The Role Of Ultrasound In Evaluation Of Endometrial Receptivity In Patient Undergoing ART Procedures.

Abstract

The techniques used in assisted reproductive technologies (ART) have advanced considerably since the first in vitro fertilization (IVF) birth in 1978. Tools are now available that enable the selection ofhigh-quality embryos and assessment of endometrial status. Furthermore, ART protocols continue to evolve with the aim of achieving higher pregnancy rates, fewer multiple births and healthy babies from genetically affected progenitors. However, despite these advances, pregnancy rates are still relatively low and have not increased significantly in the last decade This suggests that implantation rates in stimulated cycles remain suboptimal (Andersen et al, 2005). Successful embryo implantation is a crucial event in natural and assisted human reproduction. Blastocyst implantation is a dynamic process, involving embryo apposition, attachment to the maternal endometrial epithelium, and invasion into the endometrial stroma (Hanna and Ariel, 2006).Within vitro fertilization (IVF), implantation failure can occur due to several factors (Levi et al., 2004),including poor embryo quality which is identified as a major cause of implantation failure (Urmanet al., 2005). Another widely acknowledged barrier to successful blastocyst implantation is an inappropriately developed endometrium. It is well established that embryos cannot implant in a poorly matured endometrium(Hanna and Ariel, 2006)and this may be responsible for low implantation rates with transfer or "good quality" embryos(Hanna and Ariel, 2006).Moreover, the success of in vitro fertilization and embryo transfer (IVF-ET) cycles depends mainly on embryo quality and uterine receptivity(Barker etal., 2009). With respect to uterine receptivity, evaluation of endometrial receptivity continues to be a challenge in assisted reproductive technology (ART)(ZhaoJ. et al., 2012) Endometrial receptivity can be evaluated by histological examination of an endometrial biopsy, endometrial proteins in uterine Hushing (Li et al., Introduction 2 1993)Ultrasonographic examination has been routinely performed for evaluation of the endometrium in ART treatment because it allows accurate and noninvasive evaluation(Zhao J. et al., 2012). Endometrial thickness has been utilized as an indirect indicator for endometrial