Serial uterine artery Doppler velocity parameters and human uterine receptivity in IVF/ICSI cycles.

OBJECTIVE: To evaluate the predictive value of serial uterine artery Doppler ultrasound for embryo implantation in in-vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) cycles. METHODS: This was a prospective observational study at the VU University Medical Center, Amsterdam. Patients with an indication for IVF or IVF-ICSI according to departmental protocol underwent controlled ovarian hyperstimulation followed by IVF or IVF-ICSI and embryo transfer and had serial Doppler ultrasound performed during this treatment cycle. Patient and cycle characteristics, number of conceptions and ongoing pregnancies and pulsatility index (PI) of both uterine arteries on different cycle days were assessed and results were compared between patients who conceived and those who did not. RESULTS: Of the 102 patients enrolled into the study, 83 underwent embryo transfer. Of these, 41 became pregnant and 42 did not (Group 1). Of the 41 pregnancies, 30 were ongoing (Group 2) and 11 miscarried (Group 3). Between Groups 1, 2 and 3, linear regression revealed no significant difference between any of the variables examined except in the quality of transferred embryos. There was no significant difference in the mean PI of the left and right uterine arteries on any day of the cycle, or in the change in PI during the cycle. Receiver-operating characteristics curves derived to determine the performance of PI to predict pregnancy outcome supported our findings that the uterine artery PI is not a suitable marker for identifying patients with implantation failure. Multivariate analysis showed no relationship between pregnancy and PI between groups, but it did show a relationship between pregnancy and some patient and cycle characteristics. CONCLUSION: In an unselected group of patients undergoing IVF or IVF-ICSI and embryo transfer, serial Doppler ultrasound examination of the uterine artery does not discriminate between cycles resulting in ongoing pregnancy, miscarriage and no pregnancy.

An anatomic basis for ultrasound images of the human placenta.

Placentas after uneventful pregnancies were perfused under physiologic pressure in the fetal vessels, expanded to their predelivery volume, fixated with 4% formaldehyde, and compared to their ultrasound images in pregnancy. The placentas showed a side arrangement of the fetal cotyledons in contact with the basal plate. The centers of the cotyledons showed an empty space in which the spiral arteries ended. These spaces in the placenta corresponded with transsonic areas of ultrasound. The central spaces were surrounded by a relatively dense shell of villi containing the more or less fibrotic stem villi. This explained the areas of increased echo-density, as seen by ultrasound during the last trimester of pregnancy. The fetal cotyledons, composed of a central cavity and a dense villous shell, were separated by a reticular area. The veins ended at the basal plate in these intercotyledonary areas.