Abstract
Purpose: The objective of the present study was to evaluate an ultrasonographic uterine scoring system as a method for the prognosis of embryo implantation in patients submitted to ICSI.
Methods: A total of 562 patients submitted to an ICSI program were prospectively evaluated on the day of hCG administration in terms of the following ultrasonographic uterine parameters: A. Endometrial thickness (<7.0 mm = 0; 7 a 14 mm = 3; ≥14 mm = 1); B. Endometrial layering (three lines = 2; absence of three lines = 0); C. Myometrial contractions in 2 min (<3 = 0; ≥3 = 3); D. Uterine artery Doppler flow (>3 = 0; 2.2 a 3 = 2; ≤2.19 = 3); E. Endometrial power Doppler (The endometrium was divided into four equal quadrants and classified as grade I = 1; II = 2; III = 3; IV = 4, according to the visualization of the power Doppler in the quadrants). The colour Doppler signal was considered to be positive when it reached at least the basal layer of the endometrium; F. Myometrial power Doppler (absent = 0; weakly present = 2; strongly present = 3); G. Myometrial echogenicity (homogeneous = 2; inhomogeneous = 0). The patients were divided into 4 groups according to total score: Group I, score <10; Group II, score 10–14, Group III, score 15–17 and Group IV, score 18–20.
Results: The uterine parameters using an ultrasonographic scoring system are inversely correlated with patient age (p < 0.0001). The number of days of stimulation with FSH did not differ (p = 0.10) between groups. The number of follicles measuring ≥16 mm was different (p = 0.01) between groups. The number of metaphase II oocytes also did not differ significantly between groups (p = 0.45). The fertilization rate was also similar (p = 0.10) for all groups. The number of transferred embryos was different between groups (p = 0.02). The rate of embryo implantation did not differ (p = 0.60) between groups. Finally, the pregnancy rates did not differ significantly (p = 0.93) between groups.
Conclusions: The ultrasonographic evaluation of uterine parameters on the day of hCG administration using a scoring system is inversely correlated with patient age. In the present study, the use of this ultrasonographic score method could not identify a population with greater uterine receptivity.
Keywords: Embryo implantation, Doppler, ICSI, score, ultrasound
Full Text
The Full Text of this article is available as a PDF (53.6 KB).
REFERENCES
- 1.Sher G, Dodge S, Maassarani G, Knutzen V, Zouves C, Feinman M. Management of suboptimal sonographic endometrial patterns in patients undergoing in-vitro fertilization and embryo transfer. Hum Reprod. 1993;8:347–349. doi: 10.1093/oxfordjournals.humrep.a138049. [DOI] [PubMed] [Google Scholar]
- 2.Coulam CB, Bustillo M, Soenksen DM, Britten S. Ultrasonographic predictors of implantation after assisted reproduction. Fertil Steril. 1994;62:1004–1010. doi: 10.1016/s0015-0282(16)57065-4. [DOI] [PubMed] [Google Scholar]
- 3.Oliveira JB, Baruffi RLR, Mauri AL, Petersen CG, Campos MS, Franco JG., Jr Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization program. Hum Reprod. 1993;8:1312–1315. doi: 10.1093/oxfordjournals.humrep.a138248. [DOI] [PubMed] [Google Scholar]
- 4.Oliveira JB, Baruffi RLR, Mauri AL, Petersen CG, Borges MC, Franco JG., Jr Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme after ovarian stimulation with gonadotrophin-releasing hormone and gonadotrophins. Hum Reprod. 1997;11:2515–2518. doi: 10.1093/humrep/12.11.2515. [DOI] [PubMed] [Google Scholar]
- 5.Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, Collins WP. The use of transvaginal colour flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril. 1992;57:372–376. doi: 10.1016/s0015-0282(16)54848-1. [DOI] [PubMed] [Google Scholar]
- 6.Favre R, Bettahar K, Grange G. Predictive value of transvaginal uterine Doppler assessment in an in vitro fertilization program. Ultrasound Obstet Gynecol. 1993;3:350–353. doi: 10.1046/j.1469-0705.1993.03050350.x. [DOI] [PubMed] [Google Scholar]
- 7.Svalander P, Forsberg AS, Jakobsson AH, Wikland M. Factors of importance for the establishment of a successful program of intracytoplasmic sperm injection treatment for male infertility. Fertil Steril. 1995;63:828–837. doi: 10.1016/s0015-0282(16)57489-5. [DOI] [PubMed] [Google Scholar]
- 8.Contart P, Baruffi RLR, Coelho J, Mauri AL, Petersen C, Franco JG., Jr Power Doppler endometrial evaluation as a method for the progonosis of embryo implantation ian an ICSI program. J Assist Reprod Genet. 2000;6:329–334. doi: 10.1023/A:1009405128160. [DOI] [PMC free article] [PubMed] [Google Scholar]