| Purpose Based on follicles, ovarian size as well as ovarian position, ovarian status, endometrial thickness, endometrial movement method, endometrial blood flow typing and blood flow parameters of uterine artery and uterine spiral artery on the day of HCG and on the day of ET monitored in transvaginal color Doppler sonography IVF-ET process, this article is to explore (1 Relationship between factors, such as, age, basic sexual hormone level, Gn dosage, ovarian size, antral follicle number, number of follicles on the day of HCG, number of retrieved oocytes, etc. and ovarian reserve as well as pregnant outcome. (2) Influence of factors, such as, ovarian position, ovarian status, endometrial thickness, endometrial movement method, endometrial blood flow typing and blood flow parameters of uterine artery and uterine spiral artery on the day of HCG and on the day of ET, etc. on endometrial receptivity and pregnant outcome.Methods 1.144 infertile women patients in total during the period from October to December 2009, and period from October to December 2010 are selected as research objects for research on ovarian reserve and reactivity. The blood is sampled on the third day of natural period, laboratory in our institute provides assistance, VIDAS-30PC full-automatic photochemical instrument and test paper and full-automatic fluorescence immunoassay analyzer produced by French BioMerieux Company is used to obtain the result of sexual hormone FSH, LH and E2; GE VOLUSON E8 color Doppler ultrasonic diagnostic apparatus produced by GE Company is used to observe the follicles, ovarian size and numbers of follicles with 2-9mm diameter of both sides, which is AFC, observe growth and development of follicles, count follicles on the day of HCG, measure maximum long radium and horizontal radium of ovary and obtain the average. The total measured value of ovary at both sides represents ovarian size. As for analysis on ovarian reserve and reactivity, there are low reactivity group (number of retrieved oocytes≤5), normal reactivity group (6～15) and high reactivity group (>15) according to number of retrieved oocytes; AFC can be classified into group (≥10) and group (<10) according to antral follicle number and the groups can be classified into pregnant group and non-pregnant group according to pregnant outcome to conduct statistics and analysis respectively.2.92 infertile women patients in total during the period from October to December 2010 are selected as research objects for research on endometrial receptivity. GE VOLUSON E8 color Doppler ultrasonic diagnostic apparatus produced by GE Company is in use to observe ovarian position including anterior position, horizontal position and posterior position; observe endometrial status including Type A, Type B and Type C; measure endometrial thickness, obtain maximum real endometrial vertical section and measure the maximum distance between anterior myometrium & posterior myometrium and endometrial interface; observe endometrial movement method, keep the position of probe fixed, ask the patients to tranquilize themselves and record type and frequency of endometrial wave movement after observation for three minutes. The endometrial wave movement is in ljland typing method, which includes positive movement, negative movement, opposite movement, irregular movement and no movement; measure blood flow parameters of uterine artery, distinguish uterine artery beside cervix, put sample frame at here, adjust it until there is clear signal and satisfied blood flow spectrum, conduct measurement after there are at least 5 stable oscillograms, record peak systolic velocity PSV and end diastolic velocity D, S/D value, pulse index PI and resistance index RI; observe endometrial blood flow typing, adopt Power Doppler imaging PDI, regulate the instrument to the most sensitive status, display endometrial blood vessels in the same frequency and observe endometrial and endometrial blood flow distribution including Type A, Type B and Type C; measure blood flow parameters of uterine spiral artery, adopt Power Doppler imaging PDI to display endometrial spiral artery, sample here, measure PSV, EDV, S/D, PI and RI values after there are satisfactory blood flow spectrum and at least 5 continuous stable oscillograms. They can be divided into pregnant group and non-pregnant group upon pregnant outcome for comparison.3. Statistics treatment:After all data are encoded completely, input them into Excel database, lock database after verification, utilize SPSS15.0 statistics software to conduct statistics analysis and select corresponding statistics methods including: χ2 test, rank sum test, t test and others. The standard for test is 0.05.Result1. Comparison of FSH & E2 between pregnant group and non-pregnant group, the difference is significant in statistics (P<0.05), FSH is more in pregnant group and E2 is more in non-pregnant group; there is statistics difference of LH and ratio of between both groups ((P>0.05); Table 3 indicates that if different reactivity groups are compared in ratio and E2, the difference is significant in statistics (P<0.05) and the E2 and ratio is the most in low reactivity group; as for comparison of FSH and LH in different reactivity groups, the difference is insignificant in statistics(P>0.05). Table 4 indicates that:if comparison is conducted between pregnant group and non-pregnant group, the difference of AFC, follicles and number of retrieved oocytes is insignificant in statistics (P>0.05). Table 7 further proves that the influence of AFC on pregnant outcome is limit (P>0.05), Table 5 indicates that the difference of age, AFC, follicles, number of retrieved oocytes, number of embryo and ovarian size in comparison of different reactivity groups is significant in statistics (P<0.05), except for age, other indexes are in maximum in high reactivity group and other indexes are in minimum in low reactivity group. The age is in minimum in high reactivity group, while the age is in maximum in low reactivity group. AFC in this research is divided into two groups according to definition value 10 for research. Table 6 