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DOI: 10.1055/s-2003-41863
© Georg Thieme Verlag Stuttgart · New York
Impact of three-dimensionally measured endometrial volume on the pregnancy rate after intrauterine insemination
Einfluss des Endometriumvolumens auf die Schwangerschaftsrate bei der Intrauterinen InseminationPublication History
Publication Date:
04 September 2003 (online)
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Abstract
Objective: The success of artificial reproductive techniques not only depends on the quality of oocytes and spermatozoa but also on the receptivity of the endometrium. The aim of this study was to assess the role of endometrial volume measurement by three-dimensional ultrasound in predicting the pregnancy rate (PR) in women receiving controlled ovarian hyperstimulation followed by intrauterine insemination.
Material and Methods: 104 patients having intrauterine insemination (IUI) were included in this prospective trial. Ovarian hyperstimulation was performed with gonadotropins in 73 % of patients and with clomiphene citrate (CC) in 27 % of patients. Endometrial thickness, pattern and three-dimensional volume were measured immediately before insemination.
Results: In 104 IUI cycles a total of 14 clinical pregnancies were recorded (PR=13.5 %). The endometrial volume was 3.5 ml and was not significantly different in pregnant (4.0 ± 1.5 ml) from non-pregnant women (3.4 ± 1.9 ml). In the subgroup of women with an endometrial volume ≥ 2 ml and trilaminar endometrium the pregnancy rate was 22 %, significantly higher than that in women without these two criteria (PR 6 %, p < 0.05). The negative predictive value of an endometrial volume < 2 ml for a clinical pregnancy after IUI was 96 %. Endometrial volume and thickness were significantly higher after ovarian hyperstimulation with gonadotropins (3.7 ml and 11.0 mm) than with CC (2.8 ml and 9.5 mm; p < 0.05).
Conclusions: An endometrial volume < 2 ml at the day of insemination is associated with a poor likelihood of pregnancy. Endometrial volume measured by 3D ultrasound is a new objective parameter to predict endometrial receptivity.
Key words
Endometrial pattern - thickness and volume - insemination - 3D-ultrasound
References
- 1 Ayida G, Kennedy S, Barlow D, Chamberlain P. Contrast sonography for uterine cavity assessment: a comparison of conventional two-dimensional with three-dimensional transvaginal ultrasound; a pilot study. Fertil Steril. 1996; 66 848-850
- 2 Bohrer M K, Hock D L. Sonographic assessment of endometrial pattern and thickness in patients treated with human menopausal gonadotropins. Fertil Steril. 1996; 66 244-247
- 3 Bordes A, Bory A M, Benchaib M, Rudugoz R C, Salle B. Reproducibility of transvaginal three-dimensional endometrial volume measurements with virtual organ computer-aided analysis (VOCAL) during ovarian stimulation. Ultrasound Obstet Gynecol. 2002; 19 76-80
- 4 Check J H, Diettrich C, Lurie D. Non-homogenous hyperechogenic pattern 3 days after embryo transfer is associated with lower pregnancy rates. Hum Reprod. 2000; 15 1069-1074
- 5 De Geyter C, Schmitter M, De Geyter M, Nieschlag E, Holzgreve W, Schneider H PG. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1 186 infertile women. Fertil Steril. 2000; 73 106-113
- 6 Friedler S, Schenker J G, Herman A, Lewin A. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update. 1996; 2 323-335
- 7 Gentry W L, Thomas S, Critser E S. Use of endometrial measurement as an exclusion criterion for in vitro fertilization using clomiphene citrate. J Reprod Med. 1996; 41 545-547
- 8 Hock D L, Bohrer M K, Ananth C V, Kemmann E. Sonographic assessment of endometrial pattern and thickness in patients treated with clomiphene citrate, human menopausal gonadotropins, and intrauterine insemination. Fertil Steril. 1997; 68 2442-2445
