05 ). There exhibited no significant difference in menarche age, age, body mass index, and menstrual cycle between the normal response group and the low response group ( P > 0.05 ). The levels of EDV, OV, AFC, and PSV in the normal response group were higher compared to the low response group ( P < 0.01 ). Compared with the low response group, the levels of FSH and FSH/LH in the normal response group were lower, but the levels of LH and E2 in the normal response group were higher ( P < 0.05 ). The results of correlation analysis of FSH, FSH/LH, and ultrasound parameters between the normal response group and the low response group indicated that FSH was negatively correlated with E2, EDV, OV, AFC, and PSV in 308 infertile women ( r = − 0.817 , -0.846, -0.707, -0.845, -0.911, P < 0.01 ), but it was positively correlated with FSH/LH ( r = 0.714 , P < 0.01 ). The ultrasound parameters of ovarian reserve function in the normal response group and the low response group were compared with the indexes that predicted ovulation. The results of ROC curve analysis indicated that the cutoff values of EDV, OV, AFC, and PSV were 4.141, 3.726, 4.106, and 13.944, respectively, the specificity of each index was higher than 90.00%, and the sensitivity was higher than 80.00% except PSV. Conclusion. Transvaginal ultrasound can not only accurately evaluate the ER of infertile women but also directly observe follicular development and monitor ovulation, which is of high value in evaluating ovarian reserve function and predicting ovulation.

A comparison of Doppler measures of ovarian blood flow between women with and without ovarian dysfunction and correlations of Doppler indices with ovarian dysfunction markers: a meta-analysis

“…Al-Rab et al ( 16 ) found no correlation between FSH and either FI or VI in PCOS patients. Outside this meta-analysis, Wu et al ( 43 ) found strong negative correlations between FSH and ovarian volume, antral follicle count, peak flow velocity and end-diastolic peak velocity in infertile women. We found fewer studies to report the correlations between AMH and Doppler ultrasonography measures.…”

Three-dimensional transvaginal ultrasonography in the evaluation of diminished ovarian reserve and premature ovarian failure

“…This study investigated the application value of 3D-TVS in the assessment of DOR and POF, with the results of sex hormone detection as the gold standard, the specificity, sensitivity and accuracy of 3D-TVS in the diagnosis of DOR were 80.00%, 90.00% and 88.00% respectively; The specificity of POF was 87.50%, the sensitivity and accuracy were 95.83% and 93.75% respectively. Wu J et al 9 showed through a case-control study (308 cases vs 300 cases) that transvaginal ultrasound is of great value in evaluating ovarian reserve function and predicting ovulation, with specificity higher than 90.00% and sensitivity higher than 80.00% for AFC and OV. This is consistent with the results of this study.…”

“…17,18 In the past, the hormone level was mainly detected by biochemical examination in the evaluation of ovarian reserve function, but the biochemical examination had certain limitations and could not obtain the morphological information of the ovary. 9,11 Vaginal ultrasound is the best way to monitor follicles and the most accurate method at present. 9 Through the use of post-processing software, list marking processing can be implemented for different follicle diameters and volumes, which is convenient for clinicians to observe the subtle follicular structural changes and improves analysis of sinus follicle development.…”

“…9,11 Vaginal ultrasound is the best way to monitor follicles and the most accurate method at present. 9 Through the use of post-processing software, list marking processing can be implemented for different follicle diameters and volumes, which is convenient for clinicians to observe the subtle follicular structural changes and improves analysis of sinus follicle development. Yu L et al 12 16 This study shows that transvaginal threedimensional ultrasound has good diagnostic efficacy for both DOR and POF, which is consistent with the results of Singhal P et al 19 The use of 3D-TVS technology in the diagnosis and evaluation of DOR and POF does have application value.…”

“…Three-dimensional transvaginal ultrasonography in the evaluation of diminished ovarian reserve and premature ovarian failure reconstruction technology, and can provide a more scientific and reliable reference basis for clinical analysis of ovarian blood supply. 9,10 This study analyzed and compared the 3D-TVS results of DOR, normal ovarian function and POF, and analyzed the applicability of this technology in evaluating DOR and POF.…”