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OBJECTIVE@#To evaluate the effect of manual acupuncture on endometrial blood flow parameters by three-dimensional (3D) power Doppler ultrasound in women undergoing in vitro fertilization embryo transfer (IVF-ET).@*METHODS@#Seventy patients undergoing IVF-ET were equally randomized into traditional or sham acupuncture treatment group for totally 4 days (from the day of oocyte aspiration to the day of embryo transfer) of treatment by random envelope method at the Reproductive Medicine Center and Outpatient Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2013 to December 2015. Patients in the traditional acupuncture group accepted traditional acupuncture methods with manual acupuncture, and Zhongji (CV3), Qihai (CV 6), Sanyinjiao (SP6), Taichong (LR 3), Tianshu (ST 25), Guilai (ST 29) and Zusanli (ST 36) were chosen. Patients at the sham acupuncture group accepted shallow acupuncture methods at 4 non-meridian points at each shoulder and upper arm. Outcome measures included endometrial ultrasonic indices such as vascularization index (VI), flow index (FI) and vascularization flow index (VFI), endometrial thickness and volume, subendometrial VI (sVI), subendometrial FI (sFI), subendometrial VFI (sVFI), implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births.@*RESULTS@#Finally, 34 patients in the traditional acupuncture group and 35 in the sham acupuncture group completed this trial. VI, FI and VFI of the traditional acupuncture group were significantly higher than those in the sham acupuncture group (P<0.05). No significant differences were found in endometrial thickness, endometrial volume, sVI, sFI, sVFI, implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births (P>0.05).@*CONCLUSIONS@#Manual acupuncture performed after oocyte aspiration and before transplantation improved the endometrial blood flow parameters VI, RI and VFI in women who underwent IVF-ET, instead of sVI, sFI and sVFI. Therefore, acupuncture might be beneficial in women undergoing IVF-ET by increasing endometrial blood flow and endometrial receptivity. (Registration No. ChiCTR2100053354).
Subject(s)
Pregnancy , Humans , Female , Fertilization in Vitro/methods , Single-Blind Method , Embryo Transfer , Pregnancy Rate , Acupuncture Therapy , Endometrium/blood supplyABSTRACT
Objective:To investigate the clinical value of endometrial receptivity determination by transvaginal three-dimensional power ultrasound in the prediction of pregnancy outcome after in vitro fertilization and embryo transfer. Methods:A total of 220 infertile patients who underwent in vitro fertilization and embryo transfer in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2018 to July 2021 were included in this study. Before in vitro fertilization and embryo transfer, all patients were tested for endometrial receptivity by transvaginal two-dimensional and three-dimensional power ultrasound. Pregnancy outcomes were followed up. Anatomical indexes (endometrial thickness, endometrial volume, and endometrial morphology) and endometrial blood flow indexes [endometrial blood flow type, pulsation index, resistance index (RI), ratio of peak systolic velocity to end-diastolic velocity (S/D), vascularization index (Vl), blood flow index (FI) and vascular blood flow index (VFI)] were compared between different pregnancy outcomes. Results:There were no significant differences in endometrial thickness, endometrial volume, and endometrial morphology between successful pregnancy and failed pregnancy groups ( t or χ2 = 0.23-0.54, P = 0.523-0.890). There was no significant difference in endometrial blood flow typing between successful pregnancy and failed pregnancy groups ( χ2 = 0.217, P = 0.897). PI, RI, and S/D in the successful pregnancy group were (2.46 ± 0.29), (1.07 ± 0.21), and (0.57 ± 0.10), respectively, which were significantly lower than (2.71 ± 0.34), (1.35 ± 0.24), and (0.66 ± 0.11) in the failed pregnancy group ( t = 4.51, 5.27, 3.43, all P < 0.001). VI, FI, and VFI values in the successful pregnancy group were (23.04 ± 2.95), (32.26 ± 3.17), and (6.59 ± 0.94) respectively, which were significantly higher than (16.85 ± 2.17), (28.42 ± 3.04), and (4.88 ± 0.86) in the failed pregnancy group ( t = 10.94, 6.25, 8.37; all P < 0.001). Conclusion:Endometrial blood flow parameters such as PI, RI, S/D, VI, FI, and VFI determined by transvaginal three-dimensional power ultrasound have a certain predictive value for pregnancy outcomes after in vitro fertilization and embryo transfer. They can be used as sensitive indexes for evaluating endometrial receptivity.