- 9 Ijland M M, Evers J LH, Dunselman G AJ, Hoogland H J. Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles. Fertil Steril. 1998; 70 279-283
- 10 Ijland M M, Hoogland H J, Dunselman G AJ, Lo C R, Evers J LH. Endometrial wave direction switch and the outcome of in vitro fertilization. Fertil Steril. 1999; 71 476-481
- 11 Isaacs Jr J D, Wells C S, Williams D B, Odem R R, Gast M J, Strickler R C. Endometrial thickness is a valid monitoring parameter in cycles of ovulation induction with menotropins alone. Fertil Steril. 1996; 65 262-266
- 12 Kyei- Mensah A, Maconochie M, Zaidi J, Pittrof R, Campbell S, Tan S L. Transvaginal three-dimensional ultrasound: reproducibility of ovarian and endometrial volume measurements. Fertil Steril. 1996; 66 718-722
- 13 Lee A, Sator M, Kratochwill A, Deutinger J, Vytiska-Binsdorfer E, Bernaschek G. Endometrial volume change during spontaneous menstrual cycles: volumetry by transvaginal three-dimensional ultrasound. Fertil Steril. 1997; 68 831-835
- 14 Lesny P, Killick S R, Tetlow R L, Manton D J, Robinson J, Maguiness S D. Ultrasound evaluation of the uterine zonal anatomy during in- vitro fertilization and embryo transfer. Hum Reprod. 1999; 14 1593-1598
- 15 Oliveira J BA, Baruffi R LR, Mauri A L, Petersen C G, Borges M C, Franco JG J r. Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme after ovarian stimulation and gonadotrophin-releasing hormone and gonadotrophins. Hum Reprod. 1997; 12 2515-2518
- 16 Raga F, Bonilla-Musoles F, Casan E M, Klein O, Bonilla F. Assessment of endometrial volume by three-dimensional ultrasound prior to embryo transfer: clues to endometrial receptivity. Hum Reprod. 1999; 14 2851-2854
- 17 Raine-Fenning N, Campbell B, Collier J, Brincat M, Johnson I. The reproducibility of endometrial volume acquisition and measurement with the VOCAL-imaging program. Ultrasound Obstet Gynecol. 2002; 19 69-75
- 18 Reuter K L, Cohen S, Furey L, Baker S. Sonographic appearance of the endometrium and ovaries during cycles stimulated with human menopausal gonadotropin. J Reprod Med. 1996; 41 509-514
- 19 Schild R L, Indefrei D, Eschweiler S, van der Ven H, Fimmers R, Hansmann M. Three-dimensional endometrial volume calculation and pregnancy rate in an in-vitro fertilization programme. Hum Reprod. 1999; 14 1255-1258
- 20 Schild R L, Knobloch C, Dorn C, Fimmers R, van der Ven H, Hansmann M. Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and uterine artery blood flow. Fertil Steril. 2001; 75 361-366
- 21 Tan S L. Clinical applications of Doppler and three-dimensional ultrasound in assisted reproductive technology. Ultrasound Obstet Gynecol. 1999; 13 153-156
- 22 Tsai Y C, Tai M C, Chang J C. Predictive value of endometrial sonography in ovulation induction for intrauterine insemination. J Formos Med Assoc. 1995; 94 626-629
- 23 Tsai H D, Chang C C, Hsieh Y Y, Lee C C, Lo H Y. Artificial insemination. Role of endometrial thickness and pattern, of vascular impedance of the spiral and uterine arteries, and of the dominant follicle. J Reprod Med. 2000; 45 195-200
- 24 World Health Organization .WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. 3rd edn. Cambridge University Press, Cambridge, UK 1992
- 25 Yaman C, Sommergruber M, Ebner T, Wölz P, Moser M, Tews G. Reproducibility of transvaginal three-dimensional endometrial volume measurements during ovarian stimulation. Hum Reprod. 1999; 14 2604-2608
- 26 Zaidi J, Campbell S, Pittrof R, Tan S L. Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program. Ultrasound Obstet Gynecol. 1995; 6 191-198
- 27 Zollner U, Zollner K P, Hartl G, Dietl J, Steck T. The use of a detailed zygote score after IVF/ICSI to obtain good quality blastocysts - the German experience. Hum Reprod. 2002; 17 1327-1333
Dr. med. Ursula Zollner
Universitäts-Frauenklinik Würzburg
Josef-Schneider-Straße 4
97080 Würzburg
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Email: zollner_u@klinik.uni-wuerzburg.de