Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination

Abstract

Objective: The aim of this study was assessment of subendometrial blood flow with Doppler ultrasonography as an indicator of endometrial receptivity in stimulated cycles for intrauterine insemination (IUI).

Patients and methods: This prospective study enrolled 90 women scheduled for IUI after ovarian stimulation randomly assigned to one of the three equal groups; group (C) received Clomiphene citrate, group (H) received HMG and group (CH) received Clomiphene citrate in addition to HMG. All participants had ultrasound folliculometry starting on day 9, followed by transvaginal Doppler study of the subendometrial blood flow and perifollicular blood flow on the day of detecting at least one follicle >18 mm. Resistivity index (RI) and pulsatility index (PI) of subendometrial and perifollicular flow were measured. Endometrial thickness was measured on day of hCG injection.

Results: Group (H) showed significantly higher frequency of subendometrial flow (80%) compared to the other two groups (p = 0.009). In cases of positive subendometrial flow, the RI and PI were significantly lower in group (H) compared to the other two groups (p = 0.007 and 0.012, respectively). Endometrial thickness was significantly lower in group (C) compared to group (H) (p < 0.001) and group (CH) (p < 0.001). Successful intrauterine implantation was documented in a total of 16 women (17.8%); the highest frequency was in group (H) (23.3%) and the lowest in group (C), however, the difference between the three groups was not significant (p = 0.372). Subendometrial indices and perifollicular RI were significantly lower in cases of successful implantation, while endometrium was significantly thicker in these cases (p < 0.001).

Conclusion: The presence of subendometrial flow is associated with successful IUI in women under stimulated cycles undergoing IUI. HMG seems a superior option for induction of ovulation regarding success of implantation.