Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program

Abstract

Four distinct patterns in the ultrasonic appearance of preovulatory endometrium can be identified and described in patients undergoing stimulated cycles in an in vitro fertilization program. Ultrasonically, this endometrial response can be seen as a quantitative change in thickness and a qualitative change in gray-scale appearance or reflectivity. The application of this additional parameter of endometrial assessment together with the conventional measurement of follicular diameter as a means of optimally timing oocyte collection has been associated with a reduction in the preoperative ovulation rate from 10.9 to 3.2%, an increase in the fertilization rate from 59.2 to 82.5%, and in a pregnancy rate per embryo transfer of 20.5% in our program without the use of hormonal assays.

Doppler Ultrasonography and Implantation: A Critical Review

“…The endometrial thickness in the peri-ovulatory phase is significantly greater when the IVF cycle results in pregnancy [44][45][46]. A hypoechogenic endometrium surrounded by a hyperechogenic cavity and junction lines is also significantly more frequently observed in the event of success [46,47].…”

Endometrial Receptivity and Scoring for Prediction of Implantation and Newer Markers

“…In their experience, the five-line appearance was the most likely to be associated with implantation. Smith et al 25 felt that both endometrial thickness and pattern were important. Other investigators have also looked at the relationship between endometrial thickness or texture and outcomes.…”

“…They are considered to be useful in deciding on receptivity in IVF.The Smith system is as follows 6,25 • Grade I: Hyperechoic The spiral arteries respond to the hormonal changes of the menstrual cycle and undergo transformations, as well. These responses include proliferation of the endothelium, thickening of the wall and coiling.…”

“…21 Because Biochemical evaluation of uterine receptivity is difficult to perform in the daily clinical routine and daily IVF setups an easier, reproducible and accurate marker for endometrial receptivity was postulated to be the transvaginal ultrasound study of endometrium and its blood supply by color Doppler. [22][23][24][25] Various studies described the receptive endometrium as one that has an endometrial thickness of more than 7 mm, is three layered or five-layered, etc.…”

The Role of Ultrasound in the Evaluation of Endometrial Receptivity Following Assisted Reproductive Treatments

“…Nowadays, intermediate patterns are often discarded and the endometrium is simply described as multilayered or non-multilayered (Sher et al, 1991;Smith et al, 1984). In a prospective study, Serafimi et al(1994) found the multilayered pattern to be more predictive of implantation than any other parameter measured.…”