| Objectives:The normal endometrium allows embryo implantation only in a very short period of time,known as the “window of implantation”period.And the endometrial receptivity to embryo implantation is called endometrial receptivity.By measuring the color doppler ultrasound parameters of endometrium and the VEGF expression level of endometrium in IVF-ET patients during the period of "window of implantation",the differences between the clinical-pregnancy group and the non-pregnant group were compared to demonstrate their relationship with the outcome of pregnancy,and then to clarify whether they could be an indicator of endometrial receptivity.By examining the correlation between endometrial ultrasound parameters and VEGF expression levels,the reliability and sensitivity of the endometrial receptivity evaluation indicators were judged to further guide the clinical work.Methods: According to the inclusion criteria and exclusion criteria,collected 350 infertile patients from IVF-ET at the Reproductive Medicine Center of The First Affiliated Hospital Of Soochow University during 2016-09-01~2017-08-31.After all the factors were excluded in the study,only 50 patients completed all the experimental steps in this study.The endometrial tissue was collected during“window of implantation”period of the preparatory cycle in IVF-ET,stored in a refrigerator at-80?,and the amplification multiplier of VEGF m RNA was measured by Real-time PCR experiment,and the VEGF protein gray scale was determined by Western Blot experiment.On the same day,two-dimensional and three-dimensional color Doppler ultrasonography was performed to record the endometrium thickness,the endometrium type,the endometrial volume,the RI and PI of the uterine artery,the spiral arterial type,the RI and PI of the spiral artery,and the VI,FI and VFI of endometrium.All patients were treated with long-term ovulation therapy and transvaginal oocyte retrieval was performed 36-38 hours after the injection of HCG.All patients were fertilized by IVF.2 fresh and high-quality embryos were transplanted on the 3rd day after operation,and luteum support was given after transplantation.Serum ?-HCG was measured after 2 weeks.The serum HCG was positive and the pregnancy was confirmed by ultrasound as the clinical pregnancy group.And negative cases were non-pregnant.Ultrasound indicates that the ectopic pregnancy excluded this study,and prompt the patient to treat early.Results:1.In the period of "window of implantation",there was no significant difference between the clinical pregnancy group and the non-pregnant group in the average age,the body mass index,the causes of infertility,the basic hormones(LH,FSH,E2,Pg)and the anti-Mullerian factor(AMH)(P>0.05).2.In the period of "window of implantation",the endometrium thickness in clinical pregnancy group and non-pregnant group was(10.38±2.59)mm and(11.28±2.96)mm,the RI of uterine artery was(0.80±0.08)and(0.84±0.08),the PI of uterine arteries was(2.06±0.64)and(2.15±0.56),as well as the endometrial types and the spiral arterial types,all of them were not statistically different(P>0.05).However,the endometrial spiral artery RI(0.55±0.06)and PI(0.83±0.06)in the clinical pregnancy group were significantly smaller than those in the non-pregnant group(0.61±0.07)(0.91±0.07),with statistical significance(P<0.05);the endometrial volume(5.92±0.85),the endometrial VI(3.42±0.81),the endometrial FI(23.03±3.38),and endometrial VFI(1.44±0.72)were significantly greater than those of non-pregnancy(4.43±0.86)?(1.59±0.72)?(19.84±4.70)?(0.88±0.47);and all of them were statistically significant(P<0.05).3.In the period of "window of implantation",the results of RT-PCR showed that the expression level of VEGF m RNA in the endometrium of the clinical pregnancy group(1.54±0.71)was significantly higher than that in the non-pregnant group(0.96±0.54),with statistically significant differences(P<0.05).And the Western Blot experiments showed that the expression level of VEGF protein in the endometrium of the clinical pregnancy group(0.74 ± 0.38)was significantly higher than that of the non-pregnant group(0.45 ± 0.27),and there was a statistical difference(P <0.05).4.In the period of "window of implantation",the endometrial VI,FI,VFI and VEGF m RNA expression have a certain correlation,but the uterine spiral artery RI,PI and VEGF m RNA expression was scattered distribution.And the Pearson analysis showed that there was a high positive correlation between the expression of VEGF m RNA in endometrium and the endometrial VI(r=0.741,P<0.01),a moderate positive correlation with the endometrial FI(r= 0.561,P<0.01)and the endometrial VFI(r=0.429,P<0.05).5.In the period of "window of implantation",the area under the ROC curve of each indicator of the endometrium was: the endometrial VI> the endometrial volume> the spiral arterial RI> the spiral arterial PI> the endometrial FI> the expression level of VEGF m RNA> the expression level of VEGF protein > the endometrial VFI(0.949> 0.888> 0.828> 0.826> 0.792> 0.762> 0.742> 0.717).It can be seen that the endometrial VI/FI/VFI,the endometrial volume,the spiral arterial RI/PI and the expression level of VEGF m RNA and protein of endometriumat have certain predictive value on pregnancy outcome(P< 0.01).In addition,the area under the ROC curve of the endometrial VI was the largest,with a sensitivity of 88% and a specificity of 92% with 2.556 as the critical point,whereas the sensitivity of the endometrial VFI is relatively weak(68%),the VEGF protein expression was relatively poor(48%).Conclusions:1.In the period of "window of implantation",In the clinical pregnancy group,the endometrial spiral arteries RI and PI were significantly smaller than those in the non-pregnant group,while the endometrial VI,FI,and VFI were significantly greater than those in the non-pregnant group.The area under the ROC curve of them was greater than 0.5,the endometrial perfusion index is closely related to the pregnancy outcome and can be used as one of the ultrasonic indicators of endometrial receptivity assessment.2.In the period of "window of implantation",the expression of VEGF m RNA and protein in the endometrium of the clinical pregnancy group was higher than that in the non-pregnant group,indicating that VEGF can increase the endometrial receptivity and provide assistance for embryo implantation.3.In the period of "window of implantation",according to the analysis of the correlation between endometrial VEGF expression levels and ultrasound perfusion indicators,ultrasound perfusion indices VI,FI,and VFI were positively correlated with the expression of endometrial VEGF,and were both predictors of pregnancy outcomes.In clinical practice,the expression of intimal VEGF can be reflected according to the ultrasound parameters VI,FI and VFI,so as to avoid the use of invasive VEGF biopsy to evaluate endometrial receptivity.4.In the period of "window of implantation",the area under the ROC curve of endometrial blood flow VI in the endometrial index is the largest.It has higher sensitivity and specificity compared with other indexes,and is one of the sensitive indicators for evaluating endometrial receptivity. |
PDF Full Text Request