Endometrial vascularity and ongoing pregnancy after IVF Brigitte Maugey-Laulom a,* , Monique Commenges-Ducos b , Ve ´ronique Jullien a , Aline Papaxanthos-Roche c , Virginie Scotet d , Daniel Commenges d a Service de Radiologie A, Pr. Diard, Ho ˆpital Pellegrin, Place Ame ´lie Raba Le ´on, 33076 Bordeaux, France b Service de Gyne ´cologie, Obste ´trique, Pr. Dallay, Ho ˆpital Pellegrin, Bordeaux, France c Laboratoire de Biologie de la Reproduction/Ge ´ne ´tique Biologique Ho ˆpital Pellegrin, Bordeaux, France d Institut National pour la Sante ´ et la Recherche Me ´dicale U 330 (Epide ´miologie, Sante ´ Publique et De ´veloppement), Bordeaux, France Received 3 July 2001; accepted 16 February 2002 Abstract Background: Embryo transfer is prone to failure. Aim: To investigate whether endometrial vascularity influences in vitro fertilization (IVF) outcome. Methods: Total 144 patients receiving IVF (conventional or microinjection) were assessed with color and power Doppler on the day of embryo transfer: age, IVF type, number and quality of embryos, endometrial thickness and aspect, mean uterine PI, uterine notch, type of endometrial vascularity (peripheral or sub- and intra-endometrial), and pregnancy involving second trimester were recorded. Results: 27 (18.7%) pregnancies were obtained. By univariate analysis, two parameters were significant: high frequency of uterine notch (P ¼ 0:03) and peri- endometrial vascularity(P ¼ 0:012) in the group offailures. Multivariate analysis by logistic regression clearly showed that the absence of sub- and intra-endometrial color signal decreased the chances of pregnancy eight-fold odds ratio ðORÞ¼ 0:14 [CI: 0.029–0.68]. Conclusion: In this limited series, the presence of sub- and intra-endometrial vascularity on the day of transfer seemed to be mandatory for obtaining an ongoing pregnancy. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Endometrial vascularity; Blood flow; IVF; Logistic regression 1. Introduction Embryo transfer, the last step in IVF, is also the most prone step to failure. Factors governing the outcome concern the embryo and the endometrium. Unlike the recognized beneficial impact of the number and quality of embryos endometrial parameters are poorly understood. The endo- metrium is a complex tissue, sensitive to hormonal changes. It is where a number of biochemical factors are produced, and is crossed to various degrees by blood vessels. Understanding of its quality during nidation has moved from emphasis on steroid-dependent microscopic features (Noyes) to non-invasive sonographic macroscopic criteria such as thickness and endometrial morphology, although the value of the latter is subject to debate. It has been suggested by studies in aging animals that a uterine perfusion defect may be detrimental to fertility [1], while the transfer step has been incriminated for such an abnormality in IVF failures [2]. Since then, many authors have assessed an overall uterine vascularity in IVF patients by semi-quantitative Doppler measurement of uterine flow, using pulsatility index (PI) or resistance index (RI). It seems that the patients who become pregnant have a lower resistance in the uterine arteries. Recent advances in the detection sensitivity of slow flows with power and color Doppler, are now allowing more focalized study of endometrial. The work of Zaidi [3] was the first to establish a link between the absence of endometrial vascularity and nidation failures. This study was realized on the day of embryo transfer of IVF, and takes second trimester pregnancy as a control of suc- cessful embryo implantation. It’s originality was to examine the respective roles of uterinevascular factorsespecially endo- metrial vascularity by power Doppler, and embryo character- istics, on IVF outcome, by multivariate statistical analysis. 2. Materials and methods 2.1. Sample This prospective study was conducted during 15 months in a consecutive series of women, followed up in the European Journal of Obstetrics & Gynecology and Reproductive Biology 104 (2002) 137–143 * Corresponding author. Tel.: þ33-5-56-79-56-05; fax: þ33-5-56-79-60-14. E-mail address: brigitte.maugey-laulom@chu-bordeaux.fr (B. Maugey-Laulom). 0301-2115/02/$ – see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-2115(02)00102-1