Ultrasound in fertility monitoring shows most sensitive results on same day as hormone administration

Transvaginal ultrasound examination results predict the ultimate success of in vitro fertilization best when performed on the same day that human chorionic gonadotrophin is administered.

Ultrasound is used throughout the course of fertility treatment to assess the reproductive condition, but results were most sensitive and specific from the same day the hormone dose was given.

Dr. Hervé Dechaud and colleagues in the department of reproductive medicine and biology at Arnaud de Villeneuve Hospital in Montpellier, France, studied 124 patients over nine months as the women underwent in vitro fertilization or intracytoplasmic sperm injection. In each exam, the researchers looked at endometrial thickness, endometrial pattern, uterine artery pulsatility index, protodiastolic notch, end-diastolic blood flow, and endometrial-subendometrial blood flow distribution pattern.

The researchers conducted multiple exams for each patient: one on the day HCG was administered, one on the day of oocyte retrieval, and one on the day of embryo transfer. They published their study in the March issue of Reproductive Biomedicine Online.

At the end of the study, the researchers used recursive-partitioning analysis to evaluate the results and found the rate of pregnancy per transfer was 33%, while the rate of implantation per transfer was 19.8%. They also found that women with certain signs - including end-diastolic blood flow, endometrial-subendometrial blood flow, and multilayered endometrium - had a higher chance of getting pregnant than those women without these signs on their exams.

A combination of signs was the most effective predictor of success. End-diastolic blood flow, endometrial pattern, and endometrial thickness had a positive predictive value of 68.2%, a negative predictive value of 89.7%, and a sensitivity and specificity of 81%.

The researchers also found that exams done on the day when HCG was administered were the most sensitive, at 81.1%, and the most specific, at 81.3%. They concluded that this was the optimal timing for using ultrasound to predict the outcome of fertility treatment.