indicates that the age, total Gn quantity, ovarian size, number of retrieved oocytes, number of embryos, basic FSH,, ratio between FSH and LH and difference of E2 on the day of HCG. In different groups are significant in statistics (P<0.05), the age, total Gn quantity, basic FSH and ratio between FSH and LH in AFC<10 group are more than that in AFC≥10 group, the ovarian size, number of retrieved oocytes, number of embryos and E2 on the day of HCG in AFC<10 group are less that in AFC≥10 group. Table 8 indicates that the difference of pregnant outcome in different reactivity groups is not significant in statistics (P>0.05). The research on total measured value of both sides indicates that the difference of ovarian size in different reactivity groups is significant in statistics (P<0.05). The difference in comparison of age, BMI, total Gn quantity and total quantity between both groups is not significant in statistics (P>0.05) and the difference of total Gn quantity is significant in statistics when AFC is with 10 as definition value(P<0.05). Gn dosage as per analysis on Spearman is in negative correlation with AFC (rs=-0.486, P=0.000), while it is in positive correlation with number of retrieved oocytes (rs=0.310, P=0.000), follicles (rs= 0.449, P=0.000) and number of embryos (rs=0.350, P=0.000).2. The difference of the day of HCG and the day of ET, pregnant group and non-pregnant group, ovarian position, endometrial status and thickness in comparison is not significant in statistics (P>0.05), but the number of patients with Type A endometria on the day of HCG accounts for 53% in total number in observation, while the number on the day of ET is dominant with around 73% in total number. If the statistics and analysis is conducted when endometrial thickness is divided into those>10mm and those<10mm, the comparison result (P<0.05) between pregnant group and non-pregnant group is still insignificant in statistics (P>0.05); the difference between both movement methods in pregnant group and non-pregnant group on the day of HCG is insignificant in statistics (P>0.05), while the difference between both movement methods in pregnant group and non-pregnant group on the day of ET is significant in statistics (P<0.05), the positive movement and relative rest in pregnant group accounts for most part, around 74%, the movement frequency is mainly in slight movement, accounting for 84%, while the negative movement, opposite movement and irregular movement in non-pregnant group accounts for 78.6%, and the middle movement is the main form, accounting for 71.4%; As for comparison of blood flow parameters of uterine artery and uterine spiral artery on the day of HCG and on the day of ET between pregnant group and non-pregnant group, the difference of indexes is insignificant in statistics(P>0.05). As for comparison of blood flow parameters of uterine artery on the day of HCG and on the day of ET with only PS on the day of HCG and on the day of ET, the difference is significant in statistics (P<0.05) and that on the day of ET is higher than that on the day of HCG; the difference of endometrial blood flow typing on the day of HCG and on the day of ET in comparison between two groups is significant in statistics (P<0.05). Type B and Type C are dominant in pregnant group and Type A and Type B are dominant in non-pregnant group. Table 14 and Table 15 in this research indicate that the difference of endometrial thickness related to single factor and endometrial status on the day of HCG is insignificant in statistics. However, when the endometrial thickness is more than 10mm, the endometrial status is in A Type and three are 3 conditions for Type C of endometrial blood flow typing on the day of ET and the best condition shall meet completely three requirements, the pregnant rate which satisfies the best condition is in maximum, those which satisfy two requirements take the second place, but the difference is insignificant in statistics. If there is condition to expand samples, the difference may be significant in statistics.Conclusion1. Rise of bE2 reflects the drop of ovarian reserve function to certain extent and the correspondingly lower pregnant rate. The basic FSH/LH ratio is related to ovarian reaction of which the influence on pregnant outcome is limit.2. As for comparison between pregnant group and non-pregnant group, the difference of AFC, follicles and number of retrieved oocytes is insignificant in statistics and the influence of AFC on pregnant outcome is limit. However, as for comparison of different reactivity groups, AFC difference is significant in statistics and the ovarian reactivity can be predicted better.3. The difference of ovarian size in different reactivity groups is significant in statistics, which is valuable in prediction of ovary reactivity.4. The pregnant outcome can not be judged only based on the single factor of ovarian position, endometrial status or endometrial thickness, but the thinnest endometria of those who can be pregnant is 7.0mm. The result supports the latest view.5. The endometrial movement on the day f HCG has no influence on pregnant outcome, while the endometrial movement method on the day of ET is closely related to pregnant outcome. The positive movement and relative rest type account for the most in pregnant group and the movement is in slight movement form. However, the negative movement, opposite movement and irregular movement in pregnant group accounts for the most and the middle movement is the main form. If it is held that there is positive movement or relative rest movement on the day of ET in slight movement form, the endometrial receptivity is better which is apt to nidation. 6. The blood flow parameters of uterine artery and uterine spiral artery on the day of HCG and on the day of ET can not predict endometrial receptivity effectively.7. The endometrial blood flow typing is significant in evaluation of endometrial receptivity to certain extent. Type B and Type C are dominant in pregnant group, while Type A and Type B are dominant in non-pregnant group.
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