Human Reproduction, Vol. 19, No. 2, 330-338,
February 2004
© 2004 European Society of Human Reproduction and Embryology
Quantifying the changes in endometrial vascularity throughout the normal menstrual cycle with three-dimensional power Doppler angiography
Academic Division of Reproductive Medicine, School of Human Development, University of Nottingham, UK
1 To whom correspondence should be addressed at: Academic Division of Reproductive Medicine, D Floor, East Block, Queens Medical Centre, Nottingham NG7 2UH, UK. e-mail: nick.fenning{at}nottingham.ac.uk
BACKGROUND: We used three-dimensional power Doppler angiography (3D-PDA) to examine the periodic changes in endometrial and subendometrial vascularity during the normal menstrual cycle in 27 women without obvious menstrual dysfunction or subfertility. METHODS: 3D-PDA was performed on alternate days from day 3 of the cycle until ovulation and then every 4 days until menses. 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: Both the endometrial and subendometrial vascularization index (VI) and vascularization flow index (VFI) increased during the proliferative phase, peaking 
3 days prior to ovulation (P < 0.001) before decreasing to a nadir 5 days post-ovulation (P < 0.001). Thereafter, both vascular indices gradually increased during the transition from early to mid-secretory phase. The flow index (FI) showed a similar pattern but with a longer nadir post-ovulation. Smoking was associated with a significantly lower VI and VFI. The FI was significantly lower in women aged 
31 years and significantly higher in parous patients. CONCLUSIONS: Endometrial vascularity, as assessed by 3D-PDA, varies significantly during the menstrual cycle and is characterized by a pre-ovulatory peak and post-ovulatory nadir during the peri-implantation window.
Key words: endometrium/menstrual cycle/power Doppler/subendometrial vascularity/three-dimensional ultrasound
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