TRANSVAGINAL AND COLOR DOPPLER ASSESSMENT OF THE ENDOMETRIUM IN INFERTILE PATIENTS STIMULATED BY CLOMIPHENE CITRATE AND HUMAN MENOPAUSAL GONADOTROPINS

Abstract

Successful implantation during in-vitro fertilization (IVF) and embryo transfer depends on many factors including embryo quality and uterine receptivity. Transvaginal ultrasonography plays an, essential role in modem fertility management .In the context of IVF the transducer allows ' easy monitoring of follicular and endometrial growth, inspection of uterine,

ovarian and endometrial morphology and easy access to the ovaries for the procedure of oocyte retrieval. In recent years attempts have been made to simplifY IVF treatment and improve pregnancy rate by the use of gonadotrophin releasing hormone agonists, but the implantation rate per embryo transferred remains -10-15%.

A lot of attention has recently centered on the receptivity of the endometrium to the growing blastula, High-resolution ultrasonography is currently the imaging modality of choice, but measurement of endometrial thickness is only associated with successful treatment outcome if ovarian stimulation includes gonadotrophins. However, the ultrasonographic texture of the endometrium may have a greater prognostic value for implantatian. The current literature is relatively unanimous that a 'triple' layered appearance of the utems is associated with a 23-42% pregnancy rate and that endometrium is unreceptive when iso- or hyperechoic compared with myometrium.

Although there ts continuing debate over the usefulness of endometrial thickness measurement, the current literature would suggest that the ultrasonographic texture of the endometrium might have a greater prognostic value for implantation.