| BackgroundDespite advance in in vitro fertilization (IVF) techniques, pregnancy rates have not risen accordingly and implantation rates per embryo transferred still remain at about 15%. Embryo quality and a favorable endometrial receptivity are two most important factors for implantation. Endometrial receptivity refers to a state when endometrium allows a blastocyst to attach , penetrate and induce changes in the troma which result in embryonic implantation.Endometrial receptivity may be adversely affected by controlled ovarian hyperstimulation used in IVF cycles. Definite accepted criteria for evaluation endometrial receptivity in IVF are lacking, The method to evaluate the endometrial receptivity with no-invasive have not beenestablished.Since the introduction of transvaginal sonography, a number of studies have attempted to define a relationship between endometrial thickness, echogenicity and endometrial receptivity. Unfortunately, the sonographic parameters used to predict endometrial receptivity still lack specificity, and so the ideal method to predict endometrial receptivity by a non-invasive method has yet to be established. Development of three-dimensional(3D) ultrasonography has led improvement in the quality and precision of ultrasonographic examination. Recent studies have demonstrated the high degree of reproducibility and accuracy of volume estimation using 3D ultrasound both in vitro and in vivo . Volume estimation of the endometrium can be made easily because of good contrast between endometrial tissue and myometrium by 3D transvaginal ultrasonography. With the advent and evolution of three-dimensional ultrasonography we now stand at a new threshold in no-invasive diagnosis.Still now only three studies having reported the endometrial volume and pregnancy rate in IVF-ET patients was available. The findings of these studies are controversy. The objective of the current study was to demonstrate whether there was a value in predicting pregnancy withendometrial thickness and endometrial volume obtained by 3D transvaginal ultrosonography on the day of hCG administration in IVF-ET patients. Materials and methodsOne hundred and four patients having IVF-ET at our center for IVF between April 2003 and September 2003 were prospectively included. All patients for IVF-ET were due to tubal factor (75%),male factor(11.5%),tubal and male factor(13.5%). The mean±SD age of patients for IVF was 31.84±3.77years, Patients had been trying to get pregnancy for a mean±SD 5.10 ± 3.44 years. All patients were down-regulated with GnRH agonist according to the long protocol. Subsequently, the ovarian stimulation protocol began with the administration of recombinant human follicle stimulating hormone (rFSH) according to follicular development as assessed by transvaginal ultrasonographic scanning. The criteria for HCG administration were the presence of at least two follicles ≥18mm at mean diameter. At this stage, 10,000 IU of HCG were used to mature follicles and induce ovulation. rFSH injections were discontinued on the day of HCG administration. On the day of administration of HCG, endometrial thickness, endometrial volume and uterine volume were measured with2D and 3D transvaginal ultrasonography, meanwhile endocrine hormone LH, E2, P was examined. The endometrial thickness was measured at the maximum thickness between the highly reflective interfaces of the endometrial-myometrial junction after the uterus was located in a longitudinal view. The endometrial volume was measured by delineating the endometrial margin at the myometrial-endometrial interface from the fundus to the internal cervical os in a number of parallel slices. In addition, the entire uterine volume was also calculated as endometrial volume was. Oocyte retrieval 34-36h after HCG administration. Fertilization procedure were done according to local methods. Embryo transfer (ET) were performed 48h or 72h after oocyte retrieval. Progesterone injections was administrated intramuscularly 40mg bis in die for 14 days as luteal support after ET. Bi... |
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