Publication:

Analysis of endometrial blood flow with color Doppler energy in predicting outcome in GnRH antagonist down regulated ICSI/IVF cycles: a prospective cohort study setting

Background The study was conducted to assess the association between endometrial blood flow pattern assessed with colour Doppler around the day of HCG administration and IVF outcome following GnRH antagonist down regulated cycles.

Methods It was a prospective, cohort study. Total of sixty-eight patients undergoing IVF-ET/ICSI were recruited in the study. All the patients underwent controlled ovarian stimulation with a step-up protocol, and GnRH antagonists were used for down-regulation. Transvaginal ultrasound measurements of all patients were performed on the day of HCG injection. A 6.5 MHz pulsed Doppler system was used for blood flow analysis. Bilateral uterine arteries, pulsatility index and resistance index were calculated along with uterine artery peak systolic velocity on both sides. Endometrial blood flow was analysed by detecting flow in the intra-endometrial or the adjacent sub-endometrial regions.

Results Baseline FSH in pregnant group was lower (6.29) than non-pregnant group (7.36). The overall pregnancy rate was 45.6% (n=31) and the ongoing pregnancy rate was 41.1% (n=28). Total of 57 patients out of 68 patients had both good endometrial and sub-endometrial blood flow. The overall pregnancy rate in this group was 47.3%. Similarly, in patients who had minimal endometrial and sub-endometrial blood flow the pregnancy rate was 37.5%. There was no significant correlation between pregnancy outcomes and the color flow Doppler parameters such as average uterine PI, average uterine RI and right/left uterine peak systolic velocity.

Conclusion Uterine artery PI, RI and PSV has no role in predicting endometrial receptivity and thus pregnancy outcome in IVF-ET cycle, however those patient with good endometrial and sub-endometrial flow have higher pregnancy rate than those with minimal flow rate.