Ultrasound Indicators To Evalutate Endometrial Receptivity In Frozen Thawed Embryo Transfer Cycles

Objective: The aim of this study was assessment of endometrial parameters with transvaginal three-dimensional power Doppler ultrasound(3D-PDU)as an indicator of endometrial receptivity in artificial frozen-thawed blastocyst transfer cycles on the day before transplantation.Methods: Patients undergoing frozen-thawed blastocyst transfer cycles in gonadotropin releasing hormone-agonist hormone replacement therapy(GnRH-a+HRT)and hormone replacement therapy(HRT)were recruited.Transvaginal three-dimensional power Doppler ultrasound(3D-PDU)were performed on the day before transplantation to determine endometrial thickness,endometrial volume(V),uterine peristalsis wave frequeney(UPF),pulsatility index(PI)and resistance index(RI)of uterine artery,Pulsatility index(PI),resistance index(RI),and systolic/diastolic(S/D)ratio of spiral artery,vascular index(VI),flow index(FI),vascular flow index(VFI)of the endometrium.Measurements were analyzed relative to pregnancy outcome and the program of endometrial preparation.Results:1.In FET cycles,endometrial volume,Endometrial VI,FI,and VFI were signifcantly higher,whereas uterine peristalsis wave frequeney was lower in the pregnant group than those of the nonpregnant group.In a binary logistic regression analysis,the type FET cycles,endometrial volume,and Endometrial FI were positively related to the clinical pregnancy rate,but uterine peristalsis wave frequency and number of ET cycles were inversely related to the clinical pregnancy rate.The area under receiver operating characteristic(ROC)curve was statistically significant for Endometrial FI(0.637),uterine peristalsis wave frequeney(0.705).2.For GnRH-a+HRT cycles,The pregnant group had higher endometrial FI,and lower uterine peristalsis wave frequeney than the nonpregnant group.According to binary logistic regression analysis,endometrial FI and uterine peristalsis wave frequeney were significantly associated with the chance of pregnancy.The area under the ROC curve of endometrial FI,uterine peristalsis wave frequeney for predicting pregnancy was 0.674,0.699.3.For HRT cycles,In the pregnant group,only uterine peristalsis wave frequeney was statistically significantly lower.Binary logistic regression analysis revealed that the uterine peristaltic wave frequency on the day beforetransplantation was inversely related to the clinical pregnancy rate.The area under the ROC curve of uterine peristalsis wave frequeney was 0.723.4.For endometrial preparation protocols,The clinical pregnancy rate(71.4%)and the implantation rate(54.6%)in the GnRH-a+HRT group was higher than that in the HRT group(60.0%and 48.4%),with no statistical difference.There were no significant differences in all ultrasound parameters between two groups.Conclusions:1.Uterine peristalsis wave frequency,endometrial volume,Endometrial VI,FI,and VFI have certain value on predictiving endometrial receptivity.Uterine peristalsis wave frequency and Endometrial FI are indicators to predictor endometrial receptivity in artificial frozen-thawed blastocyst transfer cycles on the day before transplantation.Endometrial thickness,uterine artery and spiral artery blood flow parameters have no value for the prediction of endometrial receptivity if measured at one time point only.2.When the non-endometriosis patients with frozen-thawed embryo selecting endometrial preparation program,GnRH-a + HRT is not better than HRT.