Hum. Reprod. Advance Access originally published online on October 1, 2004
Human Reproduction 2004 19(11):2605-2614; doi:10.1093/humrep/deh459
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Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility
Academic Division of Reproductive Medicine, School of Human Development, University of Nottingham, Nottingham, UK
1 To whom correspondence should be addressed at: School of Human Development, D Floor, East Block, Queen's Medical Centre, Nottingham, UK, NG7 2UH, UK. Email: nick.fenning{at}nottingham.ac.uk
BACKGROUND: We used three-dimensional power Doppler angiography (3D-PDA) to examine the periodic changes in endometrial development and subendometrial vascularity during the normal menstrual cycle in 29 women with unexplained subfertility and 19 controls. METHODS: 3D-PDA was performed on alternate days from day 3 of the cycle until ovulation and then every 4 days until menses. VOCALTM (Virtual Organ Computer-aided AnaLysis) and shell-imaging were used to define and to quantify the power Doppler signal within the endometrial and subendometrial regions producing indices of their relative vascularity. RESULTS: Women with unexplained subfertility demonstrated significant changes with time (P<0.001) in the indices of vascularity within the endometrium and subendometrium during the menstrual cycle characterized by a pre-ovulatory peak and post-ovulatory fall. These changes mirrored those observed in the control group but were significantly reduced in the endometrium and subendometrium during the mid-late follicular phase and early luteal phase. There were no differences in endometrial thickness or volume between the groups or in the plasma concentrations of estradiol or progesterone. CONCLUSIONS: Endometrial and subendometrial vascularity are significantly reduced in women with unexplained subfertility during the mid-late follicular phase irrespective of estradiol or progesterone concentrations and endometrial morphometry.
Key words: endometrial perfusion/menstrual cycle/power Doppler/three-dimensional ultrasound/unexplained subfertility
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