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Objective·To study the hemodynamic parameters of uterine at midluteal phase in patients with early recurrent spontaneous abortion (ERSA) and the effect of aspirin on them. Methods·Transvaginal color Doppler ultrasonography was used to measure the parameters of uterine blood flow and the endometrial thickness at midluteal phase of 271 women with ERSA (ERSA group) and 66 women without a history of recurrent spontaneous abortion (control group). Then ERSA group were administered with aspirin 50 mg/d orally for 2 months and other individualized treatment, and the effect of aspirin on parameters of uterine blood flow and the early pregnancy outcome of them were observed. Results·At midluteal phase, the endometrium was significantly thinner in ERSA group than that in control group. Pulsatility index (PI) of endometrial blood flow and mean PI (mPI), mean resistance index (mRI), and mean systolic/diastolic ratio value (mS/D) of uterine arteries were statistically significantly higher in ERSA group in comparison to control group (P<0.05). Following aspirin treatment, resistance to uterine blood flow reduced significantly in ERSA group (P=0.000), and the endometrial thickness increased in the patients with endometrial thickness less than 7 mm (P=0.000). Only 163 ERSA patients were re-examined by transvaginal color Doppler ultrasonography after aspirin treatment, among whom 136 women was pregnant after individualized treatment. Among these pregnant patients, 97 cases were pregnant for more than or equal to 12 weeks, while 10 cases aborted during the first 12 weeks, and the early pregnancy outcomes of the other 29 cases were still unclear. Conclusion·In comparison with normal fertile women, ERSA patients have significantly higher resistance to uterine blood flow and thinner endometrium. Aspirin can improve uterine blood perfusion, which improves early pregnancy outcome.
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Background: The objective of the study was to evaluate the role of subendometrial-endometrial blood flow assessment by 3D Tran-vaginal Power Doppler in predicting pregnancy outcome in IVF-ET cycles. The study was a prospective, non-randomized clinical study. Methods: A total of 107 infertile women undergoing their first IVF-ET cycle with good response were taken for study (From March 2014 to Nov 2014 at Jaipur Fertility Centre, ART unit of Mahatma Gandhi University of Medical Sciences & Technology). Women with Tubal factor, Male factor and unexplained infertility were included in the study. Those with past h/o Genital Koch’s and hypo menorrhea were excluded. Assessment of subendometrial-endometrial blood flow was done on the day of HCG with endometrial thickness ≥ 6.5mm by Tran-vaginal 3D- Power Doppler. Results: There was no significant difference in mean age, duration of infertility, BMI, cause of infertility, stimulation protocol, serological hormone levels, number of mature oocytes, number of good quality embryos and mean endometrial thickness on the day of HCG. According to Doppler study (3D-Power Doppler), women with blood flow to zones 1, 2 and 3 were categorized in to groups A (n=15), B (n=36) and C (n=56). Overall pregnancy rate was 32.71%. The clinical pregnancy rate was significantly higher in Group C in comparison of Group B and A (42.85% vs. 27.77% and 6.66%). Similarly implantation rate was also higher in group C (23.20% vs. 11.22% and 2.38%). Conclusions: The presence of good subendometrial-endometrial vascularity significantly improves pregnancy outcome in IVF-ET cycles in our study.
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Objective To discuss the role of endometrial blood flow screening measured by color Doppler energy(CDE) in the prediction of outcomes in patients receiving in vitro fertilization and embryos transfer(IVF-ET).Methods A total of 182 women below the age of 38 years old undergoing IVF-ET in this center from November 2005 to December 2005 were recruited in this prospective study.The endometrial thickness,echo pattern,and blood flow status were detected by transvaginal ultrasonography on the day of hCG injection(8 hours before injection).The patients were divided into three groups: Group A,the endometrial blood flow could not be detected;Group B,only sub-endometrial blood flow could be detected;and Group C,both endometrial and sub-endometrial blood flow could be detected.All the patients were re-divided into three groups according to their outcomes of IVF-ET: Group 1,no pregnancy;Group 2,intrauterine pregnancy with live fetus and Group 3,other conditions(including biochemical pregnancy,embryonic diapause,ectopic pregnancy,and spontaneous abortion) were encountered.Results The clinical pregnancy rate with live fetus and the implantation rate were significantly higher in the Group C(62.2% and 65.6%) than in the Group A(0 and 0) and the Group B(17.1% and 20.7%),respectively(P