| Background:The World Health Organization announced that cardiovascular disease, cancer and infertility as three main diseases affect human life and health today. So the society pay more and more attention to the research and treatment of infertility, but no matter which treatment method is now, a good-quality embryos, good endometrial receptivity and mutual response between them is the key. Research about endometrial receptivity is growing in modern medical science, and it has become the focus that is a worldwide system of reproductive medicine research. Whether research or to improve endometrial receptivity, a good evaluating indicator is necessary. Endometrial biopsy is the best way to evaluate endometrial receptivity, but it is largely limited in clinical applications because it is an invasive examination. Ultrasonography is an intuitive, simple, non-invasive and repeatable evaluation way, it is being praised highly for it’s great valuable in clinical. Many parameters that affect endometrial receptivity has been studied by using ultrasonic Doppler.Purpose:Check the endometrial thickness and morphology, RI and PI index of uterine artery, and the endometrial blood flow distribution by using transvaginal ultrasound, to evaluate endometrial receptivity in infertility patients.Methods:From2013/03to2014/12, there are98female of infertility patients accept the treatment of ovulation, using the way of clomiphene citrate (clomiphene, CC)/menopausal gonadotropin (human menotrophin gonadotropin, HMG)/HCG ovulation induction, and have transvaginal ultrasound’s check on the HCG injection day. The check is to observe and measure the size and shape of the ovaries, measure the uterus endometrial thickness in the median sagittal plane, observe the shape of the endometrial morphology, measure the uterine artery PI/RI of follicle side which has advantage, and observe the endometrial blood flow’s distribution by power Doppler. According to endometrial thickness, the following3groups are setup.:(1)<7mm,(2)7-14mm,(3)>14mm. According to Gonen transvaginal ultrasound endometrial morphology classification, the following endometrial morphology is classified. A:Typical three line type or multiple layers type, the outer and central is hyperechoic area, between the outer and Uterine cavity middle is hypoechoic area or dark area; B:Homogeneous medium strength echoic type, Uterine cavity’s hyperechoic midline intermittently and unclearly; C:Homogeneous echogenic type, there is no Uterine cavity middle echo; Analyse endometrial thickness and endometrial morphology has the Effect on the clinical pregnancy rate. Analyse Effect of uterine artery PI/RI on the clinical pregnancy rate.Typing the uterine artery blood flow under endometrial according to the power Doppler observing, divide it into type I-III by Applehau[2] of classification system. Type Ⅰ:endometrial blood flow through the outer hypoechoic band, but did not reach the outer edge of endometrial hyperechoic; Type II:hyperechoic endometrial blood flow through the outer edge, but did not enter the endometrial hypoechoic areas; Type III:blood flow into the endometrial hypoechoic areas.According to whether or not pregnancy, divided into two groups, have the statistical analysis, compare between the presence and absence of significant differences on every parameters.Results:98patients after ovulation induction treatment,33patients with pregnancy, the pregnancy rate was33.67%. Pregnant and non-pregnant patients showed no statistical significance in general Conditions. Endometrial thickness in patients with pregnancy group was10.56±2.11mm, non-pregnant patients endometrial thickness was9.34±2.57mm, the difference between the two groups was statistically significant. Group1of15patients whit no pregnancy, the pregnancy rate was39.68%Group2, Group3pregnancy rate was40%, between the groups was statistically significant difference; A type group of endometrial pregnancy rate was51.2%, B type group pregnancy rate was22.5%, C type group pregnancy rate was17.6%, among the groups were statistically significant differences; Comprehensive comparison of endometrial thickness and morphology Type A to Type C decreased pregnancy rate in Group2and Group3. Endometrial thickness is constant, A type of endometrial with highest pregnancy rate; Uterine artery PI pregnancy group was2.23±0.42, RI was0.71±0.15, non-pregnant group PI was2.45±0.35, RI0.85±0.13, pregnant and non-pregnant group difference was statistically significant; Power Doppler blood type was observed under the endometrium, pregnancy rate was23.8%in group I, II group pregnancy rate was26.5%, III group pregnancy rate was53.6%, Ⅲ-type with type I and type II group was statistically significant, between group I and group II the difference was not statistically significant.Conclusion:Observing the endometrial thickness and the blood flow distribution patterns in endometrium and subendometrium and山e endometrial wavelike movements on the day of HCG administration using transvaginal ultrasonography may help to evaluate endometrial receptivity and to predict the pregnancy outcome. |
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