Endometrial blood flow evaluation in women with uterine fibroids during in vitro fertilization treatment

Abstract

BACKGROUND: Sufficient endometrial blood supply in the mid-secretory phase of the menstrual cycle is a key to a successful pregnancy achievement, and a decreased spiral artery blood flow resistance determined by the Doppler is known to be positively associated with successful in vitro fertilization outcome. Particular aspects of endometrial blood flow in women with uterine fibroids might affect the efficiency of in vitro fertilization and intra cytoplasmic sperm injection cycles.

AIM: The aim of this study was Doppler-based determination of the uterine and spiral artery blood flow resistance in women with uterine fibroids throughout controlled ovarian stimulation in in vitro fertilization cycles, depending on the clinical pregnancy rate.

MATERIALS AND METHODS: Doppler ultrasound spiral artery blood flow evaluation was performed in 83 women throughout the in vitro fertilization cycle. Intramural uterine fibroids were detected in 44 women, and 39 women with no uterine fibroids comprised the comparison group. All women underwent a Doppler study of spiral artery blood flow on the second or third day of the menstrual cycle (at the start of the in vitro fertilization protocol) and on the day of embryo transfer. The in vitro fertilization efficiency was determined by the onset of clinical pregnancy after visualizing the gestational sac in the uterine cavity during ultrasound examination on the 20–25th day after embryo transfer.

RESULTS: The values of the uterine and spiral artery blood flow resistance in the uterine fibroids group were determined to be significantly lower than those in the comparison group. Considering the identified influence of decreased spiral artery blood flow resistance on the results of in vitro fertilization cycles in the comparison group, we have analyzed the dependence of the efficiency of the cycles based on the rate of the spiral artery blood flow resistance decline. Thus, a significantly more reliable decline in the pulsatility index was revealed in pregnant women from the comparison group throughout the in vitro fertilization cycle compared to women with negative results. In women with uterine fibroids, the pulsatility index decline did not differ depending on the onset of pregnancy, and the decline rate differed significantly from that in the comparison group.

CONCLUSIONS: Uterine fibroids are associated with a stable decline in the uterine and spiral artery blood flow resistance. This leads in turn to increased endometrial vascularization throughout the stimulation cycle in in vitro fertilization programs and negatively affects the blastocyst implantation ability.

Keywords

uterine fibroids / infertility / in vitro fertilization / endometrium / color Doppler ultrasonography / spiral arteries

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