Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective co
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(2019) 17:74
RESEARCH
Open Access
Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study Zhaojuan Hou1,2, Qiong Zhang1,2, Jing Zhao1,2, Aizhuang Xu1,2, Aihua He1,2, Xi Huang1,2, Shi Xie1,2, Jing Fu1,2, Lan Xiao1,2 and Yanping Li1,2*
Abstract Background: There is much value in identifying non-invasive ways of measuring endometrial receptivity, as it has the potential to improve outcomes following in vitro fertilization (IVF). It has been suggested that endometrial echogenicity on the day of hCG administration was a good marker of endometrial receptivity. In the daily practice, we notice that patients with non-homogeneous hyperechoic endometrium on the embryo transfer day usually have lower pregnancy rates. We therefore extended the research onward transformation of echo pattern after hCG trigger to analyze the relationship between endometrial echogenicity transformation and IVF outcomes. Methods: A total of 146 infertile women undergoing their first IVF cycle were recruited in the prospective cohort study from August 2017 through August 2018. A series of endometrial echo pattern monitoring was carried out in these patients after hCG trigger: hCG day, from 1 through 3 days after ovum pick-up (OPU + 1, OPU + 2, OPU + 3). Results: The endometrial echogenicity value was calculated as the ratio of the hyperechogenic endometrial area over the whole endometrial area. Clinical pregnancy rate and embryo implantation rate had positive relationship with echogenicity value. The ROC curve analysis of endometrial echogenicity showed the area under curve was greatest on the second day after oocyte retrieval (OPU + 1, 2, 3 were 0.738, 0.765, 0.714 respectively) versus pregnancy. Endometrial echogenicity value on OPU + 2 had a higher predictive efficiency, and the cutoff value was 76.5%. The sensitivity was 61.3% and specificity was 82.0%. When putting the cut-off at 0.9 ng/ml at trigger day) than in the low progesterone group while it appeared similar on the day of hCG administration [27]. Supraphysiological progesterone levels could increase blood progesterone concentration and enhance endometrial secretory transformation in artificial hormonal replacement cycle. Conducting biopsy on Day 24 dated morphologically to Day 25.3 ± 0.4 denoted an advanced maturation of stroma [33]. Similarly, high progesterone receptors in the pre-ovulatory phase promoted endometrial responsiveness to progesterone stimulation after ovulation [34]. Human uterine natural killer (uNK) cells were abundant in the late secretory phase and sustained till first trimester pregnancy suggesting that they had an essential role in the progesterone-dominant phase. Studies of endometrial sampling indicated that uNK cells contributed to angiogenic process and circulatory regulation [35]. A recent study reported that the integrin-linked kinase played a pivotal part in morphologic transformation of endometrial stromal cells. It may function through organization of actin cytoskeleton or GSK3β
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