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Hum. Reprod. Advance Access published online on October 1, 2004
Human Reproduction, doi:10.1093/humrep/deh459
© 2004 by European Society of Human Reproduction and Embryology
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Received February 11, 2004
Revised April 14, 2004
Accepted July 20, 2004

Article

Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility

N.J. Raine-Fenning 1*, B.K. Campbell 1, N.R. Kendall 1, J.S. Clewes 1, and I.R. Johnson 1

1 Academic Division of Reproductive Medicine, School of Human Development, University of Nottingham, Nottingham, UK

* To whom correspondence should be addressed. E-mail: nick.fenning{at}nottingham.ac.uk.


  Abstract

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.

Keywords: endometrial perfusion; menstrual cycle; power Doppler; three-dimensional ultrasound; unexplained subfertility.
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