Author(s): Wael S Nossair*
Background: Endometrial receptivity is an important factor that determines the success of embryo implantation; however, an appropriate method of assessing endometrial receptivity has not been well identified. We attempted to determine it via ultrasonographic evaluation of endometrial thickness/pattern as well as Doppler study of uterine artery blood flow.
Methods: We studied 100 women who underwent in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). Endometrial thickness/pattern, pulsutility index (PI), and estradiol level were calculated and related to pregnancy and embryo implantation rate.
Results: Endometrial thickness ≥ 8 mm was associated with good pregnancy rate (30.8%); thin endometrium (<7.9 mm) is usually associated with implantation failure. Endometrial thickness has a high sensitivity and negative predictive value (92.3; 90.9%, respectively) with low specificity and positive predictive value (27.0; 30.8%, respectively) for predicting pregnancy. High pregnancy rate was reported with triple layered endometrium (multilayered type) in comparison to other endometrial pattern: no pregnancy occurred with hyperechoic endometrium (non-multilayered type); A multilayered endometrial pattern has 100% sensitivity and negative predictive value but, the specificity and positive predictive value remain low (40.5; 37.1%, respectively). Combination of endometrial thickness and pattern increased the specificity and positive predictive value (48.6; 38.7%, respectively) but they are still unsatisfactory. Embryo implantation and pregnancy rate were higher in cases with low PI (< 3); but without significance.
Conclusion: Endometrial thickness and pattern had high sensitivity; however, neither endometrial thickness nor pattern is specific enough for pregnancy prediction. Doppler is neither sensitive nor specific to pregnancy prediction.