Assessing Uterine 'Well-Being' Before IVF Helps

Assessing Uterine 'Well-Being' Before IVF Helps
The 'well-being' of your uterus may be a new concept to you but researchers around the world have been busy exploring the question: how can we measure the well-being of the uterus? The 'wellness' of the uterus is critical to implantation and pregnancy success so it is an important question to answer especially before IVF/ICSI. Other studies have demonstrated that when conditions in the uterus are sub-optimal treatments such as electro-acupuncture or specific medications may help.

Aside from checking that the uterus is the correct shape, free from fibroids/polyps etc. ultrasound is rarely used before IVF. Later in the IVF process ultrasound is used to count and measure follicles, to assess the depth of the lining and to help place the embryo correctly but many top clinics use ultrasound to assess a critical aspect of uterine 'well-being' and IVF success: uterine blood flow. Such clinics take heed of studies that indicate uterine blood flow dynamics are a key factor determining implantation, IVF and pregnancy success.

Although the lining of the uterus needs to reach a certain thickness to maximize the chance of IVF succeeding, equally important is the adequacy of blood flow to the uterus and the health of the incredible network of small blood vessels that must proliferate within the implantation sites to nourish the embryo.

A French study (1) highlights how important good blood flow is for implantation to succeed; this study demonstrated that the blood flow (pulsatility index PI) within the arteries supplying the uterus should be below 3.0 for optimal fertility.

"Ultrasounds with Doppler allow to estimate the endometrial receptivity, especially in IVF cycles. It is assumed that chance for ongoing pregnancy is almost zero if: endometrial thickness is < 8 mm; uterine pulsatility index (PI) is > 3."

Many top IVF clinics routinely measure the adequacy of blood flow (PI) to the uterus, and if blood flow is poor they commonly recommend a specific electro-acupuncture treatment twice a week for one month as an effective treatment. This electro-acupuncture protocol has been demonstrated to improve uterine blood flow significantly and the benefits of treatment are sustained for at least two weeks.

Other clinicians administer anti-coagulant medications such as lovanox and/or aspirin to improve blood perfusion and/or Sildenafil suppositories which also improve uterine blood flow. Certain vitamins can help blood flow too such as vitamin E and L-arginine but these most be stopped at conception.

Most fertility clinics however do not offer the test for uterine 'well-being' - they often do not have the equipment to perform the assessment - and therefore cannot offer their patients the opportunity to correct poor blood flow prior to fertility treatments. The researchers of this French study believe that such attention to detail should be mandatory:

"Doppler ultrasounds are a useful and even mandatory complement to standard ....... ultrasonoghraphy in ART. It can be viewed as an indicator of the endometrial and follicular well-being."

A 2010 study from China concurs. This study of one hundred and eighty two women undergoing IVF-ET (all under 38 years of age) were assessed for endometrial thickness, echo pattern and blood flow by ultrasonography eight hours before hCG administration. The women were divided into three groups: those with undetectable endometrial blood flow (A=10); those with sub-endometrial blood flow (B=82); and those with both endometrial and sub-endometrial blood flow (C=90).

The women with evidence of both endometrial and sub-endometrial blood flow (group C) as identified by ultrasound had a far higher pregnancy and live fetus rate (62.2%) than group A which had no detectable endometrial blood flow (0%) and group B which had sub-endometrial blood flow only (17.1%). Group C also had a much higher implantation rate (33.2%) compared to group A (0%) and group B (19.9%). The researchers conclude that:

"...patients with detectable endometrial blood flow had higher clinical pregnancy rates and implantation rates."

Some would argue that all women should have this test before IVF. Sub-optimal blood flow - once diagnosed - can be treated and may therefore increase the chances of IVF succeeding. If your fertility clinic does not perform assessments of uterine blood flow you can ask for a referral to be tested by a skilled ultrasound technician or radiologist.

This article is for purely informational purposes and is not intended to diagnose or replace medical advice.

1. Gynecol Obstet Fertil. 2002 Sep;30(9):663-72. [Contribution of ovarian and uterine color Doppler in medically assisted reproduction techniques (ART)].
[Article in French] Ardaens Y, Gougeon A, Lefebvre C, Thomas P, Leroy M, Leroy JL, Dewailly D.

2. Reprod Biol Endocrinol. 2010 Oct 18;8:122. Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles.
Wang L, Qiao J, Li R, Zhen X, Liu Z.

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